Pfingsten M, Hildebrandt J, Leibing E, Franz C, Saur P
Department of Algesiology, Center of Anesthesiology, University of Göttingen, Germany.
Pain. 1997 Oct;73(1):77-85. doi: 10.1016/s0304-3959(97)00083-3.
In recent years, multidisciplinary pain programs were seen to successfully treat patients by basing treatment on a combination of physical exercise and psychological interventions. However, in spite of their effectiveness, it still remains to be clarified exactly which features of these programs were responsible for patient improvement. Cognitive-behavioral models posit that improvement is due, in part, to changes in patient coping strategies. Nonetheless, as reflected by the conflicting opinions present in the literature, it is questionable whether a so-called 'cognitive shift' is an accurate indicator for return to work of disabled patients. Ninety patients with chronic low back pain took part in a multidisciplinary treatment program. Therapeutic environment reinforces wellness behavior and enhances the patients' sense of control over their pain and resulting disability. The main therapeutic target point was to facilitate return to work. Ways of coping were measured by a well studied coping inventory in the German language (FEKB). Factor analysis revealed three factors: 'catastrophizing', 'search for information' and 'cognitive control'. In addition, assessment included measurements of pain intensity, depression, disability, flexibility of the lumbar spine, and different performance parameters. All of them were measured prior to and at the end of treatment, and following intervals of 6 and 12 months after discharge from program. Measurements showed significant changes over time, but more importantly, nearly all results were seen to stabilize at the 6- and 12-month evaluation following treatment. The coping strategies demonstrated little or poor change. In addition, coping measures and change in coping behavior showed poor prognostic relevance. But other psycho-social parameters like self-evaluation of potential return-to-work, application for pension, the length of pre-absence from work, and a decrease in subjective disability following treatment were effective indicators for 'back-to-work'. Other objective parameters, such as medical history, physical impairment and general physical variables were seen to have little predictive value in determining a return to work. The results suggest that the primary target point for further investigation is the analysis of the patients' beliefs about their pain. Our results indicate that future research must be attentive to the complex interactions between environmental factors and the coping demands posed by the specific nature of pain problems.
近年来，多学科疼痛治疗方案被视为通过将体育锻炼和心理干预相结合来成功治疗患者。然而，尽管这些方案有效，但仍有待确切阐明这些方案的哪些特征促成了患者的改善。认知行为模型认为，改善部分归因于患者应对策略的变化。尽管如此，正如文献中相互矛盾的观点所反映的那样，所谓的“认知转变”是否是残疾患者重返工作岗位的准确指标仍值得怀疑。90名慢性下腰痛患者参加了一个多学科治疗方案。治疗环境强化了健康行为，并增强了患者对疼痛及其导致的残疾的控制感。主要治疗目标是促进重返工作岗位。应对方式通过一份经过充分研究的德语应对量表（FEKB）进行测量。因子分析揭示了三个因子：“灾难化”、“寻求信息”和“认知控制”。此外，评估还包括疼痛强度、抑郁、残疾、腰椎灵活性以及不同性能参数的测量。所有这些指标在治疗前、治疗结束时以及出院后6个月和12个月时进行测量。测量结果显示随时间有显著变化，但更重要的是，几乎所有结果在治疗后的6个月和12个月评估时趋于稳定。应对策略几乎没有变化。此外，应对措施和应对行为的变化显示出较差的预后相关性。但其他心理社会参数，如对潜在重返工作岗位的自我评估、申请养老金、缺勤前的工作时长以及治疗后主观残疾程度的降低，是“重返工作岗位”的有效指标。其他客观参数，如病史、身体损伤和一般身体变量，在确定重返工作岗位方面几乎没有预测价值。结果表明，进一步研究的主要目标是分析患者对其疼痛的信念。我们的结果表明，未来的研究必须关注环境因素与疼痛问题的特定性质所带来的应对需求之间的复杂相互作用。
