College of Nursing, University of Utah, Salt Lake City, UT, USA.
Department of Anesthesiology, University of Kansas School of Medicine, Kansas City, KS, USA.
Biol Res Nurs. 2020 Apr;22(2):205-216. doi: 10.1177/1099800420907964.
Nonpharmacologic stress reduction interventions provide an opportunity to modify chronic pain trajectories; however, the biological mechanisms underlying these interventions are poorly understood.
To examine clinical literature published in 2012-2018 with the goals of (1) identifying which biological mechanisms or biomarkers are currently being measured in nonpharmacologic stress reduction intervention studies for individuals with chronic pain and (2) evaluating the evidence to determine whether these stress reduction interventions lead to changes in (a) pain outcomes and/or (b) measured biomarkers.
Scientific articles in the electronic databases PubMed/Medline, Cumulative Index of Nursing and Allied Health Literature, PsychINFO, and SCOPUS following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.
Randomized controlled trials and quasi-experimental studies that recruited subjects with a chronic pain condition, examined a relationship between a nonpharmacologic stress reduction intervention and pain-related outcome(s), and included measurement of a biomarker.
The 13 articles that met inclusion criteria spanned four nonpharmacologic stress reduction categories: mindfulness-based stress reduction, physical exercise, manual therapies, and biofeedback. Methods for studying biomarkers included measuring biological samples, neurological function, and autonomic control. Although all studies investigated both biological measures and pain outcomes, only three demonstrated an association between the biomarker(s) and pain-related outcomes.
The results of this review highlight the complex nature of stress-pain relationships and the lack of rigorous clinical research identifying specific stress-related biological factors that modulate pain outcomes. Stress reduction interventions remain a favorable method for symptom management in patients living with chronic pain, but consistency in study measures and design is needed for robust evaluation.
非药物性减压干预为改变慢性疼痛轨迹提供了机会；然而，这些干预措施的生物学机制尚不清楚。
检查 2012-2018 年发表的临床文献，目的是：(1) 确定目前正在对慢性疼痛患者进行的非药物性减压干预研究中测量哪些生物学机制或生物标志物；(2) 评估证据，以确定这些减压干预是否导致(a)疼痛结果和/或(b)测量的生物标志物发生变化。
根据系统评价和荟萃分析的首选报告项目指南，在电子数据库 PubMed/Medline、Cumulative Index of Nursing and Allied Health Literature、PsychINFO 和 SCOPUS 中搜索科学文章。
随机对照试验和准实验研究，招募患有慢性疼痛的受试者，研究非药物性减压干预与疼痛相关结果之间的关系，并包括生物标志物的测量。
符合纳入标准的 13 篇文章涵盖了四种非药物性减压干预类别：基于正念的减压、体育锻炼、手法治疗和生物反馈。研究生物标志物的方法包括测量生物样本、神经功能和自主控制。尽管所有研究都调查了生物标志物和疼痛结果，但只有三项研究表明生物标志物与疼痛相关结果之间存在关联。
本综述的结果强调了压力-疼痛关系的复杂性以及缺乏确定调节疼痛结果的特定与压力相关的生物学因素的严格临床研究。减压干预仍然是慢性疼痛患者症状管理的有利方法，但需要在研究措施和设计上保持一致，以进行有力的评估。
