阶段转变模型在慢性疼痛管理中的应用进展

为了更好地减轻慢性疼痛给患者造成生理和心理的痛苦,患者参与慢性疼痛自我管理在疼痛护理中的作用也越来越受到重视.近年来阶段转变模型在慢性疼痛领域的应用研究,将心理和行为的理论引入到慢性疼痛患者自我管理过程当中,通过心理和行为的不同阶段反映自我管理的意图,从而有针对性地对不同阶段慢性疼痛患者采取不同的护理干预,构建更完善的疼痛自我管理的护理模式.本文通过对阶段转变模型的内容、价值及应用现状进行综述,从心理和行为层面为我国慢性疼痛患者的自我管理提供新的方法和视角.     

慢性疼痛病人不同自我管理阶段护理需求的调查研究

[目的]了解慢性疼痛病人不同自我管理行为阶段的需求情况,寻求针对性的护理措施,最大限度满足病人的需求.[方法]选取武汉市11家三级甲等医院272例慢性疼痛病人,采用疼痛阶段变化问卷及疼痛护理需求问卷进行调查.[结果]各阶段的慢性疼痛病人得分最高的需求条目均为"疼痛时希望尽快减轻或解除疼痛".思考前期的病人对生理需求较高(4.51分±0.51分);思考期对各方面的需求评分均超过4.3分;行动期病人对疼痛知识需求较高(4.40分±0.74分);维持期的病人对各方面的需求评分均超过4分.[结论]不同阶段的慢性疼痛病人的需求既有相同,也存在差异.根据不同阶段慢性疼痛病人的需求,实施相应的护理措施,可有效地满足病人的需求,有效缓解疼痛,提高护理服务效率.     

虚拟现实技术在慢性疼痛患者中的应用进展

本文从虚拟现实技术的概述、虚拟现实技术治疗慢性疼痛的作用机制、虚拟现实技术在多种类型慢性疼痛患者中的应用现状及研究展望等方面进行综述,以期为今后国内在此方面的研究和临床应用提供信息支持.     

阶段转变模型在癌症疼痛患者护理中的应用探讨

目的分析阶段转变模型在癌症疼痛患者护理中的应用。方法抽取我院于2017年2月至2018年10月收治的109例伴疼痛症状的癌症患者为研究对象。依据护理方法的差异分成对照组(53例)和观察组(56例)。分别给予两组常规护理、阶段转变模型护理。结果观察组护理后疼痛评分低于对照组(P<0.05)。观察组护理满意度高于对照组(P<0.05)。结论阶段转变模型用于癌症疼痛护理,可显著改善患者的疼痛症状。     

老年人慢性疼痛自我管理的研究进展

国际疼痛学会（international association for the study of pain,IASP）给疼痛定义为：疼痛是一种令人不愉快的生理和心理感受,伴有现存的或潜在的组织损伤。疼痛在老年人中普遍存在,疼痛可导致焦虑、忧郁、睡眠紊乱以及生理功能和社会角色退化,给家人、医疗机构、社会带来严重经济负担。随着人口老龄化的加剧,这一问题日趋严重。     

血友病患者慢性疼痛的自我管理与同伴教育

血友病是一种X染色体连锁的先天性出血性疾病,包括血友病A和血友病B,分别为凝血因子Ⅷ( FVIII)和凝血因子IX( FIX)缺乏所致。血友病常见的出血部位是关节和肌肉,出血产生的压力或局部组织炎症可引起急性或慢性的剧烈疼痛。而关节、肌肉的反复出血,最终导致永久性关节破坏、肌肉萎缩以致残废[1]。生活质量评估表明,71%的血友病患者伴有关节、肌肉的疼痛,其中4%的患者经历着非常严重的疼痛。多数血友病患者由于替代治疗受限,出血后不能得到及时治疗,造成慢性血友病性关节病,由此带来的慢性疼痛不仅损害了患者的生理功能,还限制了日常活动和社会交往,导致情绪低落、活动减少、自尊心下降以及痛感增强[2-4]。     

