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Telehealth delivery of physical therapist-led interventions for persons with chronic low back pain in underserved communities: lessons from pragmatic clinical trials 为服务不足社区的慢性腰背痛患者提供由理疗师指导的远程保健干预:从实用临床试验中汲取的经验教训
Pub Date : 2024-04-19 DOI: 10.3389/fpain.2024.1324096
Julie M. Fritz, Isaac Ford, Steven Z. George, Laura Vinci de Vanegas, Tyler Cope, Colleen A. Burke, Adam P. Goode
In this perspective, we present our experience developing and conducting two pragmatic clinical trials investigating physical therapist-led telehealth strategies for persons with chronic low back pain. Both trials, the BeatPain Utah and AIM-Back trials, are part of pragmatic clinical trial collaboratories and are being conducted with persons from communities that experience pain management disparities. Practice guidelines recommend nonpharmacologic care, and advise against opioid therapy, for the primary care management of persons with chronic low back pain. Gaps between these recommendations and actual practice patterns are pervasive, particularly for persons from racial or ethnic minoritized communities, those with fewer economic resources, and those living in rural areas including Veterans. Access barriers to evidence-based nonpharmacologic care, which is often provided by physical therapists, have contributed to these evidence-practice gaps. Telehealth delivery has created new opportunities to overcome access barriers for nonpharmacologic pain care. As a relatively new delivery mode however, telehealth delivery of physical therapy comes with additional challenges related to technology, intervention adaptations and cultural competence. The purpose of this article is to describe the challenges encountered when implementing telehealth physical therapy programs for persons with chronic low back pain in historically underserved communities. We also discuss strategies developed to overcome barriers in an effort to improve access to telehealth physical therapy and reduce pain management disparities. Inclusion of diverse and under-represented communities in pragmatic clinical trials is a critical consideration for improving disparities, but the unique circumstances present in these communities must be considered when developing implementation strategies.
在本视角中,我们介绍了开发和开展两项实用临床试验的经验,这两项试验调查了由物理治疗师主导的针对慢性腰背痛患者的远程医疗策略。BeatPain Utah 和 AIM-Back 这两项试验都是实用临床试验合作实验室的一部分,试验对象都来自疼痛管理不均衡的社区。实践指南推荐对慢性腰背痛患者进行非药物治疗,并建议不要使用阿片类药物进行初级治疗。这些建议与实际实践模式之间的差距普遍存在,尤其是对于来自少数种族或族裔社区、经济资源较少以及生活在农村地区(包括退伍军人)的人群而言。循证非药物治疗通常由物理治疗师提供,这些障碍造成了循证与实践之间的差距。远程医疗为克服非药物疼痛治疗的获取障碍创造了新的机会。然而,作为一种相对较新的理疗模式,远程医疗理疗在技术、干预适应性和文化能力方面也面临着更多的挑战。本文旨在描述在历史上服务不足的社区为慢性腰背痛患者实施远程医疗物理治疗项目时所遇到的挑战。我们还讨论了为克服障碍而制定的策略,以努力提高远程物理治疗的可及性,减少疼痛管理方面的差异。将多元化和代表性不足的社区纳入实用临床试验是改善差异的一个重要考虑因素,但在制定实施策略时必须考虑到这些社区的特殊情况。
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引用次数: 0
Editorial: Insight in musculoskeletal pain—2023 社论:洞察肌肉骨骼疼痛--2023 年
Pub Date : 2024-04-17 DOI: 10.3389/fpain.2024.1411879
Ashim Gupta, Laura A. Frey-Law
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引用次数: 0
Parent-led neonatal pain management—a narrative review and update of research and practices 家长主导的新生儿疼痛管理--研究与实践的叙述性回顾和更新
Pub Date : 2024-04-16 DOI: 10.3389/fpain.2024.1375868
Alexandra Ullsten, Marsha Campbell-Yeo, Mats Eriksson
Research related to parent-led neonatal pain management is increasing, as is the clinical implementation. Skin-to-skin contact, breastfeeding and parents' vocalizations are examples of pain reducing methods that give parents an opportunity to protect their infant from harm while alleviating their anxiety and developing their parenting skills.In this paper we will provide a narrative review and describe the current research about parent-led neonatal pain management. Based on this we will discuss clinical challenges, implementation strategies and implications for future research.Parents express great readiness to embrace opportunities to increase their self-efficacy in their ability to address infant pain. Parent-led pain-reducing methods are effective, feasible, cost-effective, culturally sensitive, and can be individualized and tailored to both the parent's and infant's needs. Both barriers and facilitators of parent-led pain care have been studied in research highlighting structural, organizational, educational, and intra- and interpersonal aspects. For example, health care professionals' attitudes and beliefs on parent-led methods, and their concern that parental presence during a procedure increases staff anxiety. On the other hand, the presence of a local pain champion whose duty is to facilitate the adoption of pain control measures and actively promote parent-professional collaboration, is crucial for culture change in neonatal pain management and nurses have a key role in this change. The knowledge-to-practice gap in parent-led management of infants' procedure-related pain highlight the need for broader educational applications and collaborative professional, parental and research initiatives to facilitate practice change.Parent-led neonatal pain management is more than simply a humane and compassionate thing to do. The inclusion of parent-led pain care has been scientifically proven to be one of the most effective ways to reduce pain associated with repeated painful procedures in early life and parents report a desire to participate. Focus on enablers across interprofessional, organizational and structural levels and implementation of recommended pediatric pain guidelines can support the provision of optimal evidence-based family-centered neonatal pain management.
