Psychological Interventions for the Treatment of Chronic Pain in Adults
Psychological Interventions for the Treatment of Chronic Pain in Adults
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DOI：
10.1177/15291006211008157
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发表时间：
2021-09-01
影响因子：
25.4
通讯作者：
Kerns, Robert D.
中科院分区：
文献类型：
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作者：
Driscoll, Mary A.;Edwards, Robert R.;Kerns, Robert D.
慢性疼痛的高患病率和社会负担、治疗不足以及管理上的差异，促使人们认识到慢性疼痛是一个严重的公共卫生问题。尽管有证据表明阿片类药物的益处有限且危害严重，但同时发生的阿片类药物流行以及人们对过度依赖阿片类药物治疗的日益担忧，已经引起了人们对这一问题的高度关注。生物心理社会模型已成为理解慢性疼痛的复杂体验和为护理模型提供信息的主要概念框架。在该模型中，心理过程作为风险和复原力因素的重要性促使人们对心理治疗进行了广泛的研究，这些治疗旨在改变慢性疼痛成人患者的疼痛、痛苦或残疾的基础或显着促成的过程。认知行为疗法被认为具有强有力的有效性证据；其他心理学方法，包括接受和承诺疗法、正念、生物反馈、催眠、情绪意识和表达疗法，也针对多种疼痛状况获得了不同程度的证据。机制研究已经确定了这些治疗可以减轻疼痛强度和影响的多种途径。尽管越来越多的证据支持和认可这些方法，但仍有一些障碍限制了它们在组织、提供者和患者层面的采用。提供心理干预的创新方法以及其他研究、实践和政策举措有望克服这些障碍。为了优化这些干预措施的范围和有效性，还需要解决其他科学知识和实践差距，包括针对个体差异进行调整，同时解决同时发生的疾病，以及纳入其他优化策略。
The high prevalence and societal burden of chronic pain, its undertreatment, and disparities in its management have contributed to the acknowledgment of chronic pain as a serious public-health concern. The concurrent opioid epidemic, and increasing concern about overreliance on opioid therapy despite evidence of limited benefit and serious harms, has heightened attention to this problem. The biopsychosocial model has emerged as the primary conceptual framework for understanding the complex experience of chronic pain and for informing models of care. The prominence of psychological processes as risk and resilience factors in this model has prompted extensive study of psychological treatments designed to alter processes that underlie or significantly contribute to pain, distress, or disability among adults with chronic pain. Cognitive-behavioral therapy is acknowledged to have strong evidence of effectiveness; other psychological approaches, including acceptance and commitment therapy, mindfulness, biofeedback, hypnosis, and emotional-awareness and expression therapy, have also garnered varying degrees of evidence across multiple pain conditions. Mechanistic studies have identified multiple pathways by which these treatments may reduce the intensity and impact of pain. Despite the growing evidence for and appreciation of these approaches, several barriers limit their uptake at the level of organizations, providers, and patients. Innovative methods for delivering psychological interventions and other research, practice, and policy initiatives hold promise for overcoming these barriers. Additional scientific knowledge and practice gaps remain to be addressed to optimize the reach and effectiveness of these interventions, including tailoring to address individual differences, concurrently addressing co-occurring disorders, and incorporating other optimization strategies.