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为接受血液透析的患者提供疼痛应对技能培训:HOPE联盟随机临床试验
Laura M Dember1,2, Jesse Y Hsu2, Rajnish Mehrotra3
1Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia.
JAMA internal medicine
|January 9, 2025
概括
疼痛应对技能培训 (PCST) 改善了血液透析患者的疼痛干扰. 虽然PCST总体上很适度,但它为许多人提供了临床上有意义的疼痛缓解,提高了生活质量并减少了抑郁症.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 疼痛管理 疼痛管理
- 行为医学是一种行为医学.
背景情况:
- 慢性疼痛是需要透析的功能衰竭患者的一个普遍问题.
- 有效的疼痛管理策略对于改善这一群体的生活质量至关重要.
研究的目的:
- 评估疼痛应对技能培训 (PCST) 的有效性,这是一种认知行为干预,在维持血液透析的患者中减少疼痛干扰.
- 评估PCST对二次结果的影响,包括疼痛强度,灾难化,生活质量,抑郁和焦虑.
主要方法:
- 一个多中心随机临床试验,涉及643名接受慢性疼痛维持血液透析的成年人.
- 参与者被随机分配1:1接受PCST (12周一次会议+12周的每日交互式语音响应会议) 或常规护理.
- 主要结局是疼痛干扰,通过简要疼痛清单 (BPI) 干扰子量衡,评估了36周的时间.
主要成果:
- 在12周后,PCST组的BPI干扰得分明显降低,与通常护理相比 (差异: -0.49;P=.009).
- 这种效应在24周持续,但在36周减少了.
- 在12周后,PCST参与者的50.9%观察到疼痛干扰的临床上有意义的改善 (下降>1点),而通常护理参与者的36.6%.
结论:
- 疼痛应对技能培训 (PCST) 证明了在维护血液透析患者的疼痛干扰和相关结果的好处.
- 虽然整体效果规模很小,但PCST在很大一部分患者中带来了临床上有意义的改善.
- 这些发现表明,PCST是管理这种脆弱人群的慢性疼痛的一个有价值的干预措施.
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