بررسي ارتباط بین نگرش بیماران مبتلا به درد مزمن در انتخاب روش درمانی، با نتیجه درمان درد


۱۰ مهر ۱۳۹۶

درد مزمن و درمان آن سالانه هزینه های اجتماعی و اقتصادی زیادی به هر جامعه ای تحمیل می کند. عدم توجه به تمایل بیماران می تواند نتایج منفی بر پاسخ به درمان و پایبندی بیماران به مداخلات انجام شده داشته باشد. بنابراین با توجه به اینکه تمایل بیماران می تواند فاکتور خطری برای پاسخ به درمان باشد، دراین مطالعه قصد نمودیم ارتباط بین تمایل بیماران مبتلا به درد مزمن به نوع درمان با نتیجه درمان درد را بسنجیم.

مواد و روش: این مطالعه مقطعی در یک کلینیک فوق تخصصی درد در بیمارستان امام خمینی، دانشگاه علوم پزشکی تهران طی سال 1393-1394 انجام شد. و بیماران از طریق پرسشنامه به تمایل خود به روش درمانی و شدت درد پاسخ دادند.

یافته ها : در این مطالعه 278 بیمار مبتلا به درد مزمن تحت بررسی قرار گرفتند.مشاهده کردیم که بین تمایل بیماران به دارو درمانی و یا درمان تزریقی و کاهش درد بیماران بعد از شش ماه ارتباط معناداری وجود داشت و افرادی که تمایل به روش درمانی مشخصی داشتند درصد بهبودی بیشتری نیز داشتند.همچنین بین تمایل بیماران به دارو درمانی و رضایت از درمان ارتباط معناداری وجود داشت و افرادی که تمایل به درمان دارویی نداشتند کمترین میزان رضایت را داشتند،به علاوه بین تمایل بیماران به روش درمانی و شدت درد،سن،جنس و وضعیت تاهل نیز ارتباط معناداری وجود نداشت.

نتیجه گیری: این نتایج موید نقش مشارکت بیماران در درمان دردهای مزمن می باشد و نشان می دهد که مشارکت فعال بیماران در درمان ، باعث نتایج بهتر و بهبود بیشتر می شود،بنابراین با توجه کردن به تمایل بیماران و توضیح بیشتر روشهای درمانی برای آنها و در نتیجه مشارکت فعال آنها به نتایج بهتری از درمان خواهیم رسید.

 

كليد واژه ها : درد مزمن ، شدت درد ، رضایت ، تمایل بیماران

 

 

مشخصات دانشجو:

نام:  زهرا معیری رشته تحصيلي: پزشکی مقطع:  دکترای عمومی                  گروه آموزشي   پزشکی         پست الكترونيك دانشجو:

z.moayeri@gmail.com

اساتيد راهنما و داور:

استاد راهنما:استاد دکتر زاهد حسین خان، استاد دکتر حسین ماجدی    اساتيد مشاور:دکتر عباس تفاخری،دکتر سید محمد میر اسکندری   اساتيد داور:دکتر مژگان رحیمی،دکتر نگار افتخار

زمان دفاع :

   روز چهارشنبه  تاريخ: 22/6/96 ساعت:7  صبح

مكان دفاع به آدرس:بیمارستان امام خمینی(ره)،ساختمان آموزش،دفتر گروه بیهوشی

اطلاعات به زبان انگليسي

Title: A study of the correlation between the preferences of the chronic pain patients for the type of their treatment and the outcome of their pain management 

 

Abstract:

BACKGROUND:
Every year, chronic pain and its treatments cause significant amount of socioeconomic costs for societies. Ignoring the patients' preferences can negatively impact the treatment outcomes and patients' adherence to the medical interventions. Since patient’s preferences can be a risk factor to treatment outcomes, we intended to evaluate the relationship between patient’s preferences for the type of their treatment and the outcomes of pain management


MATERIAL AND METHODS:
This cross-sectional study is done in a subspecialty pain clinic in Imam Khomeini hospital complex, Tehran University of medical sciences from 1393 to 1394. Patients answered a questionnaire about their preference for treatment and the level of pain and pain management.

