早期治疗改善抑郁与多发性硬化症成年患者的疲劳影响和疼痛干扰的整体改善相关。
Early Treatment Improvements in Depression Are Associated With Overall Improvements in Fatigue Impact and Pain Interference in Adults With Multiple Sclerosis.
机构信息
Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Multiple Sclerosis Center of Excellence - West, Veterans Administration Puget Sound, Seattle Division, Seattle, WA, USA.
出版信息
Ann Behav Med. 2021 Aug 23;55(9):833-843. doi: 10.1093/abm/kaaa102.
BACKGROUND
Depression, fatigue, and pain commonly co-occur in multiple sclerosis (MS) and are positively associated with one another. However, it is unclear whether treatment-related improvement in one of these symptoms is associated with improvements in the other two symptoms.
PURPOSE
This study examined whether early improvements in depressive symptoms, fatigue impact, and pain interference during a multisymptom intervention in persons with MS were associated with overall improvements in the other two symptoms.
METHODS
Secondary analysis of a randomized controlled trial in which both treatments improved depressive symptoms, fatigue, and pain interference. Adults with MS experiencing chronic pain, chronic fatigue, and/or moderate depressive symptoms (N = 154, 86% women) participated in an 8-week, telephone-delivered intervention: self-management (n = 69) or education (n = 85); intervention groups were combined for the current study. Outcome measures were depressive symptoms (PHQ-9), fatigue impact (Modified Fatigue Impact Scale), and pain interference (Brief Pain Inventory). Path analysis examined associations between pre-to-mid intervention improvement in one symptom (i.e., depression, fatigue, pain interference) and pre-to-post (overall) improvement in the other two symptoms.
RESULTS
Early reduction in depressive symptoms was associated with an overall reduction in pain interference and fatigue impact (p's < .01). Early reduction in fatigue impact was associated with an overall reduction in depressive symptom severity (p = .04) but not pain interference. Early reduction in pain interference was not associated with reductions in fatigue impact or depressive symptoms.
CONCLUSIONS
These findings suggest the potential importance of reducing depressive symptoms to overall improvement in fatigue and pain interference in persons with MS.
CLINICAL TRIAL REGISTRATIONS
NCT00944190.
背景
抑郁、疲劳和疼痛在多发性硬化症（MS）中经常同时出现，并且彼此之间呈正相关。然而，尚不清楚这些症状之一的治疗相关改善是否与其他两种症状的改善相关。
目的
本研究旨在探讨多发性硬化症患者在多症状干预治疗中抑郁症状、疲劳影响和疼痛干扰的早期改善是否与其他两种症状的整体改善相关。
方法
对一项随机对照试验进行二次分析，该试验中的两种治疗方法均改善了抑郁症状、疲劳和疼痛干扰。患有慢性疼痛、慢性疲劳和/或中度抑郁症状的多发性硬化症成年人（N=154，86%为女性）参加了为期 8 周的电话干预：自我管理（n=69）或教育（n=85）；干预组在此研究中合并。结局测量指标包括抑郁症状（PHQ-9）、疲劳影响（改良疲劳影响量表）和疼痛干扰（简明疼痛量表）。路径分析检验了一种症状（即抑郁、疲劳、疼痛干扰）的预至中期改善与其他两种症状的预至总体改善之间的关联。
结果
抑郁症状的早期减轻与疼痛干扰和疲劳影响的整体减轻相关（p<0.01）。疲劳影响的早期减轻与抑郁症状严重程度的整体减轻相关（p=0.04），但与疼痛干扰无关。疼痛干扰的早期减轻与疲劳影响或抑郁症状的减轻无关。
结论
这些发现表明，对于多发性硬化症患者，减轻抑郁症状对于整体改善疲劳和疼痛干扰可能具有重要意义。
临床试验注册
NCT00944190。
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