Psychosocial interventions for chronic pain and comorbid prescription opioid use disorders: A narrative review of the literature.
Psychosocial interventions for chronic pain and comorbid prescription opioid use disorders: A narrative review of the literature.
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DOI：
10.5055/jom.2018.0467
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发表时间：
2018-09-01
影响因子：
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通讯作者：
Wasan, Ajay D
中科院分区：
文献类型：
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作者：
Hruschak, Valerie;Cochran, Gerald;Wasan, Ajay D
目的：阿片类药物滥用在慢性非癌性疼痛(CNCP)中的应用是一个多方面和复杂的问题。由于阿片类药物滥用以及相应的成瘾和过量死亡率超过流行比例，迫切需要在这一领域进行研究。本综述的目的是评价针对CNCP和处方阿片滥用的心理社会干预的文献。设计：对PubMed、MEDLINE、Souinfo、ClinicalTrials.gov进行系统搜索，以确定评估针对CNCP和处方阿片滥用的心理社会干预的研究。结果：从1993年到2016年7月共纳入56篇同行评议的研究文章，其中包括针对CNCP和阿片类药物使用障碍的心理社会干预研究。研究了CNCP的心理社会干预，治疗方式包括：认知行为疗法(CBT)、接受和承诺疗法、基于正念的认知疗法和基于正念的压力缓解，以及慢性疼痛自我管理计划。针对阿片类药物滥用的心理社会干预措施包括：CBT和复发预防、动机增强治疗和改变阶段、应急管理、自助和基于同伴支持的团体。结论：本综述的结果提供了临床洞察力，并加强了心理社会干预在CNCP和阿片类药物使用障碍中的重要性。然而，几乎没有经验数据可以指导医生治疗滥用阿片类药物的CNCP患者，因此需要未来对综合方法的研究。
OBJECTIVE: Opioid misuse in the context of chronic noncancer pain (CNCP) is a multifaceted and complex issue. As opioid misuse and corresponding rates of addiction and overdose deaths exceed epidemic proportions, there is an urgent need for research in this area. The objective of this review is to evaluate the literature addressing psychosocial interventions targeting CNCP and prescription opioid misuse.DESIGN: A systematic search of PubMed, MEDLINE, PsychINFO, ClinicalTrials.gov was conducted to identify studies evaluating psychosocial interventions targeting CNCP and prescription opioid misuse. The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.RESULTS: 56 peer-reviewed research articles from 1993 to July, 2016, which included studies of psychosocial interventions for CNCP and opioid use disorders. Studies that examined psychosocial interventions for CNCP, treatment modalities included: cognitive behavioral therapy (CBT), acceptance and commitment therapy, mindfulness-based cognitive therapy and mindfulness-based stress reduction, and chronic pain self-management programs. The psychosocial interventions for opioid misuse included: CBT and relapse prevention, motivational enhancement therapy and stages of change, contingency management, and self-help and peer support-based groups.CONCLUSIONS: The findings of this review offer clinical insight and reinforce the importance of psychosocial interventions in CNCP and opioid use disorders. However, little empirical data are available to guide practitioners in treating patients with CNCP who misuse opioid medications, and thus future research on integrated approaches, is needed.