Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Kerava Health Center, Kerava, Finland.
Eur J Pain. 2024 Jul;28(6):886-900. doi: 10.1002/ejp.2240. Epub 2024 Jan 31.
A multidisciplinary approach is the gold standard in the management of persistent pain and is current practice in tertiary pain clinics. However, such approaches seem to be a rarity in primary care, although pain is the most common reason for visiting a primary care physician. A comprehensive systematic review was conducted to explore whether studies on multidisciplinary management programs for persistent pain exist in primary care.
PubMed, Ovid MEDLINE, Scopus, CINAHL, and PsychINFO were searched from inception to October 2022, and supplementary research was conducted in June 2023. Screening, data extraction, and quality assessment were independently carried out by two researchers. The inclusion criteria were (1) adult patients (age >18 years); (2) non-cancer pain, persisting over 3 months; (3) multidisciplinary intervention (treatment included ≥3 heathcare professionals); (4) intervention conducted in a primary care setting; and (5) reports published in English.
Of the 1250 initially identified studies, 17 were selected for final analysis. Only studies reporting empirical data were included (cohort, case-control, randomized controlled trial, and observational). The study settings and intervention characteristics showed great heterogeneity. The primary care practices also varied across different countries and cultures. Overall, the quality of the studies was rather low and sample sizes were relatively small.
The review revealed that studies about such treatment interventions for persistent pain patients are scarce. The existing studies were heterogeneous in terms of intervention characteristics, population, outcome variables, and study methodology. Future studies are urgently needed.
Persistent pain is a growing challenge to the health care system, and most patients are treated in primary care. The biopsychosocial concept is the basis for the multidisciplinary management of pain. The review revealed that studies about treatment interventions for persistent pain patients are scarce. Existing studies were heterogeneous in terms of intervention characteristics, population, outcome variables, and study methodology. There is an urgent need for further studies on systematic multidisciplinary treatment protocols for managing persistent pain in primary care.
多学科方法是持续性疼痛管理的金标准，也是三级疼痛诊所的当前实践。然而，尽管疼痛是初级保健医生就诊的最常见原因，但这种方法在初级保健中似乎很少见。进行了一项全面的系统评价，以探讨初级保健中是否存在针对持续性疼痛的多学科管理方案的研究。
从成立到 2022 年 10 月，在 PubMed、Ovid MEDLINE、Scopus、CINAHL 和 PsychINFO 中进行了搜索，并于 2023 年 6 月进行了补充研究。两名研究人员独立进行了筛选、数据提取和质量评估。纳入标准为：（1）成年患者（年龄>18 岁）；（2）非癌症疼痛，持续超过 3 个月；（3）多学科干预（治疗包括≥3 名医疗保健专业人员）；（4）在初级保健环境中进行的干预；（5）用英语发表的报告。
最初确定的 1250 项研究中，有 17 项被选入最终分析。仅包括报告实证数据的研究（队列、病例对照、随机对照试验和观察性研究）。研究设置和干预特征显示出很大的异质性。初级保健实践也因不同国家和文化而异。总体而言，研究质量相当低，样本量相对较小。
该综述表明，针对持续性疼痛患者的此类治疗干预措施的研究很少。现有研究在干预特征、人群、结局变量和研究方法方面存在异质性。迫切需要开展进一步的研究。
持续性疼痛对医疗保健系统构成日益严峻的挑战，大多数患者在初级保健中接受治疗。生物心理社会概念是疼痛多学科管理的基础。该综述表明，针对持续性疼痛患者的治疗干预措施的研究很少。现有研究在干预特征、人群、结局变量和研究方法方面存在异质性。迫切需要开展进一步的研究，以制定针对初级保健中持续性疼痛的系统多学科治疗方案。
