Tidmarsh Lydia V, Harrison Richard, Finlay Katherine A
School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
Centre for Integrative Neuroscience and Neurodynamics, University of Reading, Reading, UK.
Br J Pain. 2024 Aug;18(4):354-364. doi: 10.1177/20494637241250239. Epub 2024 Apr 29.
Prehabilitation encompasses preparatory clinical intervention(s) delivered during the period between diagnosis and treatment commencement. Despite widespread successful usage preoperatively, prehabilitation is neglected in outpatient chronic pain management. Although pain management waitlists are associated with treatment attrition and psychological and physical decline, this time window is underutilised in preventing escalation. Waitlists present an under-explored opportunity to 'prehabilitate' patients waiting for treatment. This topical review aimed to: (1) examine the effectiveness of psychological prehabilitation for pain services; (2) evaluate the psychological and physical decline associated with waiting for pain management; (3) highlight key psychological prehabilitative targets for increasing treatment engagement; (4) promote pain management psychological prehabilitation within personalised pain medicine, building recommendations for future interventions.
Studies regarding the impact of waitlists and prehabilitation for chronic pain were reviewed.
Findings demonstrated that the psychological constructs of patient expectations, health locus of control, self-efficacy and pain catastrophizing dynamically influence attrition, treatment engagement and outcomes while waiting. These constructs are amenable to change, emphasising their potential utility within a targeted waitlist intervention.
Prehabilitating chronic pain patients towards treatment engagement could circumvent cycles of failed treatment seeking, preventing psychological and physical decline, and reducing healthcare utilisation. Utilising the waitlist to identify psychosocial risk factors (external health locus of control, low self-efficacy and high pain catastrophizing) would identify requires additional support to prevent increased risk of treatment failure, enhancing personalised care before prescribed treatment is accessed. This review cements the urgent need for pain services to engage proactively with prehabilitation innovation.
术前康复包括在诊断和开始治疗期间进行的预备性临床干预。尽管术前康复在临床上已广泛成功应用，但在门诊慢性疼痛管理中却被忽视。虽然疼痛管理等候名单与治疗放弃以及心理和身体机能衰退相关，但这一时间段在预防病情恶化方面未得到充分利用。等候名单为对等待治疗的患者进行“术前康复”提供了一个尚未充分探索的机会。本专题综述旨在：（1）检验心理术前康复对疼痛治疗服务的有效性；（2）评估与等待疼痛管理相关的心理和身体机能衰退；（3）突出提高治疗参与度的关键心理术前康复目标；（4）在个性化疼痛医学中推广疼痛管理心理术前康复，为未来干预措施提出建议。
对有关等候名单和术前康复对慢性疼痛影响的研究进行综述。
研究结果表明，患者期望、健康控制点、自我效能感和疼痛灾难化等心理结构在等待期间会动态影响治疗放弃、治疗参与度和治疗结果。这些结构是可以改变的，这突出了它们在有针对性的等候名单干预中的潜在效用。
使慢性疼痛患者做好接受治疗的准备可以避免寻求治疗失败的循环，防止心理和身体机能衰退，并减少医疗资源的利用。利用等候名单来识别心理社会风险因素（外部健康控制点、低自我效能感和高疼痛灾难化）将识别出需要额外支持以防止治疗失败风险增加的患者，在开始规定治疗之前加强个性化护理。本综述强调了疼痛治疗服务迫切需要积极参与术前康复创新。
