老年人慢性疼痛自我管理策略及有效性的调查研究

目的探讨老年人慢性疼痛的临床特征和自我管理策略及有效性的现状，并分析之间的关系。方法对243名年龄≥65岁慢性疼痛老年人进行系列问卷调查，了解老年人慢性疼痛的临床特征及自我管理策略，并对结果进行分析。结果非麻醉性镇痛药、体育运动、冷热疗法和精神转移活动为4种最常使用的疼痛管理策略，不同年龄组的老年慢性疼痛患者间其所应用的疼痛管理策略比较差异无统计学意义。管理策略的有效性与疼痛强度，疼痛干扰日常生活程度及忧郁程度呈负相关，但与自我效能分数呈正相关。结论老年人愿意尝试各种不同的策略应对慢性疼痛，在今后的老年人慢性疼痛管理培训中应注重体育运动程序的规范化、对抗抑郁并增加自我效能以提高疼痛管理的效果。     

慢性疼痛住院患者自我效能感与心理弹性、疼痛灾难化的相关性分析

目的 探讨慢性疼痛患者心理弹性与疼痛灾难化对其自我效能感的影响。方法 采用一般资料调查表、心理弹性量表、疼痛灾难化量表、慢性疼痛自我效能感量表对西安市某三级甲等医院疼痛科住院治疗的慢性疼痛274例患者进行相关调查。结果 慢性疼痛患者的心理弹性总分59.61±17.05分,疼痛灾难化总分22.00±11.40分,慢性疼痛自我效能感总分66.01±20.13分。单因素分析显示,慢性疼痛患者自我效能感得分在不同年龄、婚姻状况、文化程度、职业、每周疼痛次数、疼痛程度、有无其他慢性病方面比较差异有统计学意义（P<0.05）。相关性分析显示,慢性疼痛患者心理弹性总分与自我效能感总分呈正相关（r=0.466,P<0.01）;疼痛灾难化总分与自我效能感总分呈负相关（r=-0.446,P<0.01）。多元线性回归分析显示,年龄、婚姻状况、文化程度、职业、心理弹性总分和疼痛灾难化总分是慢性疼痛患者自我效能感的影响因素。结论 医护人员应及时采取措施,形成个体化干预方案,关注老年患者的心理状态及疼痛灾难化心理,提高慢性疼痛患者的心理弹性,降低其疼痛灾难化,进而提高其自我效能感,为患者树立自我...     

老年人慢性疼痛自我管理研究进展

本文对老年人慢性疼痛类型和原因、管理现状、自我管理及慢性疼痛自我管理概念、影响老年人慢性疼痛自我管理的因素、老年人慢性疼痛常见的自我管理策略进行综述,以期为慢性疼痛的老年人进行自我管理提供参考依据,为今后的研究提供一些思考。     

主要照顾者参与慢性腰背痛病人疼痛管理的效果

[目的]探讨慢性腰背痛病人及其照顾者的疼痛管理能力。[方法]将102例符合入选标准的研究对象随机分为干预1组35例、干预2组34例及对照组33例。对照组接受常规物理治疗;干预2组除接受物理治疗外还接受研究干预;干预1组除病人接受常规物理治疗、研究干预,还要对重要人(即主要照顾者)进行健康教育。评价干预前后3组的疼痛、疼痛认知阶段、慢性疼痛自我效能及疼痛应对策略的变化。[结果]干预前后,干预1组在疼痛程度、病人自我效能及疼痛应对策略方面差异均有统计学意义(P<0.05)。[结论]本研究通过发挥病人重要人的监督促进作用,病人能建立疼痛认知和自我效能,掌握疼痛应对策略,减轻疼痛程度,提高疼痛自我管理能力。     

