Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27708-0187 (USA).
Research Institute for Primary Care & Health Sciences, Keele University, North Staffordshire, United Kingdom.
Phys Ther. 2018 May 1;98(5):398-407. doi: 10.1093/ptj/pzy024.
There has been growing interest in psychologically oriented pain management over the past 3 to 4 decades, including a 2011 description of psychologically informed practice (PIP) for low back pain. PIP requires a broader focus than traditional biomechanical and pathology-based approaches that have been traditionally used to manage musculoskeletal pain. A major focus of PIP is addressing the behavioral aspects of pain (ie, peoples' responses to pain) by identifying individual expectations, beliefs, and feelings as prognostic factors for clinical and occupational outcomes indicating progression to chronicity. Since 2011, the interest in PIP seems to be growing, as evidenced by its use in large trials, inclusion in scientific conferences, increasing evidence base, and expansion to other musculoskeletal pain conditions. Primary care physicians and physical therapists have delivered PIP as part of a stratified care approach involving screening and targeting of treatment for people at high risk for continued pain-associated disability. Furthermore, PIP is consistent with recent national priorities emphasizing nonpharmacological pain management options. In this perspective, PIP techniques that range in complexity are described, considerations for implementation in clinical practice are offered, and future directions that will advance the understanding of PIP are outlined.
在过去的 30 到 40 年中，人们对以心理学为导向的疼痛管理越来越感兴趣，包括 2011 年对下腰痛的心理知情实践（PIP）的描述。PIP 需要比传统的生物力学和基于病理学的方法更广泛的关注，这些方法传统上用于管理肌肉骨骼疼痛。PIP 的一个主要重点是通过确定个人的期望、信念和感受来解决疼痛的行为方面（即人们对疼痛的反应），这些方面是预示临床和职业结果进展为慢性的预后因素。自 2011 年以来，人们对 PIP 的兴趣似乎在增长，这可以从它在大型试验中的应用、在科学会议中的纳入、不断增加的证据基础以及扩展到其他肌肉骨骼疼痛疾病中得到证明。初级保健医生和物理治疗师已经提供了 PIP，作为一种分层护理方法的一部分，该方法包括对有持续疼痛相关残疾高风险的人群进行筛查和治疗。此外，PIP 符合最近强调非药物性疼痛管理选择的国家重点。在这篇观点文章中，描述了范围从复杂到简单的 PIP 技术，提供了在临床实践中实施的考虑因素，并概述了将推进对 PIP 理解的未来方向。