 


RESULTS:
In this study, 278 patients suffering from chronic pain were evaluated. There was a significant relationship between patient’s preference to medical or interventional treatment and their pain relief in 6 months and those patients who had a specific preference had more reduction in pain. The patients' preference to get treatment affected their satisfaction of treatments and those patients who refused to get medical treatments had significantly lower satisfaction rates. The patient’s pain intensity, gender, age, and marital status had no significant correlation with their preference for the treatments.


CONCLUSION:
The results of this study can provide theoretical support for patients' preference-based treatments among patients suffering from chronic pain. This results enhance the importance of active patient participation in their treatment, therefore by explaining more about the type of treatments for patients and help them for active participation in their treatment we will have better outcomes.

 

Keywords: Chronic pain, pain intensity, consent, patients' preference

 

فهرست منابع و ماخذ فارسي و لاتين:

 

  1. Merskey H, Bogduk N. Classification of Chronic Pain. 2nd ed. Seattle: IASP Press; 1994.
  2. Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Supplement. 1986;3:S1-226.
  3. Burton KE, Wright V, Richards J. Patients’ expectations in relation to outcome of total hip replacement surgery. Ann Rheum Dis. 1979;38 (5):471–4.
  4. Flood AB, Lorence DP, Ding J, McPherson K, Black NA. The role of expectations in patients’ reports of post-operative outcomes and improvement following therapy. Med Care. 1993;31(11):1043–56.
  5. Iversen MD, Daltroy LH, Fossel AH, Katz JN. The prognostic importance of patient pre-operative expectations of surgery for lumbar spinal stenosis. Patient Educ Couns. 1998;34(2):169–78.
  6. Kalauokalani D, Cherkin DC, Sherman KJ, Koepsell TD, Deyo RA. Lessons from a trial of acupuncture and massage for low back pain: patient expectations and treatment effects. Spine. 2001;26(13):1418–24.
  7. Leedham B, Meyerowitz BE, Muirhead J, Frist WH. Positive expectations predict health after heart transplantation. Health Psychol. 1995;14 (1):74–9.
  8. Linde KWC, Streng A, Weidenhammer W, Wagenpfeil S, Brinkhaus B, Willich SN, Melchart D. The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain. Pain. 2007;128(3):264–71.
  9. Lutz GK, Butzlaff ME, Atlas SJ, Keller RB, Singer DE, Deyo RA. The relation between expectations and outcomes in surgery for sciatica. J Gen Intern Med. 1999;14(12):740–4.
  10. Tielsch JM, Steinberg EP, Cassard SD, Schein OD, Javitt JC, Legro MW, et al. Preoperative functional expectations and postoperative outcomes among patients undergoing first eye cataract surgery. Arch Ophthalmol. 1995;113(10):1312–8.
  11. Mondloch MV, Cole DC, Frank JW. Does how you do depend on how you think you’ll do? A systematic review of the evidence for a relation between patients’ recovery expectations and health outcomes. CMAJ Can Med Assoc J. 2001;165(2):174–9.
  12. Roscoe JA, Morrow GR, Hickok JT, et al. The efficacy of acupressure and acustimulation wrist bands for the relief of chemotherapy-induced nausea and vomiting. A University of Rochester Cancer Center Community Clinical Oncology Program multicenter study. Journal of Pain and Symptom Management. 2003;26(2):731–42.
  13. Mahomed NN, Liang MH, Cook EF, et al. The importance of patient expectations in predicting functional outcomes after total joint arthroplasty. J Rheumatol. 2002;29(6):1273–9.
  14. Eisenberg DM, Post DE, Davis RB, et al. Addition of choice of complementary therapies to usual care for acute low back pain: a randomized controlled trial. Spine. 2007;32(2):151–8.
