Bults Rinske M, van Dongen Johanna M, Ostelo Raymond W J G, Nijs Jo, Keizer Doeke, van Wilgen C Paul
Department of Rehabilitation Science, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, 1050 Brussels, Belgium.
Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussels, Belgium.
J Clin Med. 2023 Jan 22;12(3):885. doi: 10.3390/jcm12030885.
To manage chronic pain, multidisciplinary interventions have been increasingly deployed, mostly in secondary or tertiary care settings. Evidence on the effectiveness of multidisciplinary intervention within primary care is scarce. This study examined the effectiveness of a primary care multidisciplinary treatment for chronic pain compared with treatment as usual (TAU). The intervention consisted of pain neuroscience education and treatment by a GP, psychologist, and physiotherapist. Both groups filled out patient-reported outcome measures at baseline, 6 months, and 12 months. The results indicated there were no statistically significant differences for the primary outcomes of pain intensity, number of pain sites, and health-related quality of life (HR-QoL). There was a statistically significant difference in the secondary outcome perceived health change in favor of the intervention group. None of the other differences were statistically significant. A post-hoc analysis showed that there were statistically significant effects on patients' illness perceptions in favor of the intervention group. Based on the results, the findings do not support effectiveness of a low intensity outpatient multidisciplinary primary care treatment to treat chronic pain compared with TAU. However, as a result of several study limitations, it is considered unwarranted to conclude that multidisciplinary treatment in primary care is not valuable at all.
为了管理慢性疼痛，多学科干预措施已越来越多地被采用，主要是在二级或三级医疗环境中。关于初级保健中多学科干预有效性的证据很少。本研究比较了初级保健多学科慢性疼痛治疗与常规治疗（TAU）的有效性。干预措施包括由全科医生、心理学家和物理治疗师进行疼痛神经科学教育和治疗。两组患者在基线、6个月和12个月时填写患者报告的结局指标。结果表明，在疼痛强度、疼痛部位数量和健康相关生活质量（HR-QoL）等主要结局方面，没有统计学上的显著差异。在次要结局“感知健康变化”方面，干预组有统计学上的显著差异，且有利于干预组。其他差异均无统计学意义。事后分析表明，干预组在患者疾病认知方面有统计学上的显著效果。基于这些结果，研究结果不支持与常规治疗相比，低强度门诊多学科初级保健治疗对慢性疼痛的有效性。然而，由于本研究存在若干局限性，因此认为得出初级保健中的多学科治疗毫无价值的结论是不合理的。
