Knoerl Robert, Barton Debra L, Holden Janean E, Krauss John C, LaVasseur Beth, Smith Ellen M L
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:
Can Oncol Nurs J. 2018 Jul 1;28(3):178-183. doi: 10.5737/23688076283178183. eCollection 2018 Summer.
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.
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.
None of the hypothesized mediators had a statistically significant effect on worst pain (n=38).
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.
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。
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。
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。
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。