  15. Patrick DL, Deyo RA, Atlas SJ, Singer DE, Chapin A, Keller RB. Assessing health-related quality of life in patients with sciatica. Spine. 1995;20(17):1899–908; discussion 1909.
  16. Roland M, Morris R. A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine. 1983;8(2):141–4.
  17. Roland M, Morris R. A study of the natural history of low-back pain. Part II: development of guidelines for trials of treatment in primary care. Spine. 1983;8(2):145–50.
  18. McPherson K, Britton A. Preferences and understanding their effects on health. Qual Health Care. 2001;10(suppl 1):i61–6.
  19. Chilvers C, Dewey M, Fielding K, et al. Antidepressant drugs and generic counselling for treatment of major depression in primary care: randomised trial with patient preference arms. BMJ. 2001;322 (7289):772–5.
  20. Bedi N, Chilvers C, Churchill R, et al. Assessing effectiveness of treatment of depression in primary care. Partially randomised preference trial. Br J Psychiatry. 2000;177:312–8.
  21. Barry MJ, Mulley AG Jr, Fowler FJ, Wennberg JW. Watchful waiting vs immediate transurethral resection for symptomatic prostatism. The importance of patients’ preferences. JAMA. 1988;259(20):3010–7.
  22. Kassirer JP. Incorporating patients’ preferences into medical decisions. N Engl J Med. 1994;330(26):1895–6.
  23. PocockSJ.Clinical trials: a practical approach. Chichester: John Wiley and Sons, 1983.
  24. Brewin CR, Bradley C. Patient preferences and randomised clinical trials. BMJ 1989;299:313-5. McPherson K, Britton AR, Wennberg JE. Are randomised trials controlled? Patient preferences and unblind trials. J Roy Soc Med 1997;90:652-6.
  25. Howard L, Thornicroft G. Patient preference randomised controlled trials in mental health research. Br J Psychiatry 2006;188:303-4.
  26. King M, Nazareth I, Lampe F, Bower P, Chandler M, Morou M, et al. Impact of participants and physician intervention preferences on randomised trials: a systematic review. JAMA 2005;293:1089-99.
  27. Torgerson DJ, Klaber-Moffett J, Russell IT. Patient preferences in randomised trials: threat or opportunity? J Health Serv Res Policy 1996;1:194-7.
  28. McPherson K, Britton AR, Wennberg JE. Are randomised trials controlled? Patient preferences and unblind trials. J Roy Soc Med 1997;90:652-6.
  29. McPherson K, Chalmers I. Incorporating patient preferences into clinical trials [letter]. BMJ 1998;317:78.
  30. Silverman WA, Altman DG. Patients’ preferences and randomized trials. Lancet 1996;347:171-4.
  31. Halpern SD. Evaluating preference effects in partially unblinded, randomized clinical trials. J Clin Epidemiol 2003;56:109-15.
  32. Torgerson D, Sibbald B. Understanding controlled trials: what is a patient preference trial? BMJ 1998;316:360.
  33. King M, Nazareth I, Lampe F, Bower P, Chandler M, Morou M, et al. Conceptual framework and systematic review of the effects of participants’ and professionals’ preferences in randomized controlled trials. Health Technol Assess 2005;9(35):1-186, iii-iv.
  34. Hardy GE, BarkhamM, Shapiro D, Reynolds S, Rees A. Credibility and outcome of cognitive-behavioural and psychodynamic-interpersonal psychotherapy. Br J Clin Psychol 1995;34:555-69.
  35. Manca A, Epstein DM, Torgerson DJ, Klaber-Moffett JA, Coulton S, Farrin AJ, et al. Randomized trial of a brief physiotherapy intervention compared with usual physiotherapy for neck pain patients: costeffectiveness analysis. Int J Technol Assess Health Care 2006;22:67-75.
  36. UK BEAM Trial Team. United Kingdom back pain exercise and manipulation (UKBEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ 2004;329:1377, doi:10.1136/bmj.38282.669225.AE
  37. Shapiro DA, Barkham M, Rees A, Hardy GE, Reynolds S, Startup M. Effects of treatment duration and severity of depression on the effectiveness of cognitive-behavioural and psychodynamicinterpersonalpsychotherapy. J Consult Clin Psychol1994;62:522-34.
