Abid Azam Muhammad, Weinrib Aliza Z, Montbriand Janice, Burns Lindsay C, McMillan Kayla, Clarke Hance, Katz Joel
Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada.
Department of Psychology, York University, Toronto, Ontario, Canada.
Can J Pain. 2017 Jun 28;1(1):37-49. doi: 10.1080/24740527.2017.1325317. eCollection 2017.
: Chronic postsurgical pain (CPSP) and associated long-term opioid use are major public health concerns. : The Toronto General Hospital Transitional Pain Service (TPS) is a multidisciplinary, hospital-integrated program developed to prevent and manage CPSP and support opioid tapering. This clinical practice-based study reports on preliminary outcomes of the TPS psychology program, which provides acceptance and commitment therapy (ACT) to patients at risk for CPSP and persistent opioid use. : Ninety-one patients received ACT, whereas 252 patients did not (no ACT group). Patient outcomes were compared for the two groups at first and last TPS visits. Pain, pain interference, sensitivity to pain traumatization, pain catastrophizing, anxiety, depression, and opioid use were analyzed using two-way (Group [ACT, no ACT] × Time [first, last visit]) analyses of variance (ANOVAs). : Patients referred to ACT were more likely to report a mental health condition preoperatively ( < 0.001), had higher opioid use ( < 0.001) at the first postsurgical visit, and reported higher sensitivity to pain traumatization ( < 0.05) and anxiety ( < 0.05) than the no ACT group at both time points. Both groups showed reductions in pain, pain interference, pain catastrophizing, anxiety, and opioid use by the last TPS visit ( < 0.05). The ACT group demonstrated greater reductions in opioid use and pain interference and showed reductions in depressed mood ( = 0.001) by the end of treatment compared to the no ACT group. : Preliminary outcomes suggest that ACT was effective in reducing opioid use while pain interference and mood improved.
慢性术后疼痛（CPSP）及相关的长期阿片类药物使用是重大的公共卫生问题。多伦多综合医院过渡性疼痛服务（TPS）是一个多学科的、医院整合项目，旨在预防和管理CPSP并支持阿片类药物减量。这项基于临床实践的研究报告了TPS心理项目的初步结果，该项目为有CPSP风险和持续使用阿片类药物的患者提供接受与承诺疗法（ACT）。91名患者接受了ACT，而252名患者未接受（非ACT组）。在TPS首次和末次就诊时比较了两组患者的结局。使用双向（组[ACT，非ACT]×时间[首次、末次就诊]）方差分析（ANOVA）对疼痛、疼痛干扰、对疼痛创伤的敏感性、疼痛灾难化、焦虑、抑郁和阿片类药物使用情况进行分析。被转诊接受ACT的患者术前更有可能报告有心理健康状况（<0.001），在术后首次就诊时阿片类药物使用量更高（<0.001），并且在两个时间点均比非ACT组报告对疼痛创伤的敏感性更高（<0.05）和焦虑程度更高（<0.05）。到TPS末次就诊时，两组的疼痛、疼痛干扰、疼痛灾难化、焦虑和阿片类药物使用均有所减少（<0.05）。与非ACT组相比，ACT组在治疗结束时阿片类药物使用量和疼痛干扰的减少幅度更大，并且抑郁情绪有所减轻（=0.001）。初步结果表明，ACT在减少阿片类药物使用方面有效，同时疼痛干扰和情绪得到改善。