慢性疼痛病人自我效能感现状调查及影响因素分析

目的：本研究探讨慢性疼痛病人自我效能水平现状,并分析其影响因素,为医护人员在疼痛管理过程中对病人提供针对性改善措施提供参考和依据。方法：采用便利抽样法,于2023年2月至6月使用慢性疼痛自我效能感评估量表(chronic pain self-efficacy scale, CPSS)对中日友好医院慢性疼痛病人进行问卷调查。该问卷包括3个维度和22个条目。结果：慢性疼痛病人自我效能总分为(65.5±20.7)分,慢性疼痛管理维度项目均分(2.2±0.8)分,躯体功能维度项目均分为(3.3±1.2)分,症状应对维度项目均分为(2.9±1.2)分。不同性别、年龄、教育程度和就业状况影响慢性疼痛病人自我效能感水平。回归分析显示,年龄是其最主要影响因素。结论：慢性疼痛病人自我效能处于中等偏下水平,医护人员在制订计划时,需根据病人的不同特征,关注病人的身心状况与社会文化背景,制订切实可行的个体化措施以提高慢性疼痛病人自我效能。     

维持性血液透析患者自我管理行为状况及相关因素分析

目的 描述维持性血液透析患者的自我管理行为状况,并探讨其影响因素.方法 采用血液透析患者自我管理行为问卷、慢性病自我效能量表、一般资料调查表对天津市某医院的维持性血液透析患者125例进行调查,并对结果进行分析.结果 维持性血液透析患者的自我管理行为平均得分为（65.420±9.897）分,性别、文化程度、自我效能是维持性血液透析患者自我管理行为的影响因素.结论 维持性血液透析患者的自我管理行为不太理想,临床护理工作中可结合自我管理行为的影响因素制订健康教育策略,进而提高患者的自我管理行为.     

慢性疼痛患者生活质量影响因素的分析

采取疼痛调查问卷、BECK焦虑及抑郁自评问卷、简明MG疼痛量表、阿森斯失眠量表、疼痛自我效能量表以及生活质量SF-12表对我院94例慢性疼痛患者与同期的94例健康者予以比较分析。结果慢性疼痛患者的抑郁、焦虑以及失眠得分远远高于健康组,P〈0.05,差异有统计学意义。疼痛自我效能与生活质量得分明显小于健康组,不同疼痛部位数目、不同疼痛程度的慢性疼痛患者之间生活质量得分具有显著差异,P〈0.05有统计学意义。影响慢性疼痛患者的生活质量的因素有多种,需采取多方位的干预措施。     

空巢老年膝骨性关节炎患者护患信任与疼痛自我管理的关系:疼痛自我效能的中介效应

目的调查空巢老年膝骨性关节炎患者护患信任、疼痛自我效能、疼痛自我管理水平,分析之间的关系,探讨疼痛自我效能在护患信任与疼痛自我管理之间的中介效应。方法2020年1月至6月于陕西省某三级甲等医院骨科住院的114例空巢老年膝骨性关节炎患者为研究对象,采用一般情况调查表、护患关系信任度量表、疼痛自我效能问卷以及疼痛自我管理现状问卷进行调查。结果空巢老年膝骨性关节炎患者护患信任总分(129.96±20.80)分,疼痛自我效能总分(41.73±13.85)分,疼痛自我管理方法总数为(10.78±3.28)个,使用频率(55.23±15.43)分,使用有效性(54.61±16.19)分。护患信任、疼痛自我效能、疼痛自我管理三者间均成呈正相关(P<0.01);疼痛自我效能在护患信任与疼痛自我管理间的中介效应为0.281,占总效应的43.84%。结论空巢老年膝骨性关节炎患者存在护患信任问题,患者疼痛自我效能相对偏低,患者疼痛自我管理能力较好。疼痛自我效能作为中介变量对疼痛自我管理行为产生影响。     

中老年关节炎疼痛患者抑郁状况及影响因素的调查

目的 探讨中老年关节炎慢性疼痛患者的抑郁状况及影响因素.方法 采用一般情况调查表、老年抑郁量表、简明疼痛量表、关节炎自我效能量表、社会支持量表,对197例关节炎慢性疼痛患者进行调查.结果 患者抑郁得分的中位数为6.0,抑郁发生率为56.9％.影响抑郁的主要因素是疼痛影响程度、社会支持总分、患类风湿性关节炎、自我效能感及疼痛部位数.结论 应注重对关节炎疼痛患者的心理护理,针对抑郁的影响因素施以干预,改善其抑郁状况.     

