Johnson Selina, Bradshaw Alison, Bresnahan Rebecca, Evans Emma, Herron Katie, Hapangama Dharani K
Pain Management Department, Walton Centre NHS Foundation Trust, Liverpool, UK.
Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
BJOG. 2025 Feb;132(3):266-277. doi: 10.1111/1471-0528.17987. Epub 2024 Oct 27.
BACKGROUND/OBJECTIVE: Current guidelines recommend biopsychosocial-informed treatment for chronic pelvic pain (CPP). The objective of this systematic review was to describe the available biopsychosocial approaches for the treatment of CPP, and the outcomes reported, to understand how guideline-recommended treatments can be applied.
MEDLINE, CINAHL, PsycINFO, EMBASE, Emcare, AMED and Cochrane trial registries were searched (inception to 17 November 2023).
CPP Studies in women where the principal treatment modality was a biopsychosocial approach were included. Prospero registration: CRD42022374256.
DATA COLLECTION/ANALYSIS: Data extraction included study setting, population, study design, intervention characteristics and outcome measures and is described via a narrative synthesis.
The review included 14 RCTs (871 patients) and identified four broad intervention categories (Acceptance Commitment Therapy n = 2, Cognitive Behavioural Therapy n = 6, Mindfulness-based approaches n = 2, and Physiotherapy-based interventions n = 4). Pain science education (PSE) and, exposure/engagement with valued activity were recognised as important aspects of treatment regardless of intervention type. The most utilised outcomes were pain reduction and emotional functioning, with all studies reporting improvements in these domains. Heterogeneity in outcomes prevented efficacy comparison. High risk of bias was identified in six studies (1/4 physiotherapy-based approaches, 2/6 CBT, 1/2 ACT and 2/2 mindfulness-based interventions).
CBT and ACT-based biopsychosocial approaches were found effective in reducing pain and improving psychometric outcomes for CPP. Evaluation indicated PSE, and exposure/engagement in valued activity are important components of biopsychosocial management. Outcome heterogeneity needs to be addressed in future trials.
背景/目的：当前指南推荐采用生物心理社会综合治疗慢性盆腔疼痛（CPP）。本系统评价的目的是描述现有的用于治疗CPP的生物心理社会方法以及所报告的结果，以了解如何应用指南推荐的治疗方法。
检索了MEDLINE、CINAHL、PsycINFO、EMBASE、Emcare、AMED和Cochrane试验注册库（从创刊至2023年11月17日）。
纳入以生物心理社会方法作为主要治疗方式的女性CPP研究。Prospero注册号：CRD42022374256。
数据收集/分析：数据提取包括研究背景、人群、研究设计、干预特征和结局指标，并通过叙述性综合进行描述。
该评价纳入了14项随机对照试验（871例患者），并确定了四大类干预措施（接受与承诺疗法n = 2、认知行为疗法n = 6、正念疗法n = 2、物理治疗干预n = 4）。无论干预类型如何，疼痛科学教育（PSE）以及参与有价值的活动都被认为是治疗的重要方面。最常用的结局指标是疼痛减轻和情绪功能，所有研究均报告这些领域有改善。结局的异质性妨碍了疗效比较。六项研究存在高偏倚风险（基于物理治疗的方法1/4、认知行为疗法2/6、接受与承诺疗法1/2、基于正念的干预措施2/2）。
基于认知行为疗法和接受与承诺疗法的生物心理社会方法被发现可有效减轻CPP患者的疼痛并改善心理测量结果。评估表明，PSE以及参与有价值的活动是生物心理社会管理的重要组成部分。未来试验需要解决结局异质性问题。
