Syrjala Karen L, Donaldson Gary W, Davis Martha W, Kippes Michael E, Carr John E
Fred Hutchinson Cancer Research Center, Seattle, WA 98104 USA University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, RP-10, Seattle, WA 98195 USA.
Pain. 1995 Nov;63(2):189-198. doi: 10.1016/0304-3959(95)00039-U.
Few controlled clinical trials of psychological interventions for cancer pain relief exist in spite of frequent support for their importance as adjuncts to medical treatment. This study compared oral mucositis pain levels in 4 groups of cancer patients receiving bone marrow transplants (BMT): (1) treatment as usual control, (2) therapist support, (3) relaxation and imagery training, and (4) training in a package of cognitive-behavioral coping skills which included relaxation and imagery. A total of 94 patients completed the study which involved two training sessions prior to treatment and twice a week 'booster' sessions during the first 5 weeks of treatment. Results confirmed our hypothesis that patients who received either relaxation and imagery alone or patients who received the package of cognitive-behavioral coping skills would report less pain than patients in the other 2 groups. The hypothesis that the cognitive-behavioral skills package would have an additive effect beyond relaxation and imagery alone was not confirmed. Average visual analogue scale (VAS) report of pain within the therapist support group was not significantly lower than the control group (P = 0.103) nor significantly higher than the training groups. Patient reports of relative helpfulness of the interventions for managing pain and nausea matched the results of VAS reports. From these results, we conclude that relaxation and imagery training reduces cancer treatment-related pain; adding cognitive-behavioral skills to the relaxation with imagery does not, on average, further improve pain relief.
尽管心理干预作为癌症疼痛缓解辅助手段的重要性经常得到支持，但针对癌症疼痛缓解的心理干预的对照临床试验却很少。本研究比较了4组接受骨髓移植（BMT）的癌症患者的口腔黏膜炎疼痛程度：（1）常规治疗对照组，（2）治疗师支持组，（3）放松和意象训练组，以及（4）包含放松和意象的一整套认知行为应对技能训练组。共有94名患者完成了该研究，研究包括治疗前的两次训练课程以及治疗前5周每周两次的“强化”课程。结果证实了我们的假设，即单独接受放松和意象训练的患者或接受认知行为应对技能整套训练的患者报告的疼痛程度低于其他两组患者。认知行为技能整套训练比单独的放松和意象训练有叠加效果这一假设未得到证实。治疗师支持组内疼痛的平均视觉模拟量表（VAS）报告并不显著低于对照组（P = .103），也不显著高于训练组。患者对干预措施在管理疼痛和恶心方面相对有效性的报告与VAS报告结果相符。从这些结果来看，我们得出结论，放松和意象训练可减轻癌症治疗相关疼痛；平均而言，在放松和意象训练中加入认知行为技能并不能进一步改善疼痛缓解情况。
