Penlington Chris
School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.
Br J Pain. 2019 Feb;13(1):59-66. doi: 10.1177/2049463718772148. Epub 2018 Apr 24.
It is widely known that the mind and the body, although described medically almost as separate entities, are in fact highly interrelated. This is not, however, always reflected within medical settings where physical interventions are often favoured over more holistic management, even in the case of long-term symptoms and/or pain where there is a strong evidence to favour the use of the latter. Mindfulness is an established and evidence-based intervention which can help people living with pain and physical symptoms. Interventions based on Compassion and Loving-kindness have also shown early promise but have not been fully explored. This study proposes a compassion-focused conceptualisation of persistent pain and reports on an intervention based upon this formulation.
The study took place within a routine clinical setting. Standardised outcome measures were collected pre- and post-intervention and effect sizes calculated for mean differences on each measure. Written qualitative comments that participants attributed to the group were also collected post-intervention and analysed with a thematic analysis. This was an uncontrolled, unpowered study conducted within a clinical setting which aimed to examine the intervention for any initial evidence of promise and to explore how it would be received by patients.
The results of the study indicated that engagement of patients in the intervention was reasonable. Improvements were recorded in pain distress (effect size (ES), 0.47) and intensity (ES, 0.23), anxiety (ES, 0.72), depression (ES, 0.46) and self-efficacy (ES, 0.36). Following the intervention, patients described changes that were grouped into the categories of feeling different, doing things differently and changed attitude.
This exploratory study has demonstrated that a group-based intervention based on a model of compassion and including mindfulness and loving-kindness exercise has potential as an intervention to be used within routine pain management settings.
众所周知,尽管从医学角度来看,心理和身体几乎被描述为相互独立的实体,但实际上它们之间存在高度的相互关系。然而,在医疗环境中,这种关系并不总是得到体现,在这种环境中,即使在有充分证据支持采用更全面管理方法的长期症状和/或疼痛的情况下,身体干预措施通常也比更全面的管理方法更受青睐。正念是一种既定的、有循证依据的干预措施,可以帮助患有疼痛和身体症状的人。基于同情和慈爱的干预措施也已显示出初步的前景,但尚未得到充分探索。本研究提出了一种以同情为重点的持续性疼痛概念化方法,并报告了基于这一构想的干预措施。
该研究在常规临床环境中进行。在干预前后收集标准化的结果测量数据,并计算每项测量指标平均差异的效应量。干预后还收集了参与者对该组干预的书面定性评论,并采用主题分析法进行分析。这是一项在临床环境中进行的无对照、无统计学效力的研究,旨在检查该干预措施是否有任何初步的前景证据,并探索患者对其的接受程度。
研究结果表明,患者对干预措施的参与度合理。疼痛困扰(效应量(ES),0.47)、疼痛强度(ES,0.23)、焦虑(ES,0.72)、抑郁(ES,0.46)和自我效能感(ES,0.36)均有改善。干预后,患者描述了一些变化,这些变化可分为感觉不同、行为方式不同和态度改变几类。
这项探索性研究表明,基于同情模型、包括正念和慈爱练习的团体干预措施有潜力作为一种在常规疼痛管理环境中使用的干预方法。