青少年慢性疼痛管理移动医疗的应用与思考

慢性疼痛会对青少年后期健康发展产生不良影响,并对青少年家庭、情感、行为领域产生连锁反应。本文对青少年慢性疼痛管理移动医疗的概念、作用机制、应用现状及未来展望进行综述,以产生有关治疗青少年慢性疼痛最佳治疗的新思维方式,为国内进一步临床研究与应用提供多方面技术支持。     

行为阶段转变理论在老年糖尿病病人健康教育中的应用研究

目的:探讨行为阶段转变理论在老年糖尿病病人中的应用效果.方法:选择2018年8月—2020年2月于医院就诊的100例老年糖尿病病人,按随机数字表法分为观察组与对照组,每组50例.对照组采取常规健康教育,观察组实施基于行为阶段转变理论的健康教育,比较两组病人干预前和干预3个月后血糖水平[空腹血糖(FPG)、餐后2 h血糖(2 hPG)及糖化血红蛋白(HbA1c)]、自我管理行为[糖尿病自我管理行为量表(SDSCA)评分]、生存质量[糖尿病特异性生存质量量表(DSQL)评分].结果:观察组病人干预3个月后FPG为(6.47±0.51)mmol/L、2 hPG为(9.13±1.07)mmol/L、HbA1c为(5.97±0.38)％,分别低于对照组的(7.26±0.65)mmol/L、(9.82±1.12)mmol/L、(6.47±0.41)％,比较差异有统计学意义(P<0.05).观察组病人干预后SDSCA和DSQL各项评分均高于对照组,比较差异有统计学意义(P<0.05).结论:基于行为阶段转变理论的健康教育能够维持老年糖尿病病人血糖水平的稳定,提高病人自我管理能力和生存质量.     

终末期肝病模型在肝功能衰竭中的应用进展

肝功能衰竭（hepatic failure,HF）是一切肝脏疾病重症化的共同结局,其病死率高达60％～80％［1］。通常终末期肝病（end-stage liver disease, ESLD）泛指各种慢性肝脏损害所致肝病的晚期阶段。2006年《肝衰竭诊疗指南》［2］中慢性肝衰竭（chronic liver failure,CLF）定义：在肝硬化基础上,肝功能进行性减退导致的以腹水或门静脉高压、凝血功能障碍和肝性脑病等为主要表现的慢性肝功能失代偿。因此ESLD相当于失代偿期肝硬化所致的CLF。在我国乙型肝炎病毒慢性感染者高达2千万,其中约15％～25％慢性感染者会发展为 HF和肝细胞癌等乙型肝炎相关性疾病［3,4］。     

叙事护理在慢性疼痛患者中的应用及研究进展

本文通过回顾国内外关于慢性疼痛患者实施叙事护理的相关文献,对叙事护理的概念、慢性疼痛患者实施叙事护理的步骤、干预形式及效果评价进行综述。从培养疼痛专科护士叙事能力、网络化管理慢性疼痛患者叙事护理的远期效果、丰富叙事形式以实现慢性疼痛个性化叙事护理以及注重患者实施叙事护理前后生理指标的监测共4个方面提出建议,以期为我国护理人员对慢性疼痛患者的疼痛管理提供新思路和新方法。     

The effectiveness of a multidisciplinary pain management programme managing chronic pain on pain perceptions, health-related quality of life and stages of change—A non-randomized controlled study

Background

Cognitive behavioural therapy (CBT) has been useful in the treatment of chronic pain conditions for many years. Given the increasing number of persons with chronic pain and associated psychosocial problems, the development and implementation of effective interventions based on CBT is warranted.

Objectives

The aim of this study is to evaluate the effects of a multidisciplinary pain management programme on health-related quality of life (HRQL), as measured by the Short Form Health Survey (SF-36), pain perception as measured by the Brief Pain Inventory (BPI), and readiness-to-change as measured by the Pain Stages of Change Questionnaire (PSOCQ).

Design

A pretest-post-test quasi-experimental design, with waiting list controls and baseline and post-test measures, was used.

Setting

The study was conducted in the rehabilitation unit of a university hospital.

