University of Washington, United States of America.
University of Maryland, United States of America.
J Psychosom Res. 2019 Nov;126:109821. doi: 10.1016/j.jpsychores.2019.109821. Epub 2019 Aug 29.
Adults with irritable bowel syndrome (IBS) often report extraintestinal pain, fatigue, and sleep disturbances in addition to abdominal pain. Few interventions have sought to reduce these extraintestinal symptoms within the IBS population. To address this, we compared the effects of a comprehensive self-management (CSM) intervention to a control intervention (usual care) on extraintestinal pain, fatigue, and sleep disturbances among patients with IBS.
Data were obtained from 243 IBS patients participating in two CSM intervention trials. Daily symptom diaries were collected at baseline, 3 and 6 months post-randomization. Daily symptoms of headache, backache, muscle pain, joint pain, fatigue, sleepiness during the day, sleep quality, and refreshed by sleep were analyzed. Analysis of covariance was used to determine the effects of the intervention on each symptom at 3 and 6 months controlling for 'study' and baseline symptom levels.
Patients in the CSM intervention group reported decreased symptoms of fatigue, sleep disturbances, backache and headache compared to usual care at 3 and 6 months. The CSM group also reported significantly decreased joint pain at 3 months compared to usual care, but not 6 months. No significant difference was found for muscle pain.
An existing CSM intervention is effective in reducing fatigue and sleep disturbances. However, mixed results for extraintestinal pain indicates a need to better differentiate between underlying mechanisms. Addressing such symptoms is important to decrease the overall burden of IBS, reduce health care expenditures, and improve patients' quality of life.
NCT00907790; NCT00167635.
肠易激综合征（IBS）患者除腹痛外，常报告有肠外疼痛、疲劳和睡眠障碍。很少有干预措施试图减少 IBS 人群的这些肠外症状。为了解决这个问题，我们比较了综合自我管理（CSM）干预与对照干预（常规护理）对 IBS 患者肠外疼痛、疲劳和睡眠障碍的影响。
数据来自参与两项 CSM 干预试验的 243 名 IBS 患者。在随机分组后 3 个月和 6 个月时收集每日症状日记。分析头痛、背痛、肌肉疼痛、关节疼痛、疲劳、白天嗜睡、睡眠质量和睡眠恢复程度的每日症状。采用协方差分析，控制“研究”和基线症状水平，确定干预对每种症状的影响。
CSM 干预组患者在 3 个月和 6 个月时报告疲劳、睡眠障碍、背痛和头痛症状较常规护理组减轻。与常规护理相比，CSM 组在 3 个月时报告关节疼痛明显减轻，但 6 个月时没有明显差异。肌肉疼痛无显著差异。
现有的 CSM 干预措施在减轻疲劳和睡眠障碍方面是有效的。然而，肠外疼痛的混合结果表明需要更好地区分潜在机制。解决这些症状对于减轻 IBS 的整体负担、减少医疗保健支出和提高患者的生活质量非常重要。
NCT00907790；NCT00167635。
