慢性神经性疼痛多学科治疗结局的预测因素
Predicting factors of outcome in multidisciplinary treatment of chronic neuropathic pain.
作者信息
Shaygan Maryam, Böger Andreas, Kröner-Herwig Birgit
机构信息
Department of Psychiatric Nursing, Community Based Psychiatric Care Research Centre, Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran,
Pain Management Clinic at the Red Cross Hospital, Kassel, Germany.
出版信息
J Pain Res. 2018 Oct 18;11:2433-2443. doi: 10.2147/JPR.S175817. eCollection 2018.
PURPOSE
Evidence of the effectiveness of multidisciplinary treatment with a focus on neuropathic pain is still rare. The present study investigated whether multidisciplinary treatment leads to improvement of neuropathic pain in outcome (pain intensity and disability) and psychological (depression, pain acceptance, and catastrophizing) variables at posttreatment and 3-month follow-up. We examined whether and to what extent psychological changes can predict long-term outcome at 3-month follow-up, when other variables are controlled for (baseline characteristics and changes in pain parameters).
PATIENTS AND METHODS
Patients suffering from a chronic neuropathic pain condition (n=141) attended an inpatient multidisciplinary program lasting about 15 continuous days with self-report data collected at pretreatment, posttreatment, and 3-month follow-up.
RESULTS
Repeated-measures ANOVAs showed a significant improvement of pain intensity, disability, pain acceptance, catastrophizing, and depression at posttreatment. These improvements remained stable over the 3-month follow-up for all variables except for depression. The inclusion of psychological changes in multiple regression analyses greatly increased the variance in outcome, explained by baseline characteristics and changes in pain parameters.
CONCLUSION
The results could help clinicians to determine which variables should be emphasized during inpatient treatment and during the follow-up period, in order to maintain the gains after an inpatient multidisciplinary treatment for neuropathic pain.
PERSPECTIVE
The present study demonstrates the beneficial effects of an inpatient multidisciplinary program for neuropathic pain and further question the resistant nature of neuropathic pain to treatment. The results add evidence to the relevance of cognitive-behavioral models of pain positing an important role for pain-related thoughts and emotions in long-term outcome following multidisciplinary pain treatment.
目的
以神经性疼痛为重点的多学科治疗有效性的证据仍然很少。本研究调查了多学科治疗是否能在治疗后及3个月随访时改善神经性疼痛的结局（疼痛强度和残疾情况）以及心理（抑郁、疼痛接受度和灾难化思维）变量。我们研究了在控制其他变量（基线特征和疼痛参数变化）的情况下，心理变化能否以及在多大程度上预测3个月随访时的长期结局。
患者与方法
患有慢性神经性疼痛的患者（n = 141）参加了一个为期约15天的住院多学科项目，并在治疗前、治疗后及3个月随访时收集了自我报告数据。
结果
重复测量方差分析显示，治疗后疼痛强度、残疾情况、疼痛接受度、灾难化思维和抑郁均有显著改善。除抑郁外，所有变量在3个月随访期间的改善情况保持稳定。在多元回归分析中纳入心理变化极大地增加了由基线特征和疼痛参数变化所解释的结局方差。
结论
这些结果有助于临床医生确定在住院治疗期间及随访期间应强调哪些变量，以维持神经性疼痛住院多学科治疗后的疗效。
展望
本研究证明了住院多学科项目对神经性疼痛的有益效果，并进一步质疑了神经性疼痛对治疗的抵抗性。这些结果为疼痛的认知行为模型的相关性提供了证据，该模型认为疼痛相关的思想和情绪在多学科疼痛治疗后的长期结局中起重要作用。
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