  38. Kendrick T, Simons L,Mynors-Wallis L, Gray A, Lathlean J, Pickering R, et al.Atrialofproblem-solvingbycommunitymentalhealthnursesfor anxiety, depression and life difficulties among general practice patients: the CPN-GP study. Health Technol Assess 2005;9(37):1-104, iii.
  39. Pepper J, Lamb S, Doughty G, Fereday Smith J. Female urinary incontinence:women’s preferences for group or individual treatment. BMC Women’s Health (in press).
  40. Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA. Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial. Ann Intern Med 2005;143:849-56.
  41. Simpson S, Corney R, Fitzgerald P, Beecham J. A randomized controlled trial to evaluate the effectiveness and cost-effectiveness of counselling patients with chronic depression. Health Technol Assess 2000;4(36):1-83.
  42. Unützer J, KatonW, Callahan CM, Williams JW, Hunkeler E, Harpole, L, et al. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA 2002;288:2836-45.
  43. Sonia B. Felix Ribeiro 1, João Carlos Pizani Pinto 2, João Batista Ribeiro 3, Márcia M. Santos Felix 4, Pain Management at Inpatient Wards of a University Hospital , Rev Bras Anestesiol , 2012; 62: 5: 599-611
  44. Coker E, Papaioannou A, Turpie I et al. – Pain management practices with older adults on acute medical units. Perspectives, 2008;32(1):5- 12.
  45. Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. European journal of pain (London, England). 2006;10(4):287-333.
  46. Kreling MC, da Cruz DA, Pimenta CA. [Prevalence of chronic pain in adult workers]. Revista brasileira de enfermagem. 2006;59(4):509-13.
  47. Gatchel RJ, Okifuji A. Evidence-based scientific data documenting the treatment and cost-effectiveness of comprehensive pain programs for chronic nonmalignant pain. The journal of pain : official journal of the American Pain Society. 2006;7(11):779-93.
  48. Maniadakis N, Gray A. The economic burden of back pain in the UK. Pain. 2000;84(1):95-103.
  49. Andersson GB. Epidemiological features of chronic low-back pain. Lancet (London, England). 1999;354(9178):581-5.
  50. Abram S, Haddox J. The pain clinic manual. 2nd ed. Philadelphia: Lippincott Williams & wilkins; 2000.
  51. Miller R, Pardo M. Basics of Anesthesia. 6th ed. Philadelphia: Elsevier saunders; 2011.
  52. Fordyce WE, Fowler RS, DeLateur B. An application of behavior modification technique to a problem of chronic pain. Behaviour research and therapy. 1968;6(1):105-7.
  53. Fordyce W. Learned pain: Pain as behavior. In: Bonica J, editor. The Management of Pain. 1. Philadelphia: Lea & Febiger; 1990. p. 291-9.
  54. Flor H, Diers M. Limitations of pharmacotherapy: behavioral approaches to chronic pain. Handbook of experimental pharmacology. 2007(177):415-27.
  55. Engel GL. The need for a new medical model: a challenge for biomedicine. Science (New York, NY). 1977;196(4286):129-36.
  56. Guzman J, Esmail R, Karjalainen K, Malmivaara A, Irvin E, Bombardier C. Multidisciplinary bio-psycho-social rehabilitation for chronic low back pain. The Cochrane database of systematic reviews. 2002(1):Cd000963.
  57. Eisenberger NI, Lieberman MD, Williams KD. Does rejection hurt? An FMRI study of social exclusion. Science (New York, NY). 2003;302(5643):290-2.
  58. Jacobson L, Mariano AJ, Chabal C, Chaney EF. Beyond the needle: expanding the role of anesthesiologists in the management of chronic non-malignant pain. Anesthesiology. 1997;87(5):1210-8.
  59. Gardea MA, Gatchel RJ. Interdisciplinary treatment of chronic pain. Current review of pain. 2000;4(1):18-23.
  60. Patrick LE, Altmaier EM, Found EM. Long-term outcomes in multidisciplinary treatment of chronic low back pain: results of a 13-year follow-up. Spine. 2004;29(8):850-5.