与家长主导的新生儿疼痛管理相关的研究和临床实施都在不断增加。皮肤接触、母乳喂养和父母发声都是减轻疼痛的方法,这些方法为父母提供了保护婴儿免受伤害的机会,同时减轻了他们的焦虑并培养了他们的育儿技能。在本文中,我们将对父母主导的新生儿疼痛管理的现有研究进行叙述性回顾和描述。在此基础上,我们将讨论临床挑战、实施策略和对未来研究的影响。家长们表示非常愿意接受各种机会,以提高他们应对婴儿疼痛的自我效能。家长主导的减轻疼痛方法有效、可行、成本效益高、具有文化敏感性,而且可以根据家长和婴儿的需求进行个性化定制。研究强调了结构、组织、教育、内部和人际关系等方面,对家长主导的疼痛护理的障碍和促进因素进行了研究。例如,医护人员对家长主导方法的态度和信念,以及他们担心家长在手术过程中的出现会增加工作人员的焦虑。另一方面,当地疼痛卫士的存在对于新生儿疼痛管理文化的改变至关重要,其职责是促进疼痛控制措施的采用并积极推动家长与专业人员的合作,而护士在这一改变中扮演着关键角色。家长主导的新生儿疼痛管理不仅仅是一件人道和富有同情心的事情。科学证明,纳入家长主导的疼痛护理是减少生命早期反复疼痛程序相关疼痛的最有效方法之一,而且家长也表示愿意参与其中。关注跨专业、组织和结构层面的推动因素,实施推荐的儿科疼痛指南,可支持提供以家庭为中心的最佳循证新生儿疼痛管理。
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引用次数: 0
Content validity of the electronic faces thermometer scale for pain in children: is a picture worth more than a thousand words? 儿童疼痛电子面孔温度计量表的内容效度:一图胜千言?
Pub Date : 2024-04-11 DOI: 10.3389/fpain.2024.1372167
A. Höök, Charlotte Castor, Maria Björk, Emma Forsgren, Anders Muszta, Stefan Nilsson
Introduction Early recognition of pain in children is crucial, and their self-report is the primary source of information. However, communication about pain in healthcare settings can be challenging. For non-verbal communication regarding different symptoms, children prefer digital tools. The electronic Faces Thermometer Scale (eFTS) utilizes a universal design with colors, face emojis, and numbers on an 11-point scale (0–10) for pain assessment. The aim of this study was to establish content validity of the eFTS for pain assessments in children. Methods A mixed methods design was used. The study took place at a university hospital in eastern Sweden, involving 102 children aged 8–17 years who visited outpatient clinics. Participants were presented with 17 pictures representing varying pain levels and asked to assess hypothetical pain using the eFTS. A think-aloud approach was employed, prompting children to verbalize their thoughts about assessments and the eFTS. Quantitative data were analyzed using descriptive and comparative statistics, together with a qualitative approach for analysis of think-aloud conversations. Results A total of 1,734 assessments of hypothetical pain using the eFTS were conducted. The eFTS differentiated between no pain (level 0–1) and pain (level 2–10). However, no clear agreement was found in the differentiation between hypothetical pain intensity levels (level 2–10). The analysis revealed that children utilized the entire scale, ranging from no pain to high pain, incorporating numbers, colors, and face emojis in their assessments. Discussion The variability in assessments was influenced by prior experiences, which had an impact on the statistical outcome in our study. However, employing the think-aloud method enhances our understanding of how children utilize the scale and perceive its design, including the incorporation of emotion-laden anchors. Children express a preference for using the eFTS to assess their pain during hospital visits.