Participants

Of 117 people suffering from chronic pain, 113 completed the 8-week multidisciplinary pain management programme. The patients were consecutive referrals. Inclusion criteria were: adults (18-67 years), pain lasting over 6 months, motivation and no ongoing litigation. Exclusion criteria were affected by major mental disorders or major medical conditions requiring treatment.

Methods

The intervention was based on a cognitive behavioural approach. Therapeutic dialogues and training, combined with physical activity, were provided to a fixed plan, including homework. The programme has several features that directly address psychosocial aspects of chronic pain. Statistical and clinical significance are considered.

Results

The findings suggest that this programme has the potential to improve HRQL, reduce pain intensity and interference, and contribute to improvement in readiness-to-change. Statistically significant results are supplemented by results showing their clinical significance.

Conclusions

Improvements in HRQL, pain-related disability, and readiness-to-change suggest that the vicious cycle of chronic pain may be alleviated by our programme. As we see it, effective treatment results are about identifying and addressing the important and changeable influences maintaining pain problems such as acceptance, understanding the mind-body connection and self-management. Although further research is needed to evaluate the effectiveness of this work, such group approaches appear to represent a feasible treatment option for many patients with chronic pain.     

Predicting responses to self-management treatments for chronic pain: application of the pain stages of change model

Psychological treatments emphasizing a self-management approach have become commonly accepted alternatives to medical interventions for chronic pain. Unfortunately, these approaches often fail to engage a significant portion of targeted individuals and are associated with high drop-out and relapse rates. Informed by the transtheoretical model of behavior change and the cognitive behavioral perspective on chronic pain, the Pain Stages of Change Questionnaire (PSOCQ) was developed to assess readiness to adopt a self-management approach to chronic pain. Initial studies supported the reliability and validity of four distinct scales, Precontemplation, Contemplation, Action and Maintenance. The current study was designed to assess the ability of the PSOCQ to predict self-management participation and outcome. The PSOCQ and several relevant outcome measures were assessed before and after self-management treatment by 109 chronic pain patients. Profile analysis revealed that treatment completers and non-completers differed significantly across the four PSOCQ scales. Post-hoc comparisons indicated that pretreatment PSOCQ Precontemplation and Contemplation scores discriminated these two groups. Separate analyses revealed that Action and Maintenance scores increased over the course of treatment, and that changes in the PSOCQ scales were associated with improved outcomes. These findings suggest that increased commitment to a self-management approach to chronic pain may serve as a mediator or moderator of successful treatment. This study supports the predictive validity and utility of the PSOCQ, as well as the relevance of the stages of change model to self-management of chronic pain.     

Role of pain catastrophizing during pain processing in a cohort of patients with chronic and severe arthritic knee pain

We examined the relationship between catastrophizing and a 3-stage model of pain processing, consisting of pain sensation intensity (stage 1), pain unpleasantness (stage 2), and suffering (stage 3). We studied 310 patients with chronic and severe osteoarthritic knee pain (68.7% female) using 4 competing structural equation models. A strong relationship was found between the suffering construct and its indicators. Of the 4 theoretically plausible models, we found a model with 3 specific pathways of pain sensation leading to the final stage of pain-related suffering. A unique contribution of this study is the integration of catastrophizing into the 3 pain stages. In this model, catastrophizing mediates the relationship between pain-related unpleasantness and suffering, as well as the relationship between sensation and suffering through unpleasantness. Psychological intervention targeting catastrophizing could provide reduction of pain-related suffering that adds to the benefits of therapies directed toward the primary sensory and immediate unpleasant dimensions of pain. These results emphasize the benefit of integrating knowledge of the psychological and neural mechanisms of pain.     

Adjustment to chronic pain in back pain patients classified according to the motivational stages of chronic pain management.

