Does mindfulness improve outcomes in patients with chronic pain? Systematic review and meta-analysis
Does mindfulness improve outcomes in patients with chronic pain? Systematic review and meta-analysis
复制标题
DOI：
10.3399/bjgp15x685297
复制
发表时间：
2015-06-01
影响因子：
5.9
通讯作者：
Bond, Christine M.
中科院分区：
文献类型：
--
作者：
Bawa, Fathima L. Marikar;Mercer, Stewart W.;Bond, Christine M.
慢性疼痛及其相关的痛苦和残疾是寻求医疗帮助的常见原因。慢性疼痛患者使用初级医疗服务的人数是其他人群的五倍。正念已成为一种日益流行的自我管理技术。目的评估正念干预对慢性疼痛患者的有效性。设计和设置系统综述和荟萃分析，包括基于正念的慢性疼痛干预的随机对照试验。方法检索MEDLINE(R)、EMBASE、AMED、CINAHL、CINCINFO、主题索引等数据库。根据以下纳入标准反复筛选标题、摘要和全文：基于正念的干预的随机对照试验；非恶性慢性疼痛患者；以及已报道的经济、临床或人文结果。纳入的研究用Yates质量评定量表进行评估。结果共纳入11篇研究。慢性疼痛情况包括：纤维肌痛、类风湿性关节炎、慢性肌肉骨骼疼痛、背部手术失败综合征和混合病因。论文的方法学质量参差不齐。报告的主要结果是疼痛强度、抑郁、身体功能、生活质量、疼痛接受度和正念。经济成果很少被报道。Meta分析对临床结果的影响范围为0.12(95%可信区间[CI]=-0.05至0.30)(抑郁)至1.32(95%CI=-1.19至3.82)(睡眠质量)，对人文结果的Meta分析效应大小为0.03(95%CI=-0.66至0.72)(正念)至1.58(95%CI=-0.57至3.74)(疼痛接受)。与不活跃的对照组相比，积极的控制组显示的效果较小。结论基于正念的干预对慢性疼痛患者的有效性的证据有限。需要更高质量的研究。
BackgroundChronic pain and its associated distress and disability are common reasons for seeking medical help. Patients with chronic pain use primary healthcare services five times more than the rest of the population. Mindfulness has become an increasingly popular self-management technique.AimTo assess the effectiveness of mindfulness-based interventions for patients with chronic pain.Design and settingSystematic review and meta-analysis including randomised controlled trials of mindfulness-based interventions for chronic pain. There was no restriction to study site or setting.MethodThe databases MEDLINE (R), Embase, AMED, CINAHL, PsycINFO, and Index to Theses were searched. Titles, abstracts, and full texts were screened iteratively against inclusion criteria of: randomised controlled trials of mindfulness-based intervention; patients with non-malignant chronic pain; and economic, clinical, or humanistic outcome reported. Included studies were assessed with the Yates Quality Rating Scale. Meta-analysis was conducted.ResultsEleven studies were included. Chronic pain conditions included: fibromyalgia, rheumatoid arthritis, chronic musculoskeletal pain, failed back surgery syndrome, and mixed aetiology. Papers were of mixed methodological quality. Main outcomes reported were pain intensity, depression, physical functioning, quality of life, pain acceptance, and mindfulness. Economic outcomes were rarely reported. Meta-analysis effect sizes for clinical outcomes ranged from 0.12 (95% confidence interval [CI] = -0.05 to 0.30) (depression) to 1.32 (95% CI = -1.19 to 3.82) (sleep quality), and for humanistic outcomes 0.03 (95% CI = -0.66 to 0.72) (mindfulness) to 1.58 (95% CI = -0.57 to 3.74) (pain acceptance). Studies with active, compared with inactive, control groups showed smaller effects.ConclusionThere is limited evidence for effectiveness of mindfulness-based interventions for patients with chronic pain. Better-quality studies are required.