慢性疼痛战役-接受与灵活疗法


  【24drs.com】随著研究人员致力于寻找合适的心理治疗方法,以最佳地帮助患者突破「持续的慢性疼痛具有破坏性」的思维模式,「接受和承诺治疗(ACT) 」和「心理灵活性」受到青睐-且有证据。
  
  发表于美国疼痛协会第35届年度科学会议、探讨此议题的许多报告之一,研究者发现,接受对于抵销患者的不公平感具有重要性,而不公平感与疼痛相关的结果有强烈关联。
  
  第一作者、加拿大魁北克蒙特娄McGill大学疼痛失能暨社会整合研究中心、实验心理学博士候选人Junie Carriere表示,变成慢性疼痛时,患者会体验到很多损失:功能损失、就业的损失和独立性的损失。这是相当直观的,对它感到难以负责而最后发展出不公平感。
  
  不公平感接著会进一步造成负面结果,如功能下降和感知障碍的恶性循环。反之,接受疼痛与较少疼痛相关困难及更好的生活质量有关。
  
  Carriere表示,整体而言,接受度高的人在精神上和生理上都往前进,这样一来,他们在健康与疼痛相关结果都有比较好的经验。
  
  为了探讨ACT在潜在调解这些认知的作用,Carriere和来自McGill大学与加州Palo Alto、史丹佛医学院的研究伙伴,评估了史丹佛疼痛门诊处理中心的344名慢性疼痛成年患者。
  
  在使用多个中介分析的分析中,他们发现,不公平感和接受疼痛呈现负相关,这与以前的研究结果一致。
  
  不过,接受疼痛调解了不公平感和疼痛干扰之间的关系(P < .001),接受并没有完全抵消不公平感和疼痛强度之间的关系。
  
  作者们写道,这些研究结果认为,不公平感和接受对于疼痛对慢性疼痛患者之生活干扰的程度有显著影响。
  
  尽管这项研究的设计限制了我们建立因果关系的能力,它提供了一个理论架构-采用目标为接受疼痛的介入方式以改善对慢性疼痛的生理、心理和社会适应,特别是那些认为他们的疼痛是不公平的患者。
  
  Carriere指出,医师应该意识到,对疼痛的结果衍生的不公平感觉会带来不利影响。
  
  她表示,他们可能需要确定哪里些患者有这种不公平的感受,并考虑将以接受为基础的疗法纳入疼痛管理治疗计画内。
  
  许多其它研究都强调接受疼痛对慢性疼痛的影响,2015年时发表于疼痛期刊的一篇研究显示,认知行为疗法的5周门诊多科别计划中,诸多结果指标里面,疼痛相关接受度是最强的调节因子。
  
  发表于APS会议,有关心理灵活性和功能情境的全体会谈中,研究共同作者Lance M. McCracken博士推论,灵活性在转变持续慢性疼痛之思维模式上的附加作用。
  
  英国伦敦国王学院精神病学、心理学和神经科学研究院McCracken教授表示,取代转变我们的想法与感受,或许我们可以从我们怎么想与感受改变成我们要做什么。
  
  我会把这称为从言语调节转变成行为调节,而这个问题应该是:在某些情况下,我们可以减少言语调节而在其它方面增加吗?
  
  这种努力的更广泛的重点是,让患者远离疼痛灾难化,疼痛灾难化会造成不良结果与持续疼痛。
  
  McCracken教授表示,当你悲剧化,它就像生活在一个灾难中-这当然会影响你。正确的思想与文字将对他们描述事情的经验有所影响。
  
  问题是我们可以如何破坏它,我们如何对抗悲剧化,还是与它讲和?我的想法是,我们正在学习的是:讲和是一种选择,而且我认为我们知道怎么办。
  
  ACT已被证明,用于有慢性疼痛的退伍军人是特别有益的,有助于减轻疼痛干扰,提高生活质量。不过,取得上的受限是常见的一个限制,而使患者无法取得他们需要的帮助。
  
  发表于会议的另一篇研究中,研究者试图确定远端医疗是否可成为提供相同ACT效果的选项。
  
  在这个研究中,研究者随机指派圣地亚哥退伍军人事务部医疗保健系统的129名有慢性疼痛的退伍军人透过视讯会议或面对面接受8周的ACT治疗。
  
  根据这篇研究采用之简明疼痛量表的疼痛干扰初步结果,显示出远端医疗方式的非劣效性,两组研究对象的疼痛干扰分数都比开始时降低(P < .05),两组在时间-治疗交互作用上也没有显著差异。
  
  在减少忧郁症状和疼痛相关的焦虑、生活质量的改善方面,两组也没有显著差异。
  
  虽然两组在睡眠或创伤后压力异常方面没有显著改善,远端医疗组的流失率比较高,这是远端医疗的关键挑战之一。
  
  作者们结论指出,目前的研究结果认为,使用远端或面对面方式对慢性疼痛进行ACT的效果是相当的,而这两种方式的流失率会有差异。
  
  
  资料来源:http://www.24drs.com/
  
  Native link:Acceptance, Flexibility Key in Chronic Pain Battle

Acceptance, Flexibility Key in Chronic Pain Battle

By Nancy A. Melville
Medscape Medical News

AUSTIN, Texas — As researchers strive to find the right psychotherapeutic approaches to best help patients break destructive thought patterns that perpetuate chronic pain, acceptance and commitment therapy (ACT) and psychological flexibility are gaining favor — and evidence.