上海市社区老年人的慢性疼痛认知与应对方式的研究

目的 了解上海市社区老年人对于老年慢性疼痛的认知和应对方式。方法 选取上海市13个社区99名老年人进行问卷调查,内容主要包括一般情况、慢性疼痛应对策略问卷和面部疼痛表情(FPS-R)量表。结果 据调查老年人最近一段时间疼痛程度为(4.78±2.32)分,疼痛程度与应对策略问卷中寻求支持(r=0.51)、忽视疼痛(r=0.26)、行动解决(r=0.28)、限定活动(r=0.53)、消极心态(r=0.61)这五个维度相关性较大。结论 上海社区老年人的疼痛程度处于中重度,其疼痛程度与应对策略相关,医护人员应重视社区老年慢性疼痛的患者,重视疼痛教育与管理,采取相应措施提高患者的应对策略,减轻慢性疼痛对生活带来的影响。     

Pilot study of a 4-week Pain Coping Strategies (PCS) programme for the chronic pain patient

Purpose. A 4-week Pain Coping Strategies (PCS) programme has been developed for chronic pain patients who may still be undergoing medical interventions but who would benefit from learning pain management skills. The long-term negative behaviours associated with chronic pain may be prevented by introducing pain management strategies at an earlier stage. The PCS programme combines all the fundamental aspects of the traditional Pain Management Programme including exercise, relaxation, pacing, medication review, pain pathways, posture and challenging negative thoughts.

Method. The study compared 31 patients' mood, functional status and physical ability pre and 6 weeks post the programme using the Hospital Anxiety and Depression Scale (HAD), Canadian Occupational Performance Measure (COPM) and a series of physical tests. A paired samples t-test showed a significant improvement in levels of depression and anxiety, functional status and physical ability.

Results. The results reveal that an early intervention programme may be effective for chronic pain patients by promoting self-management and teaching positive coping strategies.

Conclusions. The current study has found promising results for a brief early intervention for chronic pain, regardless of completion of medical interventions.     

Self-management of chronic pain: a population-based study

While effective self-management of chronic pain is important, clinic-based studies exclude the more typical pattern of self-management that occurs in the community, often without reference to health professionals. We examined specific hypotheses about the use of self-management strategies in a population-based study of chronic pain subjects. Data came from an Australian population-based random digit dialling computer-assisted telephone survey and included 474 adults aged 18 or over with chronic pain (response rate 73.4%). Passive strategies were more often reported than active ones: passive strategies such as taking medication (47%), resting (31.5%), and using hot/cold packs (23.4%) were most commonly reported, while the most commonly reported active strategy was exercising (25.8%). Only 33.5% of those who used active behavioural and/or cognitive strategies used them exclusively, while 67.7% of those who used passive behavioural and/or conventional medical strategies did so exclusively. Self-management strategies were associated with both pain-related disability and use of health services in multiple logistic regression models. Using passive strategies increased the likelihood of having high levels of pain-related disability (adjusted OR 2.59) and more pain-related health care visits (adjusted OR 2.9); using active strategies substantially reduced the likelihood of having high levels of pain-related disability (adjusted OR 0.2). In conclusion, we have shown in a population-based study that clinical findings regarding self-management strategies apply to the broader population and advocate that more attention be given to community-based strategies for improving awareness and uptake of active self-management strategies for chronic pain.     

Long-term clinical benefits and costs of an integrated rehabilitation programme compared with outpatient physiotherapy for chronic knee pain

Background

Chronic knee pain is a major cause of disability in the elderly. Management guidelines recommend exercise and self-management interventions as effective treatments. The authors previously described a rehabilitation programme integrating exercise and self-management [Enabling Self-management and Coping with Arthritic knee Pain through Exercise (ESCAPE-knee pain)] that produced short-term improvements in pain and physical function, but sustaining these improvements is difficult. Moreover, the programme is untried in clinical environments, where it would ultimately be delivered.

Objectives

To establish the feasibility of ESCAPE-knee pain and compare its clinical effectiveness and costs with outpatient physiotherapy.

Design

Pragmatic, randomised controlled trial.

Setting

Outpatient physiotherapy department and community centre.

Participants

Sixty-four people with chronic knee pain.

Interventions

Outpatient physiotherapy compared with ESCAPE-knee pain.

Outcomes

The primary outcome was physical function assessed using the Western Ontario and McMaster Universities Osteoarthritis Index. Secondary outcomes included pain, objective functional performance, anxiety, depression, exercise-related health beliefs and healthcare utilisation. All outcomes were assessed at baseline and 12 months after completing the interventions (primary endpoint). ANCOVA investigated between-group differences.

