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认知行为疗法与正念疗法对慢性疼痛的疗效差异:系统评价

Differential efficacy between cognitive-behavioral therapy and mindfulness-based therapies for chronic pain: Systematic review.

作者信息

Pardos-Gascón Estela M, Narambuena Lucas, Leal-Costa César, van-der Hofstadt-Román Carlos J

机构信息

Hospital Marina Baixa, Spain.

Hospital Vega Baja, Spain.

出版信息

Int J Clin Health Psychol. 2021 Jan-Apr;21(1):100197. doi: 10.1016/j.ijchp.2020.08.001. Epub 2020 Oct 23.

DOI:10.1016/j.ijchp.2020.08.001
PMID:33363580
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7753033/
Abstract

To assess the differential efficacy between mindfulness-based interventions and cognitive-behavioral Therapy (CBT) on chronic pain across medical conditions involving pain. ProQuest, Science Direct, Google Scholar, Pubmed, and Embase databases were searched to identify randomized clinical trials. Measurements of mindfulness, pain, mood, and further miscellaneous measurements were included. 18 studies met the inclusion criteria (fibromyalgia, = 5; low back pain, = 5; headache/migraine, = 4; non-specific chronic pain, = 4). In fibromyalgia, mindfulness based stress reduction (MBSR) was superior to the usual care and Fibroqol, in impact and symptoms. In low back pain, MBSR was superior to the usual care, but not to CBT, in physical functionality and pain intensity. There were no studies on differential efficacy between mindfulness and CBT for headache and non-specific chronic pain, but Mindfulness interventions were superior to the usual care in these syndromes. Mindfulness interventions are superior to usual cares in all diagnoses, but it is not possible to conclude their superiority over CBT. Comparisons between mindfulness interventions are scarce, with MBSR being the most studied. In central sensitization syndromes, variables associated with pain tend to improve with treatment. More research is needed to differentiate diagnosis and intervention.

摘要

为评估基于正念的干预措施与认知行为疗法(CBT)对涉及疼痛的各种医学病症中的慢性疼痛的疗效差异。检索了ProQuest、Science Direct、谷歌学术、PubMed和Embase数据库以识别随机临床试验。纳入了正念、疼痛、情绪及其他杂项测量。18项研究符合纳入标准(纤维肌痛,5项;腰痛,5项;头痛/偏头痛,4项;非特异性慢性疼痛,4项)。在纤维肌痛中,基于正念的减压疗法(MBSR)在影响和症状方面优于常规护理和Fibroqol。在腰痛方面,MBSR在身体功能和疼痛强度方面优于常规护理,但不优于CBT。对于头痛和非特异性慢性疼痛,没有关于正念与CBT疗效差异的研究,但正念干预在这些综合征中优于常规护理。正念干预在所有诊断中均优于常规护理,但无法得出其优于CBT的结论。正念干预之间的比较较少,MBSR是研究最多的。在中枢敏化综合征中,与疼痛相关的变量往往会随着治疗而改善。需要更多研究来区分诊断和干预。

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