Jepegnanam Chandran, Bull Eleanor, Bansal Sujesh, McCarthy David, Booth Maureen, Purser Elizabeth, Makaka Tecla, Shapley Gemma, Cooper Jo, Probert Jill, Malpus Zoey
Inpatient Pain Service, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK.
Br J Pain. 2021 May;15(2):163-174. doi: 10.1177/2049463720926212. Epub 2020 Jun 6.
This article describes the development and initial evaluation of introducing a psychologist role within an adult inpatient pain service (IPS) in a large North West of England National Health Service (NHS) trust.
The role of a psychologist in the management of outpatient chronic pain has been well documented, but their role within the IPS is less well described and rarely evaluated. We describe the development of a psychologist role within the team and initial service evaluation outcomes.
Following an initial needs assessment, a band 8c psychologist joined the IPS one day per week offering brief one-to-one psychological interventions to people struggling with acute or chronic pain in hospital referred by inpatient pain team. The psychologist had an indirect role offering training, supervision and support to members of the inpatient pain team. Regarding direct patient work, following psychometric screening for pain-related disability and distress, a cognitive behavioural therapy (CBT) approach was applied including identifying unhelpful beliefs about pain, psychoeducation about acute and persistent pain, developing and sharing formulations, skills training including breathing and relaxation exercises and where appropriate, signposting onto an outpatient chronic pain services for further pain self-management advice (e.g. pain management programme. To explore the impact of this direct intervention, a prospective service evaluation with a controlled before and after design was conducted. This compared (a) number of admissions and (b) length-of-stay outcomes in the 12 months following psychometric screening for patients who received psychological input (n = 34, the treatment group) and a sample who did not receive input because of discharge before intervention or non-availability of the psychologist, for example, annual leave (n = 30, control group). Demographic information and summaries of psychometric questionnaires were also analysed.
Of the sample of 64 patients, 50 were women, ages ranged from 18-80 years, 72% reported being currently unemployed or off sick from work and on screening and 39% and 48% met criteria for severe depression and pain-related anxiety, respectively. Hospital admissions in the intervention group reduced significantly (by 60%) in the 12 months following screening but increased (by 7%) for the control group (F(1,62) = 7.21, = .009). Days of stay in hospital reduced significantly more (by 84%) in the intervention group than in the control group (by 41%) (F(1,62) = 8.90, = .004). Illustrated case studies of brief psychological intervention with three people struggling with pain-related distress are presented.
The psychologist became a valuable member of the multi-disciplinary IPS team, offering brief direct and indirect psychological interventions. While a relatively small sample, our prospective service evaluation data suggest brief psychological intervention may contribute to reduced length of stay and hospital admissions for people experiencing pain-related distress in hospital.
本文介绍了在英格兰西北部一家大型国民医疗服务体系（NHS）信托机构的成人住院疼痛服务（IPS）中引入心理学家角色的发展情况及初步评估。
心理学家在门诊慢性疼痛管理中的作用已有充分记录，但他们在IPS中的作用描述较少且很少得到评估。我们描述了团队中心理学家角色的发展及初步服务评估结果。
在进行初步需求评估后，一名8c级心理学家每周一天加入IPS，为住院疼痛团队转诊的、正在与急性或慢性疼痛作斗争的患者提供简短的一对一心理干预。该心理学家还承担为住院疼痛团队成员提供培训、监督和支持的间接职责。在直接的患者工作方面，在对与疼痛相关的残疾和痛苦进行心理测评筛查后，采用认知行为疗法（CBT），包括识别对疼痛的无益信念、对急性和持续性疼痛进行心理教育、制定并分享方案、技能培训（包括呼吸和放松练习），并在适当时，将患者转介到门诊慢性疼痛服务部门以获取进一步的疼痛自我管理建议（如疼痛管理计划）。为探究这种直接干预的影响，进行了一项采用前后对照设计的前瞻性服务评估。比较了（a）接受心理干预的患者（n = 34，治疗组）在心理测评筛查后的12个月内的入院次数，以及（b）因在干预前出院或心理学家无法提供服务（如年假）而未接受干预的样本（n = 30，对照组）的住院时间。还分析了人口统计学信息和心理测评问卷摘要。
在64名患者样本中，50名是女性，年龄在18至80岁之间，72%的患者报告目前失业或因病休假，在筛查时，分别有39%和48%的患者符合重度抑郁和疼痛相关焦虑的标准。干预组在筛查后的12个月内住院次数显著减少（60%），而对照组增加了7%（F(1,62) = 7.21，p = .009）。干预组的住院天数减少幅度（84%）比对照组（41%）显著更大（F(1,62) = 8.90，p = .004）。文中呈现了对三名与疼痛相关痛苦作斗争的患者进行简短心理干预的实例研究。
心理学家成为多学科IPS团队中有价值的一员，提供简短的直接和间接心理干预。虽然样本相对较小，但我们的前瞻性服务评估数据表明，简短心理干预可能有助于减少在医院中经历疼痛相关痛苦的患者的住院时间和入院次数。