  61. Engel CC, von Korff M, Katon WJ. Back pain in primary care: predictors of high health-care costs. Pain. 1996;65(2-3):197-204.
  62. Morley S, Eccleston C, Williams A. Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain. 1999;80(1-2):1-13.
  63. Warfield C, Fausett H. Manual of pain management. 2nd ed. Philadelphia: Lippincott Williams & wilkins; 2002.
  64. Schafer LM, Hsu C, Eaves ER, Ritenbaugh C, Turner J, Cherkin DC, et al. Complementary and alternative medicine (CAM) providers' views of chronic low back pain patients' expectations of CAM therapies: a qualitative study. BMC complementary and alternative medicine. 2012;12:234.
  65. Smeets RJ, Beelen S, Goossens ME, Schouten EG, Knottnerus JA, Vlaeyen JW. Treatment expectancy and credibility are associated with the outcome of both physical and cognitive-behavioral treatment in chronic low back pain. The Clinical journal of pain. 2008;24(4):305-15.
  66. Kalauokalani D, Cherkin DC, Sherman KJ, Koepsell TD, Deyo RA. Lessons from a trial of acupuncture and massage for low back pain: patient expectations and treatment effects. Spine. 2001;26(13):1418-24.
  67. Colagiuri B, Smith CA. A systematic review of the effect of expectancy on treatment responses to acupuncture. Evidence-based complementary and alternative medicine : eCAM. 2012;2012:857804.
  68. Franco MR, Ferreira ML, Ferreira PH, Maher CG, Pinto RZ, Cherkin DC. Methodological limitations prevent definitive conclusions on the effects of patients' preferences in randomized clinical trials evaluating musculoskeletal conditions. Journal of clinical epidemiology. 2013;66(6):586-98.
  69. Apkarian AV, Sosa Y, Krauss BR, Thomas PS, Fredrickson BE, Levy RE, et al. Chronic pain patients are impaired on an emotional decision-making task. Pain. 2004;108(1-2):129-36.
  70. Kelley-Moore JA, Ferraro KF: The black/white disability gap: Persistent inequality in later life? J Gerontol B Psychol Sci Soc Sci 59:S34-43, 2004
  71. Green CR, Wheeler JR, LaPorte F: Clinical decision making in pain management: Contributions of physician and patient characteristics to variations in practice. J Pain 4:29-39, 2003
  72. Carmen R. Green, Tamera Hart-Johnson: The Adequacy of Chronic Pain Management Prior to Presenting at a Tertiary Care Pain Center: The Role of Patient Socio-Demographic Characteristics: The Journal of Pain, Vol 11, No 8 (August), 2010: pp 746-754
  73. Benzon HT. Essentials of pain medicine. 3rd ed. Saunders: Elsevier Inc;2011.34-38.
  74. ROBERT P. JACKMAN, JANEY M. PURVIS, BARBARA S. MALLETT: Chronic Nonmalignant Pain in Primary Care: American Family Physician: Volume 78, Number 10:November 15, 2008
  75. Hinkley BS, Jaremko ME. Effects of pain duration on psychosocial adjustment in orthopedic patients: the importance of early diagnosis and treatment of pain. J Pain Symptom Manage 1994; 9: 175-185.
  76. Shin Y. Assessment of pain and Adequacy of pain management in Hospitalized cancer patients. Journal Of Korean Academy of Nursing 1994;29(3) :1113-1122
  77. Apkarian AV, Sosa Y, Krauss BR, Thomas PS, Fredrickson BE, Levy RE, et al. Chronic pain patients are impaired on an emotional decision-making task. Pain. 2004;108(1-2):129-36.
  78. A. Vania Apkarian,1 Yamaya Sosa,1 Sreepadma Sonty,2 Robert M. Levy et al. Chronic Back Pain Is Associated with Decreased Prefrontal and Thalamic Gray Matter Density. The Journal of Neuroscience, November 17, 2004 • 24(46):10410 –10415
  79. SHELDON GREENFIELD,M.D.;SHERRIE KAPLAN, Ph.D et al. Expanding Patient Involvement in Care Effects on Patient Outcomes. ACADEMIA AND CLINIC. Annals of Internal Medicine. 19S5;102:520-528
  80. Linde, Klaus, et al. "The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain." Pain 128.3 (2007): 264-271.

 



منبع: معاونت پژوهشي دانشکده پزشکي