Shaygan Maryam, Zamani Mahsa, Jaberi Azita, Eghbal Keyvan, Dehghani Azime
Maryam Shaygan, Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Mahsa Zamani, Shiraz University of Medical Sciences, Shiraz, Iran.
Spine J. 2023 May;23(5):656-664. doi: 10.1016/j.spinee.2023.01.016. Epub 2023 Feb 1.
BACKGROUND/CONTEXT: Lumbar surgery is one of the interventions performed for patients with degenerative conditions.
This study aimed to investigate the effect of pain management education on pain intensity, anxiety, and disability after the lumbar surgery.
STUDY DESIGN/SETTING: This randomized controlled trial was performed on 70 30-65-year-old patients with lumbar canal stenosis and lumbar disc herniation from 2018 to 2019.
Seventy participants were randomly divided into a control and an intervention group by a randomized block design. Participants in the intervention group received in-person pain management training twice a week for seven 60-90-minute sessions.
All participants in the two groups completed the study instruments (numeric rating scale [NRS], Oswestery disability index [ODI], and pain anxiety symptoms scale [PASS]) before, immediately after, and 3 months after the study.
Participants in the intervention group received in-person pain management training twice a week for seven 60-90-minute sessions. To analyze the treatment effects, repeated-measures multivariate analysis of variance (MANOVA) and effect sizes were used where appropriate and calculated by Partial ɳ. Clinical outcome (MDC) for pain intensity and PASS was also reported. For participants lost to follow-up, we also used an "intention-to-treat" (ITT) approach.
The results of MANOVA indicated that there were significant differences between the two groups on ratings of pain intensity, anxiety, and disability. According to the MDC, the mean differences of pain intensity for the intervention group was also clinically improved. Meanwhile, the mean differences in pain anxiety between three different times in the two groups were not above the MDC (20.14), suggesting that the clinical improvements were not significant. The results were confirmed for all outcome measures; a statistically significant difference was found between the groups in ITT analyses (p<.001).
Physical and psychological pain management education was shown to be effective in decreasing pain intensity, anxiety, and disability. This strategy may be beneficial for such patients. Variables such as smoking behavior, past history of psychological disorders, and previous surgeries should be considered in future studies.
背景/情境：腰椎手术是针对退行性疾病患者实施的干预措施之一。
本研究旨在调查疼痛管理教育对腰椎手术后疼痛强度、焦虑和残疾状况的影响。
研究设计/地点：本随机对照试验于2018年至2019年对70名30 - 65岁的腰椎管狭窄症和腰椎间盘突出症患者进行。
70名参与者通过随机区组设计随机分为对照组和干预组。干预组参与者每周接受两次面对面的疼痛管理培训，共七次，每次60 - 90分钟。
两组所有参与者在研究前、研究结束后即刻以及研究后3个月完成研究工具（数字评分量表[NRS]、Oswestry残疾指数[ODI]和疼痛焦虑症状量表[PASS]）。
干预组参与者每周接受两次面对面的疼痛管理培训，共七次，每次60 - 90分钟。为分析治疗效果，在适当情况下使用重复测量多元方差分析（MANOVA）和效应量，并通过偏ƞ计算。还报告了疼痛强度和PASS的临床结局（MDC）。对于失访的参与者，我们也采用了“意向性分析”（ITT）方法。
MANOVA结果表明，两组在疼痛强度、焦虑和残疾评分方面存在显著差异。根据MDC，干预组疼痛强度的平均差异在临床上也有所改善。同时，两组在三个不同时间点的疼痛焦虑平均差异未超过MDC（20.14），表明临床改善不显著。所有结局指标的结果均得到证实；ITT分析中两组之间存在统计学显著差异（p <.001）。
身体和心理疼痛管理教育被证明在降低疼痛强度、焦虑和残疾方面有效。该策略可能对此类患者有益。未来研究应考虑吸烟行为、既往心理障碍史和既往手术史等变量。
