Svanberg Mikael, Johansson Ann-Christin, Boersma Katja
Psychosomatic Medicine Clinic, Region of Västmanland, Karlsgatan 17 A, Västerås 722 14, Sweden.
School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
Scand J Pain. 2019 Jan 28;19(1):73-82. doi: 10.1515/sjpain-2018-0051.
Background and aims Among chronic pain patients who are referred to participation in a multimodal rehabilitation program (MMRP), pain catastrophizing and dysfunctional pain coping is common. In many cases it may have driven the patient to a range of unsuccessful searches for biomedical explanations and pain relief. Often these efforts have left patients feeling disappointed, hopeless and misunderstood. The MMRP process can be preceded by a multimodal investigation (MMI) where an important effort is to validate the patient to create a good alliance and begin a process of change towards acceptance of the pain. However, whether the MMI has such therapeutic effect is unclear. Using a repeated single case experimental design, the purpose of this study was to investigate the therapeutic effect of MMI by studying changes in patients' experience of validation, alliance, acceptance of pain, coping, catastrophizing, and depression before and during the MMI process. Methods Participants were six chronic pain patients with high levels of pain catastrophizing (>25 on the Pain Catastrophizing Scale) and risk for long term disability (>105 on the Örebro Musculoskeletal Pain Screening Questionnaire) who were subjected to MMI before planned MMRP. For each patient, weekly self-report measures of validation, alliance and acceptance of pain were obtained during a 5-10-weeks baseline, before the MMI started. Subsequently, these measures were also obtained during a 6-8 weeks MMI process in order to enable comparative analyses. Additionally, pain coping, depression and pain catastrophizing were measured using standardized questionnaires before and after the MMI. Results Irrespective of experiences of validation and alliance before MMI, all six patients felt validated and experienced a good alliance during MMI. Acceptance of pain improved only in one patient during MMI. None of the patients showed clinically relevant improvement in pain coping, depression or catastrophizing after the MMI. Conclusions The patients did not change their acceptance and pain coping strategies despite of good alliance and experience of validation during the MMI process. Even if the design of this study precludes generalization to chronic pain patients in general, the results suggest that MMI may not have a therapeutic effect.
背景与目的 在被转介参与多模式康复计划（MMRP）的慢性疼痛患者中，疼痛灾难化和功能失调性疼痛应对很常见。在许多情况下，这可能促使患者进行一系列无果的寻找生物医学解释和缓解疼痛的尝试。这些努力常常让患者感到失望、绝望和被误解。在MMRP过程之前可以先进行多模式调查（MMI），其中一项重要工作是使患者获得认可，以建立良好的医患关系，并开启一个朝着接受疼痛转变的过程。然而，MMI是否具有这种治疗效果尚不清楚。本研究采用重复单病例实验设计，旨在通过研究患者在MMI过程之前和期间在认可、医患关系、对疼痛的接受度、应对方式、灾难化思维和抑郁方面的变化，来探究MMI的治疗效果。
方法 参与者为6名慢性疼痛患者，他们的疼痛灾难化程度较高（疼痛灾难化量表得分>25）且有长期残疾风险（Örebro肌肉骨骼疼痛筛查问卷得分>105），在计划的MMRP之前接受了MMI。对于每位患者，在MMI开始前的5 - 10周基线期内，每周获取关于认可、医患关系和对疼痛接受度的自我报告测量值。随后，在6 - 8周的MMI过程中也获取这些测量值，以便进行比较分析。此外，在MMI前后使用标准化问卷测量疼痛应对、抑郁和疼痛灾难化情况。
结果 无论MMI之前的认可和医患关系体验如何，所有6名患者在MMI期间都感到被认可并体验到良好的医患关系。在MMI期间只有1名患者对疼痛的接受度有所改善。MMI后，没有患者在疼痛应对、抑郁或灾难化思维方面表现出临床相关的改善。
结论 尽管在MMI过程中患者有良好的医患关系和认可体验，但他们并未改变对疼痛的接受度和疼痛应对策略。即使本研究的设计排除了将结果推广至一般慢性疼痛患者的可能性，但结果表明MMI可能没有治疗效果。
