Wexler Ryan S, Fox Devon J, ZuZero Danielle, Bollen Melissa, Parikshak Anand, Edmond Hannah, Lemau Johnny, Montenegro Diane, Ramirez Jillian, Kwin Sophia, Thompson Austin R, Carlson Hans L, Marshall Lynn M, Kern Thomas, Mist Scott D, Bradley Ryan, Hanes Douglas A, Zwickey Heather, Pickworth Courtney K
Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA.
Center for Research and Training, Department of Wellness and Preventive Medicine, Cleveland Clinic, Cleveland, OH, USA.
Pain Rep. 2024 Mar 14;9(2):e1132. doi: 10.1097/PR9.0000000000001132. eCollection 2024 Apr.
Lumbosacral radiculopathy (LR), also known as sciatica, is a common type of radiating neurologic pain involving burning, tingling, and numbness in the lower extremities. It has an estimated lifetime prevalence as high as 43%.
The objective of this randomized controlled trial was to evaluate the impact of virtually delivered Mindfulness-Oriented Recovery Enhancement (MORE) on patients with LR during the COVID-19 pandemic.
Potentially eligible patients were identified using electronic health record queries and phone screenings. Participants were then randomized to MORE or treatment-as-usual (TAU) for 8 weeks, with pain intensity assessed daily. At baseline and follow-up visits, participants completed questionnaires assessing the primary outcome, disability, as well as quality of life, depression, mindful reinterpretation of pain, and trait mindfulness.
In our study, patients undergoing virtual delivery of MORE had greater improvements in daily pain intensity ( = 0.002) but not in disability ( = 0.09), depression ( = 0.26), or quality of life ( = 0.99 and = 0.89, SF-12 physical and mental component scores, respectively), relative to TAU patients. In addition, patients in MORE experienced significantly greater increases in mindful reinterpretation of pain ( = 0.029) and trait mindfulness ( = 0.035).
Among patients with lumbar radiculopathy, MORE significantly reduced daily pain intensity but did not decrease disability or depression symptoms. Given the long duration of symptoms in our sample, we hypothesize the discrepancy between changes in daily pain intensity and disability is due to fear avoidance behaviors common in patients with chronic pain. As the first trial of a mindfulness intervention in patients with LR, these findings should inform future integrative approaches to LR treatment, particularly when considering the increasing use of virtual interventions throughout the COVID-19 pandemic.
腰骶神经根病（LR），也称为坐骨神经痛，是一种常见的放射性神经疼痛，表现为下肢灼痛、刺痛和麻木。其终生患病率估计高达43%。
本随机对照试验的目的是评估在2019年冠状病毒病（COVID-19）大流行期间，虚拟提供的正念导向康复强化疗法（MORE）对LR患者的影响。
通过电子健康记录查询和电话筛查确定潜在符合条件的患者。然后将参与者随机分为接受MORE或常规治疗（TAU），为期8周，每天评估疼痛强度。在基线和随访时，参与者完成问卷，评估主要结局、残疾情况以及生活质量、抑郁、对疼痛的正念重新诠释和特质正念。
在我们的研究中，相对于TAU组患者，接受虚拟MORE治疗的患者在每日疼痛强度方面有更大改善（P = 0.002），但在残疾（P = 0.09）、抑郁（P = 0.26）或生活质量（P = 0.99和P = 0.89，分别为SF-12身体和心理成分得分）方面没有改善。此外，接受MORE治疗的患者在对疼痛的正念重新诠释（P = 0.029）和特质正念（P = 0.035）方面有显著更大的增加。
在腰骶神经根病患者中，MORE显著降低了每日疼痛强度，但没有减轻残疾或抑郁症状。鉴于我们样本中症状持续时间较长，我们推测每日疼痛强度变化与残疾之间的差异是由于慢性疼痛患者常见的恐惧回避行为所致。作为对LR患者进行正念干预的首次试验，这些发现应为未来LR治疗的综合方法提供参考，特别是在考虑到COVID-19大流行期间虚拟干预使用增加的情况下。
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