认知行为疗法在小儿镰状细胞病减少阿片类药物使用中的作用：一项系统评价方案

The Role of Cognitive Behavioral Therapy in Opioid Use Reduction in Pediatric Sickle Cell Disease: Protocol for a Systematic Review.

作者信息

Anderson Ashaunta T, Tran Nhu, Smith Kathryn, Kelley-Quon Lorraine I

机构信息

Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States.

Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA, United States.

出版信息

JMIR Res Protoc. 2019 Jul 17;8(7):e13211. doi: 10.2196/13211.

DOI:10.2196/13211

PMID:31317868

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6668294/

Abstract

BACKGROUND

Sickle cell disease (SCD) is a genetic disorder of red blood cells that results in acute and chronic health problems, including painful syndromes. Opioid analgesia is the mainstay of moderate to severe pain management in SCD, although adjunctive psychosocial approaches such as cognitive behavioral therapy (CBT) are increasingly incorporated. CBT has been used in populations of various ages to address a wide range of issues, such as mood disorders and chronic pain. It is unclear if effective CBT reduces the use of opioids to manage pain in pediatric SCD.

OBJECTIVE

The aim of this study is to evaluate the association between CBT and decreased opioid use in children with SCD.

METHODS

In this systematic review protocol, we describe our approach to applying predetermined eligibility criteria to searches of PubMed (including Medline), Embase, Cochrane, Web of Science, and PsycINFO databases, as well as Google Scholar and grey literature. In particular, we will use keywords to search for English-language studies of individuals with SCD aged 21 years old and younger published before November 2018. Keywords will allow us to assess for the primary outcome-total use of opioid medications-and the secondary outcomes-pain intensity and emotional functioning-during pain management using a combined opioid and CBT approach, opioids alone, or CBT alone. The review team will use standardized abstraction forms to review articles at the title, abstract, and full-text levels. Finally, reviewers will assess the risk for bias, quality of evidence, and adequacy of data for quantitative versus qualitative synthesis. If meta-analysis is deemed inappropriate, a narrative review will be conducted.

RESULTS

We will report a summary of findings across studies that meet eligibility criteria to compare the extent to which adjunctive CBT is associated with decreased opioid use among children with SCD.

CONCLUSIONS

This systematic review will present the current state of the evidence on CBT and opioid use in pediatric SCD, which may inform clinical practice and health policy to support optimized pain management.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/13211.

摘要

背景

镰状细胞病（SCD）是一种红细胞的遗传性疾病，会导致急性和慢性健康问题，包括疼痛综合征。阿片类药物镇痛是SCD中重度疼痛管理的主要方法，尽管诸如认知行为疗法（CBT）等辅助心理社会方法越来越多地被采用。CBT已被用于不同年龄段的人群，以解决广泛的问题，如情绪障碍和慢性疼痛。目前尚不清楚有效的CBT是否能减少小儿SCD中用于管理疼痛的阿片类药物的使用。

目的

本研究的目的是评估CBT与小儿SCD中阿片类药物使用减少之间的关联。

方法

在本系统评价方案中，我们描述了将预定的纳入标准应用于检索PubMed（包括Medline）、Embase、Cochrane、科学网和PsycINFO数据库以及谷歌学术和灰色文献的方法。特别是，我们将使用关键词搜索2018年11月之前发表的关于21岁及以下SCD个体的英文研究。关键词将使我们能够评估主要结局——阿片类药物的总使用量——以及次要结局——疼痛强度和情绪功能——在使用阿片类药物和CBT联合方法、单独使用阿片类药物或单独使用CBT进行疼痛管理期间的情况。综述团队将使用标准化的摘要表格在标题、摘要和全文层面审查文章。最后，评审人员将评估偏倚风险、证据质量以及定量与定性综合数据的充分性。如果认为荟萃分析不合适，将进行叙述性综述。