背景:越来越认识到,在神经康复的背景下,治疗疼痛对于神经康复中的有效护理至关重要。意大利神经康复疼痛共识会议旨在确定我们在这种情况下的最佳实践。除了药物治疗和物理干预,心理治疗已被证明是一些最有价值的工具,可以在多学科方法中使用,以促进减少疼痛强度。然而,有必要阐明哪些形式的心理治疗可以有效地与神经康复团队通常解决的特定病理相匹配.
目的:广泛评估支持使用心理疗法减轻神经系统疾病疼痛的现有证据。
方法:通过使用PUBMED进行电子搜索,对评估心理治疗对神经系统疾病疼痛强度的影响的研究进行了系统综述,EMBASE,和Cochrane系统评价数据库。根据纳入研究的证据水平,针对不同的条件分别提出了建议。
结果:文献检索产生2352个结果,最终数据库包含400篇文章。这些建议的总体强度中等/低。不同形式的心理干预,包括认知行为疗法,认知或行为技巧,正念,催眠,接受和承诺疗法(ACT),简短的人际治疗,虚拟现实干预,各种形式的生物反馈和镜像治疗被发现是有效的疼痛减轻病理,如肌肉骨骼疼痛,纤维肌痛,复杂的区域疼痛综合征,中央中风后疼痛,幻肢疼痛,脊髓损伤继发疼痛,多发性硬化症和其他衰弱综合征,糖尿病性神经病,医学上无法解释的症状,偏头痛和头痛。
结论:心理干预和心理治疗是安全有效的治疗方法,可用于接受神经康复治疗疼痛的患者。可以根据所治疗的疾病来具体选择不同的干预措施。论文的最后部分还提供了意大利神经康复疼痛共识会议的证据和建议表。
BACKGROUND: It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian
Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams.
OBJECTIVE: To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases.
METHODS: A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions.
RESULTS: The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive-Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post-Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache.
CONCLUSIONS: Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian
Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the paper.