Results

Both groups demonstrated similar improvements in clinical outcomes. Outpatient physiotherapy cost £130 per person and the healthcare utilisation costs of participants over 1 year were £583. The ESCAPE-knee pain programme cost £64 per person and the healthcare utilisation costs of participants over 1 year were £320.

Conclusions

ESCAPE-knee pain can be delivered as a community-based integrated rehabilitation programme for people with chronic knee pain. Both ESCAPE-knee pain and outpatient physiotherapy produced sustained physical and psychosocial benefits, but ESCAPE-knee pain cost less and was more cost-effective.Clinical Trial Registration No.: ISRCTN63848242.     

Chronic fatigue syndrome: an approach combining self-management with graded exercise to avoid exacerbations.

Controversy regarding the aetiology and treatment of patients with chronic fatigue syndrome continues among the medical professions. The Cochrane Collaboration advises practitioners to implement graded exercise therapy for patients with chronic fatigue syndrome using cognitive behavioural principles. Conversely, there is evidence that exercise can exacerbate symptoms in chronic fatigue syndrome, if too-vigorous exercise/activity promotes immune dysfunction, which in turn increases symptoms. When designing and implementing an exercise programme for chronic fatigue syndrome it is important to be aware of both of these seemingly opposing viewpoints in order to deliver a programme with no detrimental effects on the pathophysiology of the condition. Using evidence from both the biological and clinical sciences, this paper explains that graded exercise therapy for people with chronic fatigue syndrome can be undertaken safely with no detrimental effects on the immune system. Exercise programmes should be designed to cater for individual physical capabilities and should take into account the fluctuating nature of symptoms. In line with cognitive behaviourally and graded exercise-based strategies, self-management for people with chronic fatigue syndrome involves encouraging patients to pace their activities and respect their physical and mental limitations, with the ultimate aim of improving their everyday functioning.     

Pilot study of a 4-week Pain Coping Strategies (PCS) programme for the chronic pain patient

Purpose. A 4-week Pain Coping Strategies (PCS) programme has been developed for chronic pain patients who may still be undergoing medical interventions but who would benefit from learning pain management skills. The long-term negative behaviours associated with chronic pain may be prevented by introducing pain management strategies at an earlier stage. The PCS programme combines all the fundamental aspects of the traditional Pain Management Programme including exercise, relaxation, pacing, medication review, pain pathways, posture and challenging negative thoughts.

Method. The study compared 31 patients' mood, functional status and physical ability pre and 6 weeks post the programme using the Hospital Anxiety and Depression Scale (HAD), Canadian Occupational Performance Measure (COPM) and a series of physical tests. A paired samples t-test showed a significant improvement in levels of depression and anxiety, functional status and physical ability.

Results. The results reveal that an early intervention programme may be effective for chronic pain patients by promoting self-management and teaching positive coping strategies.

Conclusions. The current study has found promising results for a brief early intervention for chronic pain, regardless of completion of medical interventions.     

Self-Management of Chronic Neck and Low Back Pain and Relevance of Information Provided During Clinical Encounters: An Observational Study

Escolar-Reina P, Medina-Mirapeix F, Gascón-Cánovas JJ, Montilla-Herrador J, Valera-Garrido JF, Collins SM. Self-management of chronic neck and low back pain and relevance of information provided during clinical encounters: an observational study.

Objective

To assess the relative influence of information provided during physical therapy on a patient's adherence to self-management strategies in relation to other predictors of adherence (patient and pain characteristics, use of self-management strategies before intervention).

Design

A longitudinal observational study of the relationship between the information provided during physical therapy and adherence to self-management strategies.

Setting

Data came from a clinical-based population in 8 primary health care centers.

Participants

Patients (N=184) with chronic neck or low back pain (77% under the age of 59y) were surveyed at the beginning and 1 month after completion of physical therapy.

Interventions

Not applicable.

Main Outcome Measures

Specific and overall adherence to 2 types of strategies: (1) nonpharmacologic pain management strategies, and (2) neck/back care in activities of daily life.

