| 题名 | 认知行为疗法对慢性腰痛患者治疗效果的研究 |
| 作者 | 李楠 |
| 答辩日期 | 2021-01 |
| 文献子类 | 硕士 |
| 授予单位 | 中国科学院心理研究所 |
| 授予地点 | 中国科学院心理研究所 |
| 其他责任者 | 高文斌 |
| 关键词 | 认知行为疗法 慢性腰痛 康复治疗 康复疗效 |
| 学位名称 | 理学硕士（同等学力硕士） |
| 其他题名 | Effect of cognitive behavioral therapy on chronic low back pain |
| 学位专业 | 健康心理学 |
| 中文摘要 | Low back pain (LBP) is one of the most common disability health problems, which brings heavy economic burden to individuals and society. According to statistics, 70% to 85% of people will experience low back pain in their lifetime [1,32]. Although low back pain is considered to be a warning of protection and functional adaptation to injury, it may cause certain damage when it becomes chronic [2]. This study takes the clinical treatment of chronic low back pain as the breakthrough point, from the perioperative rehabilitation, postoperative core stability training, the whole process of cognitive behavioral therapy intervention process to explore, in order to provide effective scientific guidance and evidence for the follow-up study of chronic pain, and provide guidance for the clinical rehabilitation of chronic low back pain.This study includes two sub studies：In Study 1, a randomized controlled trial was conducted to investigate the effects of cognitive behavioral therapy on depression, anxiety, pain and quality of life in patients with lumbar disc herniation undergoing percutaneous endoscopic treatment.Methods: from February 2016 to December 2017, 120 patients with lumbar disc herniation who underwent percutaneous endoscopic treatment in Beijing Rehabilitation Hospital Affiliated to Capital Medical University were selected as the research objects. Methods: 120 patients were randomly divided into observation group and control group, 60 cases in each group. Hamilton Depression Scale (HAMD) was used to evaluate depression symptoms, Hamilton Anxiety Scale (HAMA) was used to evaluate anxiety symptoms, vas and JOA were used to evaluate pain and efficacy, SF-36 was used to evaluate quality of life. At 1 week and 3 months after operation, the adverse emotions, pain and quality of life were compared between the two groups.Results: the JOA score of the observation group was higher than that of the control group at 1 week after operation, and the difference was statistically significant (P < 0.05). 3 months after operation, VAS score of observation group was lower than that of control group, and JOA score was higher than that of control group, the difference was statistically significant (P < 0.05). After 3 months, the total effective rate of the observation group was higher than that of the control group, but there was no significant difference (P > 0.05). Three months after operation, the scores of body function in the observation group were higher than those in the control group, the difference was statistically significant (P < 0.05).In the second study, a randomized controlled trial was used to observe the effect of cognitive behavior therapy combined with core stability training on patients with chronic nonspecific low back pain. After 4 weeks of intervention training, the treatment effects and differences between the two groups before and after treatment were compared.From February 2017 to February 2019, 60 patients with chronic nonspecific low back pain who met the inclusion criteria were selected and randomly divided into treatment group (n = 30) and control group (n = 30). Both groups received core stability training, and the treatment group received CBT intervention on this basis. The disability index (ODI), visual analogue scale (VAS), self rating mental state scale (SCL-90), lumbar range of motion and clinical efficacy were compared between the two groups.Results: the vas and ODI scores of the two groups before and after treatment were compared. The results showed that the vas and ODI scores of the two groups after treatment were lower than those before treatment, and the decrease degree of the treatment group was greater than that of the control group (P < 0.05). The results showed that the scores of somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, fear and paranoia in the treatment group