Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, U.S.A.
Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili, Tarragona, Spain.
Pain Pract. 2019 Apr;19(4):354-362. doi: 10.1111/papr.12746. Epub 2018 Dec 16.
Interdisciplinary chronic pain treatment is effective for reducing pain intensity and pain-related disability, and for improving psychological function. However, the mechanisms that underlie these treatment-related benefits are not yet well understood. Sleep problems and fatigue are modifiable factors often comorbid with chronic pain. The goal of this study was to evaluate the role that changes in sleep quality and fatigue might have on the benefits of an interdisciplinary chronic pain treatment.
A total of 125 adults with chronic pain participated in a 4-week interdisciplinary pain management program. Measures of depression, sleep disturbance, fatigue, pain intensity, and physical function were administered at pre- and post-treatment. Three regression analyses were conducted to evaluate the contribution of pre- to post-treatment improvements in fatigue and sleep disturbance to the pre- to post-treatment improvements in pain intensity, disability, and depression, while controlling for demographic characteristics (age and sex) and pain intensity.
Changes in fatigue and sleep disturbance made independent and significant contributions to the prediction of treatment-related benefits in pain intensity; improvements in depressive symptoms were predicted by improvements in fatigue, and improvements in disability were only predicted by pre-treatment and pre- to post-treatment decreases in pain intensity (one of the control variables).
In addition to sleep, fatigue emerged as a key potential mechanism of multidisciplinary chronic pain treatment-related improvements, suggesting that interventions including elements that effectively target sleep and fatigue may enhance the efficacy of interdisciplinary chronic pain programs. This possibility should be evaluated in future research.
跨学科慢性疼痛治疗对于减轻疼痛强度和与疼痛相关的残疾以及改善心理功能是有效的。然而，这些治疗相关益处的潜在机制尚不清楚。睡眠问题和疲劳是与慢性疼痛常并存的可改变因素。本研究的目的是评估睡眠质量和疲劳变化在跨学科慢性疼痛治疗中的益处中的作用。
共有 125 名慢性疼痛的成年人参加了为期 4 周的跨学科疼痛管理计划。在治疗前和治疗后测量抑郁、睡眠障碍、疲劳、疼痛强度和身体功能。进行了三项回归分析，以评估疲劳和睡眠障碍的改善对疼痛强度、残疾和抑郁的改善的贡献，同时控制人口统计学特征（年龄和性别）和疼痛强度。
疲劳和睡眠障碍的变化对疼痛强度的治疗相关益处的预测有独立和显著的贡献；疲劳的改善可以预测抑郁症状的改善，而残疾的改善仅可以预测疼痛强度的降低（一个控制变量）。
除了睡眠，疲劳也成为多学科慢性疼痛治疗相关改善的关键潜在机制，这表明包括有效针对睡眠和疲劳的干预措施的干预措施可能会提高跨学科慢性疼痛治疗计划的疗效。在未来的研究中应评估这种可能性。
