LeFort S M, Gray-Donald K, Rowat K M, Jeans M E
School of Nursing, Memorial University of Newfoundland, St. John's, Canada.
Pain. 1998 Feb;74(2-3):297-306. doi: 10.1016/s0304-3959(97)00190-5.
Although chronic pain is a frequent cause of suffering and disability and is costly to society, there continues to be limited access to specialty pain clinic services. Hence, there is a need for cost-effective, accessible interventions that will help people find ways to better manage this difficult problem. This randomized controlled trial examined the effect of a low-cost, community-based, nurse-delivered, group psychoeducation program entitled the Chronic Pain Self-Management Program (CPSMP). It has a standard protocol that was modified from the successful Arthritis Self-Management Program (ASMP). One hundred and ten individuals with mixed idiopathic chronic pain conditions were enrolled in the study (75% female; mean age 40 years; mean chronicity 6 years) and were randomly assigned to one of two conditions: the 12-h (CPSMP) intervention group, or the 3-month wait-list control group. Self-report measures of pain-related and other quality of life variables as well as two hypothesized mediating variables were collected pre-treatment and 3 months later by assessors blind to group allocation. One hundred and two subjects completed the study. Results of intention-to-treat analysis indicated that the treatment group made significant short-term improvements in pain, dependency, vitality, aspects of role functioning, life satisfaction and in self-efficacy and resourcefulness as compared to the wait-list control group. Because it has a standard protocol, this intervention has the potential to be reliably delivered at low cost in varied urban and rural community settings and hence be more widely accessible to a greater number of people suffering from chronic pain than is currently the case with more specialized pain clinic services. Based on the results of this study, further research evaluating the long-term impact and potential cost savings to the individual and to the health care system is warranted.
尽管慢性疼痛是导致痛苦和残疾的常见原因，且给社会带来高昂成本，但获得专业疼痛诊所服务的机会仍然有限。因此，需要有成本效益高且易于获得的干预措施，帮助人们找到更好地应对这一难题的方法。这项随机对照试验考察了一个名为慢性疼痛自我管理项目（CPSMP）的低成本、基于社区、由护士提供的团体心理教育项目的效果。它有一个从成功的关节炎自我管理项目（ASMP）修改而来的标准方案。110名患有混合性特发性慢性疼痛疾病的个体参与了该研究（75%为女性；平均年龄40岁；平均病程6年），并被随机分配到两种情况之一：12小时的（CPSMP）干预组或3个月的等待名单对照组。在治疗前和3个月后，由对分组情况不知情的评估人员收集与疼痛相关的自我报告测量指标、其他生活质量变量以及两个假设的中介变量。102名受试者完成了研究。意向性分析结果表明，与等待名单对照组相比，治疗组在疼痛、依赖程度、活力、角色功能方面、生活满意度以及自我效能和应变能力等方面都有显著的短期改善。由于它有一个标准方案，这种干预措施有可能在不同的城乡社区环境中以低成本可靠地实施，因此与目前更专业的疼痛诊所服务相比，能让更多慢性疼痛患者更广泛地获得。基于这项研究的结果，有必要进一步开展研究，评估其对个人和医疗保健系统的长期影响以及潜在的成本节约情况。
