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Mitral Valve Prolapse III: Nursing Management
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慢性片頭痛に対する認知行動療法とアミトリプチリンを併用して,子供と青少年における慢性片頭痛:ランダム化臨床試験
Scott W Powers1, Susmita M Kashikar-Zuck2, Janelle R Allen3
1Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio3Headache Center, Cincinnati Children's Hospital Medical Center4Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
JAMA
|December 26, 2013
まとめ
アミトリプチリンと併用した認知行動療法 (CBT) は,頭痛教育と比較して,若者の慢性的な片頭痛の日数と障害を大幅に軽減しました. この組み合わせ療法は,小児慢性片頭痛の有効で,証拠に基づいた治療の選択肢を提供します.
科学分野:
- 小児神経学について
- 児童・青少年精神医学は,
- 行動医学 (Behavioral Medicine) とは,行動医学 (Behavioral Medicine) とは,行動医学 (Behavioral Medicine) とは,行動医学 (Behavioral Medicine) とは,行動医学 (Behavioral Medicine) とは,行動医学 (Behavioral Medicine) とは,行動医学 (Behavioral Medicine) とは,行動医学 (Behavioral Medicine) とは,行動医学 (Behavioral Medicine) とは,行動医学 (Behavioral
背景:
- 子どもや青少年における慢性的な片頭痛には,安全で効果的で持続的なエビデンスに基づいた介入方法が欠如しています.
- 現在の治療法は,しばしば持続的な緩和を提供できず,小児慢性片頭痛の多面的な性質に対処できません.
研究 の 目的:
- 認知行動療法 (CBT) とアミトリプチリンと頭痛教育とアミトリプチリンを併用して,若年における慢性片頭痛の治療における有効性を比較する.
- これらの併用された介入が頭痛の頻度と片頭痛に関連する障害に及ぼす影響を12ヶ月の期間で評価する.
主な方法:
- 慢性的な片頭痛を患っている135人の若者 (10-17歳) を対象としたランダム化臨床試験.
- 参加者は,アミトリプチリン (1 mg/kg/d) と並行して,CBTまたは頭痛教育の10回のセッションを受けた.
- 主なアウトカムには,頭痛の日と20週間の小児片頭痛障害評価スコア (PedMIDAS) が含まれており,耐久性については12ヶ月のフォローアップが行われました.
主要な成果:
- CBTとアミトリプチリンを併用したグループは,頭痛の日数 (4.7日間の差,P=.002) とPedMIDASスコア (14.1ポイントの差,P=.01) を20週後に大幅に減少させた.
- 20週目には,CBTグループの66%が頭痛日数を50%以上減少させ,教育グループでは36%減少した (P<.001).
- 12ヶ月の長期フォローアップでは,CBTグループの86%が≥50%の頭痛の軽減を経験し,88%が軽度の障害を達成し,持続的な利益を示しました.
結論:
- アミトリプチリンと併用した認知行動療法 (Cognitive Behavioral Therapy) は,慢性的な偏頭痛を患っている若者の頭痛の頻度と障害を軽減するために,頭痛教育とアミトリプチリンより効果的です.
- これらの発見は,小児集団における慢性片頭痛の管理における重要な構成要素として,CBTの有効性と耐久性に対する強力な証拠を提供します.
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