Burke Larisa A, Flynn Diane M, Ransom Jeffrey C, Steffen Alana D, Shah Shikhar H, Doorenbos Ardith Z
College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA.
Interdisciplinary Pain Management Center, Madigan Army Medical Center, Tacoma, Washington, USA.
J Integr Complement Med. 2025 Jan;31(1):44-53. doi: 10.1089/jicm.2024.0333. Epub 2024 Aug 22.
Pain management clinics differ in treatments offered, and little evidence exists regarding which combinations of therapies result in best outcomes. This study analyzed clinical encounters and pain outcomes data for associations between treatment composition and outcomes. Retrospective observational study of 2,142 predominantly active-duty US service members referred to an interdisciplinary pain management center between 2014 and 2021. Latent class analysis was used to identify treatment groups with distinct outcome patterns during the year following initial assessment. The primary outcome measure was the National Institutes of Health Task Force on Research Standards for Chronic Low-Back Pain impact score. Four distinct treatment groups were identified: 1 group engaged in conventional medical therapies alone ( = 726, median 3.5 treatment hours), and 3 groups used a combination of conventional, psychological, rehabilitative, and complementary therapies, with different levels of treatment hours: low ( = 814, median 15.7 h), medium ( = 177, median 40.1 h), and high ( = 425, median 72.5 h). All groups showed significant improvement in pain impact score from baseline up to 9 months but not at 12 months following initial assessment. At the 6-month time point, the group with high multimodal treatment hours had the most improvement in pain impact (-3.1 [95% CI -3.8, -2.4]) compared with the group using only conventional therapies (-1.0 points [95% CI -1.8, -0.1]) or with low multimodal treatment hours (-1.3 points [95% CI -1.9, -0.7]). There were no between-group differences at the 9- or 12-month time points. These results suggest that a combination of pain therapy approaches results in greater reduction in pain impact than the use of conventional medical treatment alone for up to 6 months after initiating therapy and that there may be a threshold of treatment hours that must be exceeded to achieve this benefit. As this study is not a clinical trial, no registration was required.
疼痛管理诊所提供的治疗方法各不相同，关于哪些治疗组合能产生最佳效果的证据很少。本研究分析了临床诊疗情况和疼痛结果数据，以探究治疗构成与结果之间的关联。对2014年至2021年间被转诊至一个跨学科疼痛管理中心的2142名主要为现役的美国军人进行了回顾性观察研究。采用潜在类别分析来确定在初次评估后的一年中具有不同结果模式的治疗组。主要结局指标是美国国立卫生研究院慢性下腰痛研究标准特别工作组的影响评分。确定了四个不同的治疗组：1组仅采用传统医学疗法（n = 726，中位治疗时长3.5小时），另外3组采用传统、心理、康复和补充疗法的组合，治疗时长各不相同：低治疗时长组（n = 814，中位治疗时长15.7小时）、中治疗时长组（n = 177，中位治疗时长40.1小时）和高治疗时长组（n = 425，中位治疗时长72.5小时）。所有组在初次评估后的基线至9个月时疼痛影响评分均有显著改善，但在12个月时未改善。在6个月时间点，与仅采用传统疗法的组（-1.0分[95%置信区间-1.8，-0.1]）或低多模式治疗时长组（-1.3分[95%置信区间-1.9，-0.7]）相比，高多模式治疗时长组的疼痛影响改善最大（-3.1[95%置信区间-3.8，-2.4]）。在9个月或12个月时间点，组间无差异。这些结果表明，在开始治疗后的6个月内，多种疼痛治疗方法的组合比单独使用传统医学治疗能更大程度地减轻疼痛影响，并且可能存在一个必须超过的治疗时长阈值才能获得这种益处。由于本研究不是临床试验，无需注册。
