Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
Department of Psychiatry, Western University, London, ON, Canada.
Pain Physician. 2021 Jan;24(1):61-72.
Psychological comorbidities in chronic pain (CP) are common and contribute to adverse health outcomes and poor quality of life. Evidence-based guidance for the management of depressive symptoms in CP is limited, particularly for mind-body interventions.
To investigate the effectiveness of mind-body interventions for the management of depressive symptoms in people with CP.
Systematic review (SR) of SRs.
SRs with meta-analyses of clinical interventions for the management of depressive symptoms in people with CP.
This SR was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic searches were performed for MEDLINE, EMBASE, PsycINFO, CINAHL, AMED, the Cochrane Database of Systematic Reviews, and the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports from inception to March 14, 2019. Reference lists and overviews were also hand-searched. SRs of mind-body interventions for CP were included if they conducted a meta-analysis of depression outcomes in people with any CP type not including headache. Two independent reviewers screened, extracted, and evaluated the quality of articles found. Quality was assessed using the AMSTAR 2 criteria and data were summarized narratively with standardized mean differences and 95% confidence intervals of the depression outcome.
Eleven SRs with 20 distinct meta-analyses demonstrated a small to moderate beneficial effect for mind-body interventions (effect sizes: -0.05 to -0.63).
Depressive symptomatology was a subordinate concern compared with other outcomes. The primary literature base was reasonably broad with 33 primary studies, but small when compared with the number of meta-analyses.
Mind-body interventions show consistent small to moderate effects in reducing depressive symptoms in CP. The literature in this area demonstrates understudy and oversynthesis. There is a need for more clinical trials focusing on people with axial pain, people with comorbid major depressive disorder, and with depression as the primary outcome of interest. Full SR registered on PROSPERO: CRD42019131871.
慢性疼痛（CP）患者常伴有心理共病，这会导致不良的健康结局和生活质量下降。针对 CP 患者抑郁症状管理的循证指南有限，特别是针对身心干预。
研究身心干预对 CP 患者抑郁症状管理的效果。
系统综述（SR）的 SR。
针对 CP 患者抑郁症状管理的临床干预进行 meta 分析的 SR。
本 SR 遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南进行报告。从创建到 2019 年 3 月 14 日，对 MEDLINE、EMBASE、PsycINFO、CINAHL、AMED、Cochrane 系统评价数据库和 Joanna Briggs 循证实践和实施报告数据库进行了电子检索。还对参考文献列表和综述进行了手工检索。如果 SR 对任何类型的 CP 患者进行了抑郁结局的 meta 分析（不包括头痛），则纳入 CP 的身心干预 SR。两名独立的评审员对发现的文章进行了筛选、提取和质量评估。使用 AMSTAR 2 标准评估质量，并使用标准化均数差值和抑郁结局的 95%置信区间进行叙述性总结。
11 项 SR 包含 20 项独立的 meta 分析，显示身心干预有较小到中度的有益效果（效应大小：-0.05 至-0.63）。
与其他结局相比，抑郁症状只是次要关注点。初级文献基础相当广泛，有 33 项初级研究，但与 meta 分析数量相比仍然较小。
身心干预在减轻 CP 患者的抑郁症状方面显示出一致的小到中度效果。该领域的文献研究不足且综合过度。需要更多的临床试验关注轴向疼痛患者、伴有共病重度抑郁症的患者，以及将抑郁作为主要关注结局的患者。全文 SR 在 PROSPERO 上注册：CRD42019131871。
