Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
Br J Anaesth. 2018 Jun;120(6):1304-1314. doi: 10.1016/j.bja.2017.10.026. Epub 2018 Feb 14.
Persistent post-surgical pain affects 10-80% of individuals after common operations, and is more common among patients with psychological factors such as depression, anxiety, or catastrophising.
We conducted a systematic review and meta-analysis of randomised, controlled trials to evaluate the efficacy of perioperative psychotherapy for persistent post-surgical pain and physical impairment. Paired independent reviewers identified studies, extracted data, and assessed risk of bias. The Grading of Recommendations, Assessment, Development and Evaluation system was used to assess the quality of evidence.
Our search of five electronic databases, up to September 1, 2016, found 15 trials (2220 patients) that were eligible for review. For both persistent post-surgical pain and physical impairment, perioperative education was ineffective, while active psychotherapy suggested a benefit (test of interaction P=0.01 for both outcomes). Moderate quality evidence showed that active perioperative psychotherapy (cognitive-behaviour therapy, relaxation therapy, or both) significantly reduced persistent post-surgical pain [weighted mean difference (WMD) -1.06 cm on a 10 cm visual analogue scale for pain, 95% confidence interval (CI) -1.56 to -0.55 cm; risk difference (RD) for achieving no more than mild pain (≤3 cm) 14%, 95% CI 8-21%] and physical impairment [WMD -9.87% on the 0-100% Oswestry Disability Index, 95% CI -13.42 to -6.32%, RD for achieving no more than mild disability (≤20%) 21%, 95% CI 13-29%].
Perioperative cognitive behavioural therapy and relaxation therapy are effective for reducing persistent pain and physical impairment after surgery. Future studies should explore targeted psychotherapy for surgical patients at higher risk for poor outcome.
PROSPERO CRD42016047335.
在常见手术后，10-80%的个体都会出现持续性术后疼痛，而在有抑郁、焦虑或灾难化等心理因素的患者中更为常见。
我们对随机对照试验进行了系统评价和荟萃分析，以评估围手术期心理治疗对持续性术后疼痛和身体功能障碍的疗效。配对的独立审查员确定了研究、提取数据并评估了偏倚风险。使用推荐、评估、制定和评估系统对证据质量进行评估。
我们对截至 2016 年 9 月 1 日的五个电子数据库进行了搜索，发现了 15 项符合审查条件的试验（2220 名患者）。对于持续性术后疼痛和身体功能障碍，围手术期教育均无效，而积极的心理治疗则提示有效（两种结局的交互检验 P=0.01）。中等质量证据表明，积极的围手术期心理治疗（认知行为疗法、放松疗法或两者结合）显著降低了持续性术后疼痛[10cm 视觉模拟评分的加权均数差值（WMD）-1.06cm，95%置信区间（CI）-1.56 至-0.55cm；实现无痛（≤3cm）的风险差异（RD）为 14%，95%CI 为 8-21%]和身体功能障碍[0-100%Oswestry 残疾指数的 WMD-9.87%，95%CI-13.42 至-6.32%，RD 实现轻度残疾（≤20%）的风险为 21%，95%CI 为 13-29%]。
围手术期认知行为疗法和放松疗法可有效减轻手术后的持续性疼痛和身体功能障碍。未来的研究应探索针对手术风险较高的患者的靶向心理治疗。
PROSPERO CRD42016047335。