In one of several papers looking at the issue presented here at the American Pain Society (APS) 35th Annual Scientific Meeting, researchers showed the importance of acceptance in offsetting patient perceptions of injustice, which are known to be strongly associated with pain-related outcomes.

"When pain becomes chronic, patients can experience many losses: loss of function, loss of employment, and loss of independence. It's very intuitive to not feel responsible for it and develop a sense of injustice," first author Junie Carriere, a PhD candidate in experimental psychology at the Center for Research on Pain, Disabilityand Social Integration at McGill University, Montreal, Quebec, Canada, told Medscape Medical News.

"The sense of injustice can further set the wheels in motion for a vicious cycle of negative outcomes, such as decreased function and perceived disability."

Conversely, an acceptance of pain has been associated with fewer pain-related difficulties and better quality of life.

"Overall, people with high acceptance push forward, mentally and physically. As a result, they experience better health and pain outcomes," Carriere said.

To study the role of ACT in potentially mediating those perceptions, Carriere and her colleagues from McGill University and Stanford Medical School, Palo Alto, California, evaluated 344 adult patients with chronic pain who presented at the Stanford Outpatient Pain Management Center.

In analyses using multiple mediation analysis, they found a negative correlation between perceived injustice and pain acceptance, which is consistent with previous research.

The acceptance of pain, however, mediated the relation between perceived injustice and pain interference (P < .001). Acceptance did not fully offset the relation between perceived injustice and pain intensity.

"These findings suggest that perceived injustice and acceptance have significant roles in the degree to which pain interferes with the lives of individuals with chronic pain," the authors write.

"Although the study design limits our ability to establish causal relationships, it provides a theoretical framework for the use of interventions that target pain acceptance in order to improve physical, mental and social adjustment to chronic pain, particularly in patients who perceive their pain as unjust."

Carriere added that "clinicians should be made aware of the detrimental impacts of feelings of injustice on pain outcomes."

"They may want to identify patients who express high feelings of injustice and consider including acceptance-based therapy as part of their pain management treatment plan," she said.

Numerous other studies have underscored the role of pain acceptance in chronic pain, and one recent study published in the Journal of Pain in 2015, showed that pain-related acceptance, part of a 5-week outpatient multidisciplinary program of cognitive-behavioral therapy, was the strongest mediator across several different indices of outcome.

In a plenary talk on psychological flexibility and functional contextualism presented at the APS meeting, Lance M. McCracken, PhD, a coauthor on that study, speculated on the additional role of flexibility in shifting the patterns of thought that perpetuate chronic pain.

"Instead of shifting what we think and feel, maybe we can shift whether what we think and feel is in charge of what we do," said Dr McCracken, a professor in the Institute of Psychiatry, Psychology and Neuroscience at King's College London, United Kingdom.

"I would call that a shift in looking at verbal regulation over behavior. And the question should be, can we decrease verbal regulation in some situations and increase it in others?"

The broader focus of such efforts is to turn patients away from pain catastrophizing, known to be a critical driver of poor outcomes and continued pain.

"When you catastrophize, it's like living in a catastrophe — of course it affects you," Dr McCracken said. "Thoughts and words, given the right context, carry the influence of the experience of the things is they describe."

"The question is how can we undermine it, and should we do battle with catastrophizing, or make peace with it? I think what we're learning is that making peace is an option, and I think we know how."

ACT and Telehealth

ACT has been shown to be particularly beneficial for veterans with chronic pain, helping to reduce pain interference and improve quality of life. However, restricted access is a common limitation in preventing patients from getting the help they need.

In another study presented at the meeting, researchers sought to determine whether telemedicine could offer an equally effective option for ACT.

For the study, the researchers randomly assigned 129 veterans with chronic pain in the Veterans Affairs San Diego Healthcare System to receive 8 weeks of ACT therapy through video conferencing or in-person.

On the study's primary outcome of pain interference on the Brief Pain Inventory, results showed noninferiority of the telehealth approach, with participants in both groups having lower pain inference scores compared with baseline (P < .05), and no significant differences between groups in time-by-treatment interaction.

There were also no significant differences between groups in terms of reductions in depressive symptoms and pain-related anxiety, and improvements in quality of life.

Despite no significant improvements in sleep or post-traumatic stress disorder between groups, attrition rates were higher in the telehealth group, underscoring one of the key challenges with telemedicine.

"The findings of the present study suggest that ACT for chronic pain delivered [by] telehealth or in-person are comparable, though attrition rates may differ based on delivery type," the authors concluded.

Ms Carriere and Dr McCracken have disclose no relevant financial relationships. The research at Veterans Affairs San Diego was supported by a Veterans Affairs Rehabilitation Research and Development grant.

American Pain Society (APS) 35th Annual Scientific Meeting. Presented May 13, 2016.

    
相关报导
不再使用安慰剂:婴儿使用甜味溶液控制疼痛
2017/1/4 下午 02:06:50
日本研究:认知行为疗法为基础的方法有助缓解HPV疫苗症状
2016/8/25 上午 09:08:53
音乐可以改善一些术后结果
2015/8/31 下午 05:28:13

上一页
   1   2   3   4   5   6   7   8   9   10  




回上一页