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一项跨学科慢性疼痛项目的评估及改变意愿的预测因素

Evaluation of an interdisciplinary chronic pain program and predictors of readiness for change.

作者信息

Katz Laura, Patterson Lisa, Zacharias Ramesh

机构信息

Michael G. DeGroote Pain Clinic, Hamilton Health Sciences, McMaster University Medical Centre, Hamilton, Ontario, Canada.

Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.

出版信息

Can J Pain. 2019 Apr 12;3(1):70-78. doi: 10.1080/24740527.2019.1582296. eCollection 2019.

Abstract

: One in five Canadians experience chronic pain, and interdisciplinary pain programs are well established as the gold standard of treatment. However, not all patients are ready to engage in interdisciplinary treatment for chronic pain. : The aims of this study were to (1) first demonstrate changes in patient-related outcomes after attending a publicly funded 8-week interdisciplinary pain program and (2) evaluate pain-related predictors of readiness for change. : The institution's research ethics board approved this study. One hundred twenty-nine patients completed questionnaires on the first and last day of attending the program. Paired sample -tests were utilized to evaluate the changes in patient-related outcomes after attending the program, and linear regressions were utilized to evaluate pain-related predictors of the stages of change. : Postprogram, there were significant decreases in pain-related interference, fear of pain/re-injury, pain catastrophizing, and symptoms of stress, depression, and anxiety and a significant increase in wellness-focused coping and self-efficacy. Postprogram, patients also demonstrated lower scores in precontemplation and contemplation and higher scores in action and maintenance stages of readiness for change. In predicting precontemplation, fear of pain/re-injury was the sole predictor, and self-efficacy was the sole predictor of the contemplation, action, and maintenance stages. : These results demonstrate the short-term benefits of an 8-week interdisciplinary pain program. It is suggested that preprogram interventions targeting kinesophobia for individuals who are precontemplative and self-efficacy for others may be important to facilitate patient engagement.

摘要

五分之一的加拿大人患有慢性疼痛,多学科疼痛治疗项目已被确立为治疗的金标准。然而,并非所有患者都愿意接受慢性疼痛的多学科治疗。

本研究的目的是

(1)首先证明参加一个由公共资金支持的为期8周的多学科疼痛治疗项目后患者相关结局的变化;(2)评估与疼痛相关的改变意愿预测因素。

该机构的研究伦理委员会批准了本研究。129名患者在参加项目的第一天和最后一天完成了问卷调查。采用配对样本t检验评估参加项目后患者相关结局的变化,采用线性回归评估改变阶段的疼痛相关预测因素。

项目结束后,与疼痛相关的干扰、对疼痛/再次受伤的恐惧、疼痛灾难化以及压力、抑郁和焦虑症状显著降低,以健康为重点的应对方式和自我效能显著提高。项目结束后,患者在未考虑改变和考虑改变阶段的得分也较低,在改变意愿的行动和维持阶段得分较高。在预测未考虑改变阶段时,对疼痛/再次受伤的恐惧是唯一的预测因素,而自我效能是考虑改变、行动和维持阶段的唯一预测因素。

这些结果证明了为期8周的多学科疼痛治疗项目的短期益处。建议针对未考虑改变的个体的运动恐惧症和针对其他人的自我效能的项目前干预措施可能对促进患者参与很重要。

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