were lower than those in the control group (P < 0.05), but there was no significant difference in the psychiatric scores between the two groups (P > 0.05). After treatment, the activities of flexion, extension and lateral bending in the treatment group were higher than those in the control group (P < 0.05). There were 3 cases of pain, 2 cases of muscle injury and 3 cases of bone injury in the control group after treatment, the incidence of adverse reactions was 26.67%; in the treatment group, there was 1 case of pain, 1 case of muscle injury and 2 cases of bone injury, with the incidence rate of 13.33%, showing no statistical significance (P > 0.05), as shown in Table 5. During the follow-up period, 7 cases of patients in the control group recurred, with the recurrence rate of 23.33%; 3 cases recurred in the treatment group, the recurrence rate was 10.00%. There was no significant difference in the recurrence rate between the two groups (P > 0.05)The results showed that: 1(1) As a supplement to the treatment of chronic pain, cognitive behavioral therapy has no pharmacological side effects compared with drug and physical therapy. It can better improve the psychological status of patients and correctly evaluate their physical and health status.(2) Cognitive behavioral therapy has a good effect on improving perioperative bad mood and postoperative fear, anxiety and pain of patients with lumbar disc herniation.(3) Cognitive behavioral therapy combined with core stability training has a significant effect on the rehabilitation of patients with nonspecific low back pain.Combined with rehabilitation therapy and cognitive-behavioral therapy, this study proved that the intervention treatment of chronic pain by biological psychological social rehabilitation multi-mode and multi-disciplinary means is a powerful supplement to the traditional solution of chronic low back pain. The core stability training is combined with cognitive behavior therapy, and the early preoperative cognitive behavior therapy intervention can reduce negative emotions and improve the prognosis of patients. It provides effective scientific guidance and evidence for the follow-up study of chronic pain. |
| 英文摘要 | 腰背痛（Low back pain ，LBP）是最常见的致残性健康问题之一，给个人和社会带来沉重经济负担。据统计，70%至85%的人一生中都会有腰痛经历[1,32]。腰痛虽然被认为是对保护和对损伤的功能适应的警告，但当它变成慢性时可能会造成一定损害的后果[2]。本研究以慢性腰痛的临床治疗为切入点，从围手术期康复，术后核心稳定性训练，整个过程中的认知行为疗法干预过程进行探讨，旨在为后续的慢性疼痛研究提供了有效的科学指导与证据，并为慢性腰痛临床康复治疗提供指导。本研究包括两个子研究：研究一采用随机对照试验，应用认知行为疗法对腰椎间盘突出症经皮内窥镜治疗患者的抑郁焦虑情绪、疼痛和生活质量的影响。选取2016年2月~2017年12月首都医科大学附属北京康复医院行经皮内窥镜治疗的腰椎间盘突出症患者120例作为研究对象。采用随机数表法将120例患者分为观察组和对照组，每组各60例。采用汉密尔顿抑郁量表（HAMD）评价抑郁症状，采用汉密尔顿焦虑量表（HAMA）评价焦虑症状，采用疼痛视觉模拟评分量表（VAS）和日本骨科协会下腰部疼痛评分量表（JOA）评价疼痛和疗效，采用健康调查简表（SF-36）评价生活质量。术后1周和术后3个月时，比较两组不良情绪、疼痛和生活质量。结果：观察组术后1周时，JOA评分高于对照组，差异有统计学意义（P＜0.05）。术后3个月，观察组VAS评分低于对照组，且JOA评分高于对照组，差异有统计学意义（P＜0.05）。术后3个月，观察组总有效率高于对照组，但是统计学无显著差异（P ＞0.05）。术后3个月，观察组躯体功能等评分均高于对照组，差异有统计学意义（P＜0.05）。研究二采用随机对照试验，应用认知行为疗法联合核心稳定性训练对慢性非特异性腰痛患者疗效进行观察。对被试进行4周的干预训练，比较治疗前后两组治疗效果及组间差异。选取2017年2月至2019年2月首都医科大学附属北京康复医院住院部收治的60例符合纳入标准的慢性非特异性腰痛患者，随机分为治疗组30例和对照组30例，两组患者均接受核心稳定性训练，治疗组在此基础上进行CBT干预。比较两组患者的功能障碍指数（ODI）、疼痛视觉模拟评分（VAS）、精神状况自评量表（SCL-90）、腰部活动度和临床疗效，记录两组患者不良反应和复发情况。结果：两组患者治疗前后VAS、ODI评分比较，结果显示，两组患者治疗后VAS、ODI评分均低于治疗前，治疗组下降程度大于对照组（P＜0.05）。两组患者治疗前后SCL-90评分比较，结果显示，接受治疗后治疗组的躯体化、强迫症状、人际关系敏感、抑郁、焦虑、敌对、恐惧、偏执的评分低于对照组（P＜0.05）；但两组精神病性评分比较，差异无统计学意义（P＞0.05）。两组患者腰部活动度比较，治疗后治疗组的前屈、后伸和侧弯的活动度皆高于对照组（P＜0.05）。两组患者不良反应及复发情况，治疗后对照组患者疼痛3例，肌肉损伤2例，骨骼损伤3例，不良反应发生率为26.67%；治疗组患者疼痛1例，肌肉损伤1例，骨骼损伤2例发生率为13.33%，差异无统计学意义（P＞0.05），见表5；随访期间，对照组患者复发7例，复发率为23.33%；治疗组复发3例，复发率为10.00%，两组复发率比较，差异无统计学意义（P＞0.05）研究发现：(1) 作为慢性疼痛治疗方案的补充，认知行为疗法干预相比药物、物理治疗方式，不具任何药理副作用，可较好改善患者心理状况，正确评价自己的身体与健康状态。(2) 认知行为疗法对改善腰椎间盘突出症患者围手术期的不良情绪和术后的恐惧焦虑疼痛具有较好的效果。(3) 认知行为疗法联合核心稳定性训练对非特异性腰痛患者康复疗效明显由于单一的核心稳定性训练，应是非特异性腰痛较为理想的治疗方案。本研究结合康复治疗和认知行为疗法，证明以生物-心理-社会康复多模式多学科的手段对慢性疼痛进行干预治疗，对传统的慢性腰痛解决方法进行有力补充，将核心稳定性训练与认知行为疗法相结合，术前早期认知行为疗法疗法干预减少负性情绪提高患者预后。为后续的慢性疼痛研究提供了有效的科学指导与证据。 |
| 语种 | 中文 |
| 内容类型 | 学位论文 |
| 源URL | [http://ir.psych.ac.cn/handle/311026/41631]  |
| 专题 | 心理研究所_健康与遗传心理学研究室 |
| 推荐引用方式 GB/T 7714 | 李楠. 认知行为疗法对慢性腰痛患者治疗效果的研究[D]. 中国科学院心理研究所. 中国科学院心理研究所. 2021. |
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