Malpus Zoey, Nazar Zaynab, Smith Chloe, Armitage Lesley
Manchester NHS Pain Service, Manchester University NHS Foundation Trust, Manchester, UK.
Trainee Health Psychologist, Manchester Metropolitan University, Manchester, UK.
Br J Pain. 2023 Feb;17(1):87-102. doi: 10.1177/20494637221133630. Epub 2022 Oct 16.
This paper describes the development of an eight-week Compassion Focused Therapy for Pain Management (CFT-PM) group. This group was specifically designed for 'strivers' a sub-group of people with persistent pain who tend to engage in over-activity and resist making reasonable adjustments to their activity levels to accommodate their persistent pain. 'Strivers' tend to cope by ignoring their pain and pushing on through, in the shorter term leading to 'boom and bust' activity-related exacerbations of their pain. They also risk the development of additional persistent fatigue and burnout in the longer term.
117 people completed the CFT-PM group; The group was delivered in person ( = 84) but in online format from July 2020 ( = 33). 162 people started the CFT-PM group but 45 dropped-out (27.43%).
There was a significant effect for time across all measures: significant improvement was found for depression, self-compassion, pain-related disability, pain-related anxiety and pain self-efficacy. Pain numeric rating scores were approaching significance. There was a significant main effect of diagnosis; post-hoc t-test analysis found significant improvement for all diagnoses on all measures with the exception of spinal. There was also a significant interaction between time and format: post-hoc t-test analysis found greater improvement for virtual format on self-compassion and pain-related anxiety.
Findings suggests that CFT-PM may be a clinically effective group intervention with virtual format showing superior improvement. This approach might be less suitable for certain diagnoses; the spinal group may benefit more from traditional CBT-based PMPs. Limitations include the lack of random selection or allocation to treatment group. Future studies should adopt an experimental design to be able to draw firm conclusions regarding causation and efficacy. Despite these limitations, present findings suggest that CFT-PM may be an effective group intervention worthy of further investigation and clinical application.
本文描述了一种为期八周的疼痛管理慈悲聚焦疗法（CFT-PM）小组的开展情况。该小组专为“奋斗者”设计，“奋斗者”是持续性疼痛患者中的一个亚组，他们往往过度活动，且拒绝为适应持续性疼痛而合理调整活动水平。“奋斗者”倾向于通过忽视疼痛并坚持下去来应对，短期内会导致与活动相关的疼痛“大起大落”式加剧。从长远来看，他们还面临额外的持续性疲劳和倦怠风险。
117人完成了CFT-PM小组治疗；该小组以面对面形式开展（n = 84），但从2020年7月起以在线形式开展（n = 33）。162人开始参加CFT-PM小组，但45人退出（27.43%）。
所有测量指标在时间维度上均有显著效应：在抑郁、自我慈悲、疼痛相关残疾、疼痛相关焦虑和疼痛自我效能方面均有显著改善。疼痛数字评分得分接近显著水平。诊断有显著的主效应；事后t检验分析发现，除脊柱疾病外，所有诊断在所有测量指标上均有显著改善。时间和形式之间也存在显著交互作用：事后t检验分析发现，虚拟形式在自我慈悲和疼痛相关焦虑方面有更大改善。
研究结果表明，CFT-PM可能是一种临床有效的小组干预措施，虚拟形式显示出更好的改善效果。这种方法可能不太适合某些诊断；脊柱疾病组可能从传统的基于认知行为疗法的疼痛管理方案中获益更多。局限性包括缺乏随机选择或分配到治疗组。未来的研究应采用实验设计，以便能够就因果关系和疗效得出确凿结论。尽管有这些局限性，但目前的研究结果表明，CFT-PM可能是一种值得进一步研究和临床应用的有效小组干预措施。
