JAMA. 1996;276(4):313-8. doi: 10.1001/jama.1996.03540040057033.
To provide physicians with a responsible assessment of the integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia.
A nonfederal, nonadvocate, 12-member panel representing the fields of family medicine, social medicine, psychiatry, psychology, public health, nursing, and epidemiology. In addition, 23 experts in behavioral medicine, pain medicine, sleep medicine, psychiatry, nursing, psychology, neurology, and behavioral and neurosciences presented data to the panel and a conference audience of 528 during a 1 1/2-day public session. Questions and statements from conference attendees were considered during the open session. Closed deliberations by the panel occurred during the remainder of the second day and the morning of the third day.
The literature was searched through MEDLINE, and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. ASSESSMENT PROCESS: The panel, answering predefined questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference.
A number of well-defined behavioral and relaxation interventions now exist and are effective in the treatment of chronic pain and insomnia. The panel found strong evidence for the use of relaxation techniques in reducing chronic pain in a variety of medical conditions as well as strong evidence for the use of hypnosis in alleviating pain associated with cancer. The evidence was moderate for the effectiveness of cognitive-behavioral techniques and biofeedback in relieving chronic pain. Regarding insomnia, behavioral techniques, particularly relaxation and biofeedback, produce improvements in some aspects of sleep, but it is questionable whether the magnitude of the improvement in sleep onset and total sleep time are clinically significant.
为医生提供关于将行为和放松方法整合到慢性疼痛和失眠治疗中的负责任评估。
一个由12名成员组成的非联邦、无党派小组，代表家庭医学、社会医学、精神病学、心理学、公共卫生、护理和流行病学领域。此外，23位行为医学、疼痛医学、睡眠医学、精神病学、护理、心理学、神经病学以及行为和神经科学方面的专家在为期一天半的公开会议期间向小组和528名参会听众展示了数据。公开会议期间考虑了参会者提出的问题和陈述。小组在第二天剩余时间和第三天上午进行了闭门审议。
通过MEDLINE检索文献，并向小组和参会听众提供了一份广泛的参考文献目录。专家们准备了带有文献中相关引用的摘要。科学证据优先于临床轶事经验。
小组回答预先设定的问题，根据公开论坛上展示的科学证据和科学文献得出结论。小组撰写了一份声明草案，全文宣读并分发给专家和听众征求意见。此后，小组解决了相互冲突的建议，并在会议结束时发布了一份修订声明。小组在会议结束后的几周内完成了修订。
现在存在一些明确的行为和放松干预措施，对慢性疼痛和失眠的治疗有效。小组发现有充分证据表明放松技术可用于减轻各种医疗状况下的慢性疼痛，也有充分证据表明催眠可用于减轻与癌症相关的疼痛。认知行为技术和生物反馈在缓解慢性疼痛方面的有效性证据中等。关于失眠，行为技术，特别是放松和生物反馈，在睡眠的某些方面有改善，但睡眠开始时间和总睡眠时间的改善幅度在临床上是否显著尚存在疑问。