导言 儿童疼痛的早期识别至关重要,而他们的自我报告是主要的信息来源。然而,在医疗保健环境中就疼痛进行交流是一项挑战。对于不同症状的非语言交流,儿童更喜欢数字工具。电子面孔温度计量表(eFTS)采用通用设计,用颜色、面孔表情符号和 11 点量表(0-10)上的数字进行疼痛评估。本研究旨在确定 eFTS 在儿童疼痛评估中的内容效度。方法 采用混合方法设计。研究在瑞典东部的一家大学医院进行,共有 102 名 8-17 岁的儿童参加了门诊。研究人员向参与者展示了 17 幅代表不同疼痛程度的图片,并要求他们使用 eFTS 评估假设疼痛。研究人员采用了 "思考-朗读 "的方法,让儿童说出他们对评估和 eFTS 的想法。采用描述性和比较性统计方法对定量数据进行分析,同时采用定性方法对思考对话进行分析。结果 使用 eFTS 对假设疼痛进行了 1734 次评估。eFTS 对无痛(0-1 级)和疼痛(2-10 级)进行了区分。但是,在区分假想疼痛强度等级(2-10 级)方面没有发现明显的一致性。分析表明,儿童使用了从无痛到剧痛的整个量表,并在评估中使用了数字、颜色和面部表情符号。讨论 评估的差异性受到先前经验的影响,这对我们研究的统计结果产生了影响。然而,采用思考-朗读法可以加深我们对儿童如何使用量表和感知量表设计的理解,包括对情感锚的理解。儿童表示更喜欢在医院就诊时使用 eFTS 来评估自己的疼痛。
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引用次数: 0
Development and feasibility of a mindfulness-based dance/movement therapy intervention for chronic low back pain 以正念为基础的舞蹈/运动疗法干预慢性腰背痛的开发和可行性研究
Pub Date : 2024-04-10 DOI: 10.3389/fpain.2024.1281085
Minjung Shim, Monica Gaydos, Natasha Goldstein-Levitas, Nicole Musalo, Nalini Prakash, J. Bradt, Fengqing Zhang, Sarah Wenger, Adam Gonzalez
Responding to the need for innovative, multi-modal, non-pharmacological strategies in chronic low back pain (cLBP) care, this article presents the development and a mixed methods feasibility trial of a manualized Mindfulness-based Dance/Movement Therapy (M-DMT) program for cLBP. The 12-week program is designed as a group therapy, integrating mindfulness principles, creative/expressive dance and movement, and psychoeducational content focused on cLBP management. This holistic program seeks to cultivate nonjudgmental awareness of pain experiences, challenge maladaptive pain-related beliefs, enhance emotional well-being, foster social support, and promote effective coping strategies for the daily challenges associated with cLBP.The 12-week M-DMT intervention was administered to individuals with non-specific cLBP (N = 18, aged 51.7 ± 13.9 years, 72% female, 55% Black and 39% White). We assessed feasibility and acceptability through monitoring enrollment and retention rates, attendance, and adverse events. Moreover, we measured the intervention's credibility/expectancy, participants' perception of changes, and overall satisfaction. Additionally, we collected qualitative data, capturing participants' perspectives on the intervention's usefulness and perceived benefits. Specific benchmarks were established to gauge the successful feasibility and acceptability of the program.The adherence rate stood at 80%, with a perfect retention rate of 100%. The study successfully met the benchmarks for treatment acceptability and satisfaction criteria, with 61% of participants reporting “feeling better” or a “great deal better” after the intervention. No adverse events were observed. Participants found the intervention enjoyable and reported that it provided effective tools for cLBP and related symptoms. Notably, participants reported a decrease in fear-avoidance behaviors, increased motivation for physical activity, and a boost in self-efficacy for pain management.These encouraging findings establish a strong basis for considering the M-DMT intervention as a promising approach for cLBP management, warranting further investigation in larger-scale studies.
