Turk D C, Okifuji A, Sinclair J D, Starz T W
Department of Anesthesiology, University of Washington School of Medicine, Seattle 98195-6540, USA.
Arthritis Care Res. 1998 Oct;11(5):397-404. doi: 10.1002/art.1790110511.
To evaluate differential treatment responses among 3 empirically derived, psychosocial subgroups of patients with fibromyalgia syndrome to a standard interdisciplinary treatment program.
Patients were classified into 1 of 3 psychosocial groups on the basis of their responses to the Multidimensional Pain Inventory. Forty-eight patients completed a 6 one-half-day outpatient treatment program consisting of medical, physical, occupational, and psychological therapies spaced over a period of 4 weeks (3 sessions the first week followed by 1 session per week for the next 3 consecutive weeks).
Statistically significant reductions were observed in pain, affective distress, perceived disability, and perceived inteference of pain in the patients characterized by poor coping and high level of pain ("dysfunctional" group). In contrast, individuals who were characterized by interpersonal difficulties ("interpersonally distressed" group) exhibited poor responses to the treatment. "Adaptive copers," the third group, revealed significant improvements in pain but due to low pretreatment levels of affective distress and disability showed little improvement on these outcomes.
The results provided support for the hypothesis that customizing treatment based on patients' psychosocial needs will lead to enhanced treatment efficacy. They also emphasize the importance of using appropriate outcome criteria, as low levels of problems at baseline are not likely to show significant changes following any treatment.
评估纤维肌痛综合征患者根据经验得出的3个心理社会亚组对标准跨学科治疗方案的不同治疗反应。
根据患者对多维疼痛量表的反应，将其分为3个心理社会组中的1组。48名患者完成了一个为期6个半天的门诊治疗方案，该方案包括医学、物理、职业和心理治疗，在4周内进行（第一周3次治疗，接下来连续3周每周1次治疗）。
在以应对能力差和疼痛程度高为特征的患者（“功能失调”组）中，疼痛、情感困扰、感知到的残疾以及疼痛的感知干扰在统计学上有显著降低。相比之下，以人际困难为特征的个体（“人际困扰”组）对治疗的反应较差。第三组“适应性应对者”在疼痛方面有显著改善，但由于治疗前情感困扰和残疾水平较低，在这些结果上几乎没有改善。
结果支持了根据患者心理社会需求定制治疗将提高治疗效果的假设。它们还强调了使用适当结果标准的重要性，因为基线时问题水平较低在任何治疗后都不太可能显示出显著变化。
