Effect of Complementary and Alternative Medicine on Pain Among Inpatients

描述(由申请人提供)：有效和安全的疼痛管理是美国医疗保健系统的主要健康优先事项。药物干预仍然是疼痛控制的主要方法，尽管药物干预有很好的不良事件风险、成瘾可能性和过度使用对康复的不利影响。这一点在术后阶段最为明显，约80%的患者报告称，即使在接受药物干预后，手术后仍有中度至重度疼痛。在住院环境中，找到一种有效的非药物干预来增加麻醉药物的使用将是一个重大的好处。全国调查表明，目前有15%的美国医院使用补充和替代医学(CAM)干预措施。大多数情况下，这些疗法被用来解决特定的未得到满足的临床需求，其中最常见的是疼痛。11项临床试验证明，在传统药物干预的同时，CAM疗法能有效地减轻住院患者的疼痛(短期和长期)。为这些止痛疗法的有效性提供更多证据将促进知识的发展，并可能影响实践模式。在一项初步研究中，我们对在雅培西北医院接受CAM治疗的1837名患者进行了回顾性研究。我们发现即时疼痛平均减少了56%，大约33%的人报告在最初的CAM就诊后疼痛完全缓解。我们认识到这项研究的不足之处，既限制了我们对医院如何实施辅助CAM疗法的了解，也限制了各种CAM疗法对疼痛管理的影响，这只能通过前瞻性的数据收集来回答。采用前瞻性、观察性设计，我们建议在这项探索性工作的基础上进行一项大规模研究。它将记录用于疼痛管理的CAM转诊、服务交付和治疗选择的预测因素。它还将检查作为传统干预措施的辅助手段的CAM疗法对医院环境下临床群体中疼痛的短期和长期变化的影响。这项CAM研究的背景是雅培西北医院的彭妮·乔治健康与治疗研究所。乔治研究所特别适合这项工作，因为它是美国最大的住院患者CAM计划，自2004年以来为超过19,000名患者提供服务。这项拟议的研究有3个目标：1)定量描述提供CAM疗法的模型，以了解疼痛管理的患者选择和CAM疗法；2)检验选定的CAM疗法对疼痛即刻变化的影响；以及3)检验选定的CAM疗法对疼痛变化持续时间的影响。这项研究的积极结果将有助于医院整合常规护理和CAM治疗以减轻疼痛。这些发现还可能推动未来对这些疼痛治疗方法的成本效益以及对患者结局的影响的研究，如住院时间和麻醉剂的使用。

DESCRIPTION (provided by applicant): Effective and safe pain management is a major health priority for the US healthcare system. Pharmaceutical interventions remain the primary approach to pain management, despite their well documented risk of adverse events, potential for addiction, and adverse impact on recovery if used excessively. Nowhere is this more evident than in the post-operative period where roughly 80% of patients report moderate to severe pain after surgery even after receiving pharmaceutical interventions. In inpatient settings, finding an effective non-pharmacologic intervention to augment narcotic medications would be a significant benefit. National surveys indicate that complementary and alternative medicine (CAM) interventions are currently used by 15% of American hospitals. Most often, these therapies are employed to address specific unmet clinical needs, the most frequent of which is pain. Eleven clinical trials have demonstrated the efficacy of CAM therapies to reduce pain (short- and long-term) in hospitalized patients along with traditional pharmaceutical interventions. Generating additional evidence of the effectiveness of these therapies for pain relief would advance knowledge and potentially affect practice patterns. In a preliminary study, we retrospectively studied 1,837 patients who received CAM therapies at Abbott Northwestern Hospital. We found an average reduction in immediate pain of 56% and roughly 33% reported complete pain relief after the initial CAM visit. We recognize inadequacies of this study that limit both our knowledge of how adjunctive CAM therapies are implemented in hospitals and the effect of various CAM therapies on pain management, which can only be answered with prospective data collection. Using a prospective, observational design, we propose a large scale study to build on this exploratory work. It will document predictors of CAM referral, service delivery, and therapy selection for pain management. It will also examine the impact of CAM therapies as adjuncts to traditional interventions on short and long-term changes in pain across clinical groups in a hospital setting. The setting for this study of CAM is the Penny George Institute for Health and Healing at Abbott Northwestern Hospital. The George Institute is uniquely suited for this work as it is the nation's largest inpatient CAM program serving over 19,000 patients since 2004. The proposed study has 3 aims: 1) quantitatively describe a model for delivering CAM therapies to understand selection of patients and CAM therapies for pain management, 2) examine the effects of selected CAM therapies on immediate change in pain, and 3) examine the effects of selected CAM therapies on duration of pain change. Positive results from this study will assist hospitals in the integration of usual care and CAM therapy for pain reduction. Findings may also drive future research on the cost effectiveness of these therapies for pain management, as well as impact on patient outcomes such as length of stay and use of narcotics.