According to Prochaska's transtheoretical model, the Freiburg Questionnaire stages of chronic pain management (FQ-STAPM) were used to classify chronic back patients into 4 distinct motivational stages. The FQ-STAMP was completed by 163 chronic back pain patients. Pain chronicity was measured by the Mainz Pain Staging System; pain intensity was measured by the numeric rating scale. Healthcare system expenses were considered as number of consulted physicians, number of stays in hospital, and number of rehabilitation programs. As psychometric tests, the lower pain disability index (PDI), the Hospital Anxiety and Depression Scale (HADS), and a quality of life score (SF36) were used. Patients were in the following motivational stages: precontemplation in 30%, preparation in 19%, action in 30%, maintenance in 21%. The intensity of pain in the precontemplation stage patients was significantly higher compared to patients in the maintenance stage. A lower pain chronicity was related to a significantly higher motivation. Moreover, there was a significant increase in healthcare system expenses by the lesser motivated patients. Patients in the maintenance stage used significantly less opioids than patients in the precontemplation stage. The higher motivated patients had a significantly lower PDI, a significantly lower HADS, and a significantly higher quality of life compared to less motivated patients. PERSPECTIVE: The study indicates that the FQ-STAPM might be a useful tool to classify chronic back pain patients and to work out a strategy together with the patient relevant to the outcome of pain management among chronic back pain patients.     

老年人慢性疼痛管理研究进展

从影响老年人疼痛评估的因素、评估工具、评估内容及疼痛的处理方面对老年人慢性疼痛管理进展进行综述.     

腰椎终板Modic Ⅱ型面积改变率与慢性下腰痛之间的相关性研究

目的：研究腰椎终板ModicⅡ型面积改变率与慢性下腰痛之间的相关性。方法检测45例ModicⅡ型患者的腰椎终板面积改变率,并采用疼痛视觉模拟评分（VAS）来评估慢性下腰痛的程度。结果所有45例ModicⅡ型患者均进行MRI检查后,统计得出Modic改变率为（15.13±10.75）％,计算VAS评分为（3.90±0.40）分, ModicⅡ型患者的面积改变率与VAS评分经Pearson相关分析,呈正相关性（r=0.31,P＜0.05）。结论腰椎终板Modic Ⅱ型面积改变率与慢性下腰痛之间具有正相关性,即终板面积改变率越大,患者下腰痛程度越严重。     

阶段性心理护理对脑卒中偏瘫患者的临床应用效果观察

目的:观察阶段性心理护理对脑卒中偏瘫患者的临床应用效果.方法:运用焦虑自评量表(SAS)和抑郁自评量表(SDS)对患者进行护理前后评定.将200例脑卒中偏瘫患者分为两组,即阶段性心理护理(观察组)和常规心理护理(对照组).观察组根据脑卒中偏瘫患者不同时期的不同心理特点进行针对性的心理护理,对照组由护士利用护理、治疗等操作的机会给予患者常规心理护理,时间不等,无阶段性.结果:两组患者在入院时SAS、SDS评分比较均无统计学意义(P＞0.05),而在7 d后、15 d后、30 d后SAS、SDS评分比较均有显著性差异(P＜0.01).结论:采用阶段性心理护理更具有针对性,对患者的康复能起到很大的推动作用.     

Effectiveness of a drinking-reduction program on drinking behavior,stages of change,drinking refusal self-efficacy,and resilience in Koreans with moderate alcohol use disorder

The purpose of this study was to examine the effects of a drinking-reduction program on drinking behavior, stages of change, drinking refusal self-efficacy, and resilience in Koreans with moderate alcohol use disorder. This study used a quasi-experimental nonequivalent control design. This study was performed from March 2015 to July 2015. The drinking-reduction program was conducted once per week for 11?weeks. This program improved drinking behavior, stages of change, drinking refusal self-efficacy, and resilience in the experimental group compared to the control group (p?<?.05, n?=?34). The drinking-reduction program can be used as a nursing intervention for people with moderate alcohol use disorder.     

Preliminary validation of a German version of pain stages of change questionnaire.

This study describes the development of the German questionnaire FF-STABS (Freiburg Questionnaire--Stages of Chronic Pain Management), which documents the willingness of chronic pain patients to use cognitive-behavioural methods for pain management independently. The newly constructed assessment instrument, modified from a similar instrument developed by Kerns and his colleagues, was administered to a heterogeneous sample of 118 chronic pain patients. Item and factor analysis support the identification of four reliable scales: precontemplation, preparation, action and maintenance. All scales evidenced sufficient indices of reliability and discriminant validity. Deviations from the original American version and suggestions for future refinements in the new measure are discussed.