Results

Adherence to strategies of nonpharmacologic self-management of pain was more probable when patients received information explaining the effectiveness of the self-management strategies (adjusted odds ratio [AOR]=10.1; P<.05) and information about their illness (AOR=3.4; P<.05) during clinical encounters. Information provided by the physical therapist did not have any influence on the adherence to neck/back care in activity of daily life (P>.05).

Conclusions

Information provided during clinical encounters is associated with adherence to different kinds of self-management strategies. While further study is required, it is suggested that more attention be given to clinical practice strategies for improving adherence to self-management of chronic pain.     

Chronic low back pain: patients' experiences, opinions and expectations for clinical management

PURPOSE: To explore the experiences, opinions and treatment expectations of chronic low back pain (LBP) patients in order to identify what components of treatment they consider as being of most value. METHOD: Three stand-alone focus groups were convened. All participants were experiencing chronic non-specific LBP (>3 months). Each group was facilitated by an independent moderator, and guided by a series of pre-determined questions. Participants were encouraged to freely air their personal opinions during the discussion. Transcribed data were organized into a series of 'categories' using the Qualitative Solutions for Researchers Nudist 6 package from which five common themes emerged. RESULTS: Each participant had typically experienced a variety of failed treatment approaches. Whilst the value of advice and exercise was recognized, participants typically questioned the appropriateness of such treatment given the fact that a precise diagnosis was rarely given, and symptoms often recurred. As a result, poor adherence with advice and exercise appeared to be a key factor limiting the potential effectiveness of long-term self-management strategies. CONCLUSIONS: Participants considered appropriate exercise (despite pain) and activity modification as important components for effective long-term self-management of symptoms. To enhance treatment effectiveness, participants welcomed the introduction of individually tailored advice and exercise programmes, with supervision and follow-up support, along with a better understanding of the physical and emotional impact of chronic LBP by practitioners.     

Physical and Psychosocial Factors in the Prevention of Chronic Pain in Older Age

Chronic pain is recognized as a major challenge as people age. Yet, despite growing research on chronic pain management, there is little research into chronic pain prevention. Thus there is a clear need to identify multimodal activities that could be encouraged among older adults as part of a healthy lifestyle to decrease the incidence risk of chronic pain. Using data from the English Longitudinal Study of Ageing we tracked 2,631 adults aged ≥50 years who were free from chronic pain at baseline across a decade and explore whether physical or psychosocial factors reduced the risk of developing chronic pain. In relation to physical factors, engaging in vigorous weekly activity was protective against the development of chronic pain (odds ratio 0.74, standard error 0.07, 95% confidence interval 0.62–0.89) when controlling for all identified socioeconomic, health, and social confounders. However, no effects were found for moderate weekly activity. In relation to psychosocial factors, cultural engagement was also protective against the development of chronic pain (odds ratio 0.75, standard error 0.07, 95% confidence interval 0.63–0.91), but community group participation was not. These findings extend previous work showing that physical activity and psychosocial factors such as positive affect are key factors in the long-term success of chronic pain self-management. Future interventional studies for chronic pain are encouraged.

A daily process design study of attentional pain control strategies in the self-management of cancer pain.

This study investigated the use of attentional control strategies in the self-management of pain using daily process design methodology. Twenty six cancer patients with pain completed diaries 3 times daily for 10 days. Diaries incorporated measures of pain intensity, affect, coping, coping efficacy, and the novelty and predictability of pain, and participants completed a cross-sectional measure of catastrophizing. At the across-person level, focusing on pain was associated with increased negative affect, and the use of pain focusing strategies was positively correlated with experiencing pain that was novel in its location or quality. Distractions that were interesting, important and pleasant were positively correlated with positive affect, perceptions of control over pain and ability to decrease pain. Over-prediction of pain was positively correlated with catastrophizing, and negatively correlated with perceptions of control over and ability to decrease pain. The within-person analysis (ARIMA modelling) showed that catastrophizing moderated the effects of pain focusing strategies, novel pain and over-predictions of pain. Meta-analysis of the ARIMA models revealed that the within-person effects of using attentional strategies did not generalize across the sample. These findings indicated that the effects of distraction strategies are influenced by their motivational-affective significance rather than the frequency with which they are used, and provided further evidence that the threat value of pain influences the way in which people cope with their pain. Theoretical and clinical implications are discussed.