手术后提高疼痛缓解技能:对外科手术后行为干预的有效性进行范围审查,以及实施的实际考虑
Beth D Darnall1, Lauren Abshire2, Rena E Courtney3
1Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA bdarnall@stanford.edu.
基于技能的干预措施显示了治疗术后疼痛和减少长期使用阿片类药物的潜力. 需要进一步的研究来确认它们在预防手术后慢性疼痛方面的有效性.
科学领域:
- 疼痛管理 疼痛管理
- 术后恢复 术后恢复
- 行为医学是一种行为医学.
背景情况:
- 术后基于技能的干预提供了非药物治疗方法,用于术后疼痛和阿片类药物减轻.
- 现有的审查缺乏全面分析手术后几个小时以外的干预措施,以及预防慢性疼痛.
- 需要对基于技能的干预措施在手术后的几天和几个月的有效性进行范围审查.
研究的目的:
- 审查术后行为干预措施的疗效,以缓解术后疼痛和减少阿片类药物的有效性.
- 确定有效性证据存在的时间框架和手术群体.
- 评估这些干预措施在预防慢性术后疼痛方面的潜力.
主要方法:
- 对20项随机试验的范围审查.
- 干预类型包括催眠,放松疗法,压力管理,正念和认知行为疗法 (CBT).
- 总结了研究方法,治疗特点和镇痛作用.
主要成果:
- 没有研究专注于预防慢性术后疼痛.
- 只有两项研究使用了活性对照.
- 两项研究表明,术后使用阿片类药物有积极影响,四项研究显示,3-12个月后具有持久的止痛作用.
结论:
- 基于外科手术周围技能的干预措施对治疗术后疼痛和减少阿片类药物使用有希望.
- 目前缺乏预防慢性术后疼痛的证据.
- 整合到外科手术期间护理途径需要进一步开发和传播策略.
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