全科医生向持续性躯体症状患者解释中枢敏化的体验：一项焦点小组研究。

Experiences of general practitioners explaining central sensitisation to patients with persistent physical symptoms: a focus group study.

机构信息

Amsterdam UMC location Vrije Universiteit Amsterdam, Department of General Practice, Boelelaan 1117, Amsterdam, The Netherlands

Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.

出版信息

BMJ Open. 2022 Jul 26;12(7):e060063. doi: 10.1136/bmjopen-2021-060063.

DOI:10.1136/bmjopen-2021-060063

PMID:35882464

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9330311/

Abstract

OBJECTIVE

Patients with persistent physical symptoms (PPS) require an explanation that is acceptable and comprehensible to them. Central sensitisation (CS) is an explanatory model for PPS and chronic pain that has been broadly applied in the context of pain medicine, but, until recently, not by general practitioners (GPs). We explored how GPs used the CS model in their consultations with patients with PPS.

DESIGN AND SETTING

A qualitative focus group study among GPs in the Netherlands.

METHODS

We instructed 33 GPs on how to explain CS to patients with PPS. After 0.5-1.5 years of using the CS model, 26 GPs participated in focus groups and interviews to report and discuss their experiences with CS as an explanatory model. Audio recordings were transcribed and two researchers independently analysed the data. The text was coded, codes were organised into themes and discussed until consensus was reached.

RESULTS

We identified eleven themes and grouped these into four categories.The GPs regarded the CS model as evidence-based, credible and giving recognition to the patient. On the other hand, they found explaining the CS model difficult and time-consuming. They tailored the CS model to their patients' needs and used multiple consultations to explain the model. The GPs reported that the use of the CS model seemed to improve the understanding and acceptance of the symptoms by the patients and seemed to reduce their need for more diagnostic tests. Furthermore, patients seemed to become more motivated to accept appropriate therapy.

CONCLUSION

GPs reported that they were able to provide explanations with the CS model to their patients with PPS. They regarded the model as evidence-based, credible and giving recognition to the patient, but explaining it difficult and time-consuming.

摘要

目的

需要为持续存在身体症状（PPS）的患者提供一种能让他们接受并理解的解释。中枢敏化（CS）是一种用于解释 PPS 和慢性疼痛的理论模型，该模型已广泛应用于疼痛医学领域，但直到最近，普通科医生（GP）并未使用该模型。我们探讨了 GP 如何在与 PPS 患者的咨询中使用 CS 模型。

设计和设置

荷兰的一项 GP 定性焦点小组研究。

方法

我们指导 33 名 GP 如何向 PPS 患者解释 CS。在使用 CS 模型 0.5-1.5 年后，26 名 GP 参加了焦点小组和访谈，以报告和讨论他们使用 CS 模型作为解释模型的经验。对音频记录进行了转录，两名研究人员独立分析了数据。对文本进行编码，将代码组织成主题并进行讨论，直到达成共识。

结果

我们确定了 11 个主题，并将其分为四个类别。GP 认为 CS 模型具有循证依据、可信且能认可患者的病情。另一方面，他们发现解释 CS 模型既困难又耗时。他们根据患者的需求调整 CS 模型，并通过多次咨询来解释该模型。GP 报告称，使用 CS 模型似乎可以提高患者对症状的理解和接受程度，并减少他们对更多诊断测试的需求。此外，患者似乎更有动力接受适当的治疗。