Ikemoto Tatsunori, Shiro Yukiko, Ikemoto Kayo, Hayashi Kazuhiro, Arai Young-Chang, Deie Masataka, Beeston Lee, Wood Bradley, Nicholas Michael
Department of Orthopaedics, Aichi Medical University, Aichi, Japan.
Pain Management Research Institute, Faculty of Medicine and Health, University of Sydney and Royal North Shore Hospital, Sydney, NSW, Australia.
Pain Ther. 2020 Dec;9(2):583-599. doi: 10.1007/s40122-020-00192-2. Epub 2020 Aug 25.
Multidisciplinary pain management programs incorporating a cognitive-behavioral therapy (CBT) approach have been reported to be helpful for elderly people with chronic pain. However, it is unclear whether the same program for elderly people with chronic pain would translate to different cultures. This study investigated whether a multidisciplinary program based on that of Nicholas et al. (Pain 154(6):824-835, 2013) in Australia would be effective for elderly people with chronic pain in Japan.
Twenty-seven community-dwelling elderly people with chronic pain were enrolled to confirm changes (effect size d = 0.5) in pain disability, which were previously reported by Nicholas et al. The multidisciplinary program consisted of eight sessions (2 sessions a week for 4 weeks). Pain disability was assessed using the Pain Disability Assessment Scale (PDAS) as the primary outcome at the baseline, the beginning and the end of the program, and the 1- and 3-month (final) follow-up. We also assessed the pain severity, catastrophizing, pain self-efficacy, and physical function with the Timed Up and Go test (TUG) and the two-step test as secondary outcomes.
PDAS, pain catastrophizing, and pain self-efficacy were significantly improved immediately after the program compared with baseline, and these effects were maintained at 3-month follow-up. The effect size (d) for the PDAS score was a medium size (0.54) from baseline to 3-month follow-up. Those who showed improvements in TUG immediately after the program tended to report improved psychometric measures at 3-month follow-up.
These results suggest that the Japanese multidisciplinary program has a similar effect on pain disability as that reported by Nicholas et al. This finding has important implications for the development of pain services in community-dwelling elderly Japanese.
据报道，采用认知行为疗法（CBT）方法的多学科疼痛管理项目对患有慢性疼痛的老年人有帮助。然而，针对患有慢性疼痛的老年人的同一项目是否适用于不同文化尚不清楚。本研究调查了基于澳大利亚尼古拉斯等人（《疼痛》154(6):824 - 835, 2013）的项目的多学科项目对日本患有慢性疼痛的老年人是否有效。
招募了27名患有慢性疼痛的社区居住老年人，以确认疼痛残疾方面的变化（效应量d = 0.5），这是尼古拉斯等人之前报告过的。多学科项目包括八个疗程（每周2个疗程，共4周）。使用疼痛残疾评估量表（PDAS）作为主要结局指标，在基线、项目开始和结束时以及1个月和3个月（最终）随访时评估疼痛残疾情况。我们还评估了疼痛严重程度、灾难化思维、疼痛自我效能以及采用定时起立行走测试（TUG）和两步测试作为次要结局指标的身体功能。
与基线相比，项目结束后PDAS、疼痛灾难化思维和疼痛自我效能立即有显著改善，并且这些效果在3个月随访时得以维持。从基线到3个月随访，PDAS评分的效应量（d）为中等大小（0.54）。在项目结束后TUG测试有改善的参与者在3个月随访时往往报告心理测量指标有所改善。
这些结果表明，日本的多学科项目对疼痛残疾的影响与尼古拉斯等人报告的类似。这一发现对日本社区居住老年人群疼痛服务的发展具有重要意义。
