通过基于网络的认知行为干预改善疼痛性化疗引起的周围神经病变的潜在中介因素。
Potential mediators of improvement in painful chemotherapy-induced peripheral neuropathy via a web-based cognitive behavioural intervention.
作者信息
Knoerl Robert, Barton Debra L, Holden Janean E, Krauss John C, LaVasseur Beth, Smith Ellen M L
机构信息
Post-Doctoral Research Fellow, Phyllis F. Cantor, Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer, Institute, 450 Brookline Avenue, LW 517, Boston, MA 02215, Email:
Mary Lou Willard French Professor of Nursing, University of Michigan School of Nursing, Ann Arbor, MI, Email:
出版信息
Can Oncol Nurs J. 2018 Jul 1;28(3):178-183. doi: 10.5737/23688076283178183. eCollection 2018 Summer.
PURPOSE
Preliminary evidence suggests that a self-guided cognitive and behaviourally-based pain management intervention (PROSPECT) is effective for chronic painful chemotherapy-induced peripheral neuropathy (CIPN), but its mechanism of action is unknown. The purpose of this secondary analysis was to explore if changes in anxiety, depression, sleep-related impairment, or fatigue mediated improvements in worst pain following PROSPECT in individuals with chronic painful CIPN.
METHODS
Sixty participants were randomized to receive self-guided cognitive behavioural pain management (access for eight weeks) or treatment as usual. A seven-day worst CIPN pain diary and the PROMIS measures of anxiety, depression, fatigue, and sleep-related impairment were administered pre/posttest (eight-weeks). Causal mediation analysis was used to quantify mediators of worst pain improvement.
RESULTS
None of the hypothesized mediators had a statistically significant effect on worst pain (n=38).
IMPLICATIONS
Further research is needed to identify potential mediators of pain intensity that can be targeted by specific cognitive behavioural strategies to improve painful CIPN severity.
目的
初步证据表明，一种基于认知和行为的自我引导式疼痛管理干预措施（PROSPECT）对慢性疼痛性化疗引起的周围神经病变（CIPN）有效，但其作用机制尚不清楚。这项二次分析的目的是探讨在慢性疼痛性CIPN患者中，PROSPECT干预后焦虑、抑郁、睡眠相关障碍或疲劳的变化是否介导了最严重疼痛的改善。
方法
60名参与者被随机分为接受自我引导式认知行为疼痛管理（为期八周）或常规治疗。在测试前/后（八周）进行为期七天的最严重CIPN疼痛日记记录，并采用PROMIS焦虑、抑郁、疲劳和睡眠相关障碍量表进行测量。采用因果中介分析来量化最严重疼痛改善的中介因素。
结果
在38名参与者中，没有一个假设的中介因素对最严重疼痛有统计学意义上的显著影响。
启示
需要进一步研究以确定疼痛强度的潜在中介因素，这些因素可作为特定认知行为策略的目标，以改善疼痛性CIPN的严重程度。
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