McClintock Andrew S, McCarrick Shannon M, Garland Eric L, Zeidan Fadel, Zgierska Aleksandra E
1 Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, Wisconsin.
2 Department of Psychology, Ohio University, Athens, Ohio.
J Altern Complement Med. 2019 Mar;25(3):265-278. doi: 10.1089/acm.2018.0351. Epub 2018 Dec 5.
Nonpharmacologic approaches have been characterized as the preferred means to treat chronic noncancer pain by the Centers for Disease Control and Prevention. There is evidence that mindfulness-based interventions (MBIs) are effective for pain management, yet the typical MBI may not be feasible across many clinical settings due to resource and time constraints. Brief MBIs (BMBIs) could prove to be more feasible and pragmatic for safe treatment of pain. The aim of the present article is to systematically review evidence of BMBI's effects on acute and chronic pain outcomes in humans.
A literature search was conducted using PubMed, PsycINFO, and Google Scholar and by examining the references of retrieved articles. Articles written in English, published up to August 16, 2017, and reporting on the effects of a BMBI (i.e., total contact time <1.5 h, with mindfulness as the primary therapeutic technique) on a pain-related outcome (i.e., pain outcome, pain affect, pain-related function/quality of life, or medication-related outcome) were eligible for inclusion. Two authors independently extracted the data and assessed risk of bias.
Twenty studies meeting eligibility criteria were identified. Studies used qualitative (n = 1), within-group (n = 3), or randomized controlled trial (n = 16) designs and were conducted with clinical (n = 6) or nonclinical (i.e., experimentally-induced pain; n = 14) samples. Of the 25 BMBIs tested across the 20 studies, 13 were delivered with audio/video recording only, and 12 were delivered by a provider (participant-provider contact ranged from 3 to 80 min). Existing evidence was limited and inconclusive overall. Nevertheless, BMBIs delivered in a particular format-by a provider and lasting more than 5 min-showed some promise in the management of acute pain.
More rigorous large scale studies conducted with pain populations are needed before unequivocally recommending BMBI as a first-line treatment for acute or chronic pain.
美国疾病控制与预防中心已将非药物治疗方法列为治疗慢性非癌性疼痛的首选手段。有证据表明,基于正念的干预措施(MBIs)对疼痛管理有效,但由于资源和时间限制,典型的MBI在许多临床环境中可能不可行。简短的MBIs(BMBIs)可能被证明在安全治疗疼痛方面更可行、更实用。本文的目的是系统回顾BMBI对人类急慢性疼痛结局影响的证据。
使用PubMed、PsycINFO和谷歌学术进行文献检索,并查阅检索到的文章的参考文献。撰写于2017年8月16日之前、用英文发表、报告BMBI(即总接触时间<1.5小时,以正念为主要治疗技术)对疼痛相关结局(即疼痛结局、疼痛情感、疼痛相关功能/生活质量或药物相关结局)影响的文章符合纳入标准。两位作者独立提取数据并评估偏倚风险。
确定了20项符合纳入标准的研究。这些研究采用了定性(n = 1)、组内(n = 3)或随机对照试验(n = 16)设计,样本为临床(n = 6)或非临床(即实验性诱导疼痛;n = 14)样本。在这20项研究中测试的25种BMBI中,13种仅通过音频/视频记录提供,12种由提供者提供(参与者与提供者的接触时间为3至80分钟)。现有证据总体有限且无定论。然而,以特定形式提供的BMBI(由提供者提供且持续超过5分钟)在急性疼痛管理方面显示出一些前景。
在明确推荐BMBI作为急性或慢性疼痛的一线治疗方法之前,需要对疼痛人群进行更严格的大规模研究。