Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio, TX; Department of Rehabilitation Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX; South Texas Veterans Health Care System, San Antonio, TX.
South Texas Veterans Health Care System, San Antonio, TX.
Arch Phys Med Rehabil. 2022 Oct;103(10):1899-1907. doi: 10.1016/j.apmr.2022.06.012. Epub 2022 Aug 6.
To evaluate the effects of interdisciplinary pain management on pain-related disability and opioid reduction in polymorbid pain patients with 2 or more comorbid psychiatric conditions.
Two-arm randomized controlled trial testing a 3-week intervention with assessments at pre-treatment, post-treatment, 6-month, and 12-month follow-up.
Department of Veterans Affairs medical facility.
103 military veterans (N=103) with moderate (or worse) levels of pain-related disability, depression, anxiety, and/or posttraumatic stress disorder randomly assigned to usual care (n=53) and interdisciplinary pain management (n=50). All participants reported recent persistent opioid use. Trial participants had high levels of comorbid medical and mental health conditions.
Experimental arm-a 3-week, interdisciplinary pain management program guided by a structured manual; comparison arm-usual care in a large Department of Veterans Affairs medical facility.
Oswestry Disability Index (pain disability); Timeline Followback Interview and Medication Event Monitoring System (opioid use). Analysis used generalized linear mixed model with all posttreatment observations (posttreatment, 6-month follow-up, 12-month follow-up) entered simultaneously to create a single posttreatment effect.
Veterans with polymorbid pain randomized to the interdisciplinary pain program reported significantly greater decreases in pain-related disability compared to veterans randomized to treatment as usual (TAU) at posttreatment, 6-month, and 12-month follow-up. Aggregated mean pain disability scores (ie, a summary effect of all posttreatment observations) for the interdisciplinary pain program were -9.1 (95% CI: -14.4, -3.7, P=.001) points lower than TAU. There was no difference between groups in the proportion of participants who resumed opioid use during trial participation (32% in both arms).
These findings offer the first evidence of short- and long-term interdisciplinary pain management efficacy in polymorbid pain patients, but more work is needed to examine how to effectively decrease opioid use in this population.
评估跨学科疼痛管理对 2 种或以上合并精神疾病的多症状疼痛患者疼痛相关残疾和阿片类药物减少的效果。
一项双臂随机对照试验，测试为期 3 周的干预措施，在治疗前、治疗后、6 个月和 12 个月随访时进行评估。
退伍军人事务部医疗设施。
103 名患有中度（或更严重）疼痛相关残疾、抑郁、焦虑和/或创伤后应激障碍的退伍军人（N=103），随机分配至常规护理（n=53）和跨学科疼痛管理（n=50）。所有参与者均报告最近持续使用阿片类药物。试验参与者合并有多种医疗和精神健康状况。
实验组-一项为期 3 周的跨学科疼痛管理计划，由结构化手册指导；对照组-在大型退伍军人事务部医疗设施中接受常规护理。
Oswestry 残疾指数（疼痛残疾）；时间线随访访谈和药物事件监测系统（阿片类药物使用）。使用广义线性混合模型分析所有治疗后观察结果（治疗后、6 个月随访、12 个月随访），同时输入以创建单一治疗后效果。
与接受常规护理的退伍军人相比，随机分配到跨学科疼痛方案的多症状疼痛退伍军人在治疗后、6 个月和 12 个月随访时报告疼痛相关残疾显著降低。跨学科疼痛方案的综合平均疼痛残疾评分（即所有治疗后观察结果的总结效果）比常规护理低-9.1（95%CI：-14.4，-3.7，P=.001）分。在试验参与期间恢复使用阿片类药物的参与者比例在两组之间没有差异（两组均为 32%）。
这些发现首次提供了多症状疼痛患者短期和长期跨学科疼痛管理疗效的证据，但仍需要更多工作来研究如何有效减少该人群中阿片类药物的使用。
