Use of multidomain management strategies by community dwelling adults with chronic pain: evidence from a systematic review
Use of multidomain management strategies by community dwelling adults with chronic pain: evidence from a systematic review
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DOI：
10.1515/sjpain-2018-0306
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发表时间：
2019-01-01
影响因子：
1.6
通讯作者：
Slack, Marion K.
中科院分区：
文献类型：
--
作者：
Axon, David R.;Patel, Mira J.;Slack, Marion K.
背景和目标：建议采用多领域策略（即两种或两种以上策略）来管理慢性疼痛，以避免过度使用阿片类药物，同时产生可能的最佳结果。本系统综述的目的是：1）确定患者报告的疼痛管理是否与多领域策略的使用一致; 2）确定阿片类药物和非甾体抗炎药（NSAID）在患者报告的疼痛管理中的作用。书目数据库，网站，并检索纳入研究的参考文献列表，以确定报告疼痛自我的社区调查的已发表文章，1989年1月至2017年6月使用受控词汇（和同义词）进行管理：疼痛;自我护理;自我管理;自我治疗;和成人。两名独立的评审员筛选研究并提取受试者人口统计学、疼痛特征、疼痛自我管理策略和疼痛结局的数据。根据我们的概念模型组织疼痛自我管理策略。对纳入的研究进行了偏倚风险评估。研究人员之间的差异通过共识解决。结果：从确定的3，235个独特记录中，包括来自10个国家的2002年至2017年发表的18项研究。确定了22种药理学策略（16种处方药，6种非处方药）。NSAID（15项研究，使用范围10-72%）和阿片类药物（12项研究，使用范围5-72%）是最常报告的处方药理学策略。其他处方药理学策略包括镇痛药、对乙酰氨基酚、抗惊厥药、抗抑郁药、抗焦虑药、水杨酸盐、β-受体阻滞剂和钙通道阻滞剂、缓解疾病的抗风湿药和类固醇、肌肉松弛剂、外用产品、曲坦类药物等。确定了22种非药物策略：4种医学策略（10项研究），10种物理策略（15项研究），4种心理策略（12项研究）和4种自我发起策略（15项研究）。医疗策略包括咨询医生，脊椎按摩和手术。物理策略包括锻炼、按摩、冷热模式、针灸、物理治疗、经皮电神经刺激、活动调整或限制、辅助设备和改变体位/姿势。心理策略包括放松，祈祷或冥想，治疗和休息/睡眠。自我发起的策略包括饮食或草药补充剂，饮食调整，以及补充和替代药物。总体而言，研究报告的战略数量从5个到28个不等（在44个确定的战略中）。在15项研究中报告了有关疼痛结局的有限数据，包括疼痛管理策略的满意度，疼痛对日常活动的干扰，不良事件，失去工作或活动受限的日子，急诊科就诊，和disability.Conclusions：各种各样的和大量的药理学和非药理学策略来管理慢性疼痛的报道，与使用多领域策略一致。还报告了大量使用NSAID和阿片类药物。
Background and aims: Multidomain strategies (i.e. two or more strategies) for managing chronic pain are recommended to avoid excessive use of opioids while producing the best outcomes possible. The aims of this systematic review were to: 1) determine if patient-reported pain management is consistent with the use of multidomain strategies; and 2) identify the role of opioids and non-steroidal anti-inflammatory drugs (NSAIDs) in patient-reported pain management.Methods: Bibliographic databases, websites, and reference lists of included studies were searched to identify published articles reporting community-based surveys of pain self-management from January 1989 to June 2017 using controlled vocabulary (and synonyms): pain; self-care; self-management; self-treatment; and adult. Two independent reviewers screened studies and extracted data on subject demographics, pain characteristics, pain self-management strategies, and pain outcomes. Pain self-management strategies were organized according to our conceptual model. Included studies were assessed for risk of bias. Differences between the researchers were resolved by consensus.Results: From the 3,235 unique records identified, 18 studies published between 2002 and 2017 from 10 countries were included. Twenty-two types of pharmacological strategies were identified (16 prescription, six non-prescription). NSAIDs (15 studies, range of use 10-72%) and opioids (12 studies, range of use 5-72%) were the most commonly reported prescription pharmacological strategies. Other prescription pharmacological strategies included analgesics, acetaminophen, anticonvulsants, antidepressants, anxiolytics, salicylates, beta-blockers and calcium channel blockers, disease-modifying antirheumatic drugs and steroids, muscle relaxants, topical products, triptans, and others. Twenty-two types of non-pharmacological strategies were identified: four medical strategies (10 studies), 10 physical strategies (15 studies), four psychological strategies (12 studies), and four self-initiated strategies (15 studies). Medical strategies included consulting a medical practitioner, chiropractic, and surgery. Physical strategies included exercise, massage, hot and cold modalities, acupuncture, physical therapy, transcutaneous electrical nerve stimulation, activity modification or restriction, assistive devices, and altering body position/posture. Psychological strategies included relaxation, prayer or meditation, therapy, and rest/sleep. Self-initiated strategies included dietary or herbal supplements, dietary modifications, and complementary and alter-native medicine. Overall, the number of strategies reported among the studies ranged from five to 28 (out of 44 identified strategies). Limited data on pain outcomes was reported in 15 studies, and included satisfaction with pain management strategies, pain interference on daily activities, adverse events, lost work or restricted activity days, emergency department visits, and disabilities.Conclusions: A wide variety and large number of pharmacological and non-pharmacological strategies to manage chronic pain were reported, consistent with the use of multidomain strategies. High levels of use of both NSAIDs and opioids also were reported.