为了满足慢性腰背痛(cLBP)治疗对创新、多模式、非药物治疗策略的需求,本文介绍了针对慢性腰背痛的正念舞蹈/运动疗法(M-DMT)手册化项目的开发和混合方法可行性试验。该项目为期 12 周,是一项团体治疗项目,融合了正念原则、创意/表现性舞蹈和动作,以及以 cLBP 管理为重点的心理教育内容。这项综合计划旨在培养对疼痛体验的非批判性意识,挑战与疼痛相关的不良信念,增强情绪健康,促进社会支持,并推广有效的应对策略,以应对与 cLBP 相关的日常挑战。我们通过监测注册率和保留率、出勤率和不良事件来评估可行性和可接受性。此外,我们还测量了干预的可信度/期望值、参与者对变化的感知以及总体满意度。此外,我们还收集了定性数据,了解参与者对干预措施的实用性和预期收益的看法。我们制定了具体的基准,以衡量该计划的成功可行性和可接受性。坚持率为 80%,完美保持率为 100%。该研究成功地达到了治疗可接受性和满意度标准的基准,61%的参与者表示干预后 "感觉更好了 "或 "好了很多"。没有观察到任何不良事件。参与者认为干预很愉快,并表示它提供了治疗 cLBP 和相关症状的有效工具。这些令人鼓舞的研究结果为将 M-DMT 干预作为一种有前途的 cLBP 管理方法奠定了坚实的基础,值得在更大规模的研究中进一步探讨。
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引用次数: 0
Editorial: Pain education research: advances, innovations, and challenges 社论:疼痛教育研究:进步、创新与挑战
Pub Date : 2024-04-08 DOI: 10.3389/fpain.2024.1403461
Mark I. Johnson, Y. Bradshaw, Scott M. Fishman, Kate Thompson, Judy Watt-Watson
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引用次数: 0
Sustained release local anesthetics for pain management: relevance and formulation approaches 用于止痛的缓释局麻药:相关性和配方方法
Pub Date : 2024-04-05 DOI: 10.3389/fpain.2024.1383461
Melese Getachew, Hana Tesfaye, Wubetu Yihunie, Tesfahun Ayenew, Sintayehu Alemu, Ephrem Mebratu Dagnew, Yalemgeta Biyazin, Dehnnet Abebe, Natanim Degefu, Abtie Abebaw
This review attempted to ascertain the rationale for the formulation of sustained-release local anesthetics and summarize the various formulation approaches designed to date to achieve sustained and localized local analgesic effects. The incidence of pain, which is the concern of patients as well as health care professionals, is increasing due to accidents, surgical procedures, and other diseases. Local anesthetics can be used for the management of moderate to severe acute and chronic pain. They also allow regional analgesia, in situations where the cause and source of the pain are limited to a particular site or region, without the need for loss of consciousness or systemic administration of other analgesics thereby decreasing the risk of potential toxicities. Though they have an interesting antipain efficacy, the short duration of action of local anesthetics makes the need for their multiple injections or opioid adjuvants mandatory. To overcome this problem, different formulations are being designed that help achieve prolonged analgesia with a single dose of administration. Combination with adjuvants, liposomal formulations, lipid-based nanoparticles, thermo-responsive nanogels, microspheres, microcapsules, complexation with multivalent counterions and HP-β-CD, lipid-based nanoparticles, and bio-adhesive films, and polymeric matrices are among the approaches. Further safety studies are required to ensure the safe and effective utilization of sustained-release local anesthetics. Moreover, the release kinetics of the various formulations should be adequately established.
本综述试图确定配制缓释局部麻醉剂的原理,并总结迄今为止为实现持续和局部镇痛效果而设计的各种配制方法。由于意外事故、外科手术和其他疾病,患者和医护人员所关注的疼痛发生率正在不断上升。局部麻醉剂可用于治疗中度到重度的急性和慢性疼痛。在疼痛的原因和来源仅限于特定部位或区域的情况下,局部麻醉剂还可用于区域镇痛,而无需失去知觉或全身使用其他镇痛剂,从而降低了潜在的毒性风险。虽然局麻药具有令人感兴趣的止痛效果,但由于其作用时间较短,因此必须多次注射或使用阿片类辅助药物。为了解决这个问题,人们正在设计不同的配方,以帮助实现单剂量给药的长效镇痛。其中包括与佐剂结合、脂质体制剂、脂基纳米颗粒、热响应纳米凝胶、微球、微囊、与多价反离子和 HP-β-CD 的复合物、脂基纳米颗粒、生物粘附性薄膜和聚合物基质等方法。要确保安全有效地使用缓释局部麻醉剂,还需要进一步开展安全性研究。此外,还应充分确定各种配方的释放动力学。
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引用次数: 0
Predictors of sexual satisfaction among patients with chronic pain 慢性疼痛患者性满意度的预测因素
Pub Date : 2024-04-04 DOI: 10.3389/fpain.2024.1375546
Aex Barr, Kayla Moore, Lindsay G. Flegge, Emily Atsaphanthong, Krissa E. Kirby, J. Craner
Objectives Sexual satisfaction is an important aspect of quality of life. Chronic pain, depression and anxiety, and relational problems correspond with higher risk for sexual difficulties. Less is known about how risk factors for sexual dysfunction and other problems—such as medical conditions, pain severity, and medication side effects—affect the sexual satisfaction of people with chronic pain. Using a biopsychosocial framework, this study explored factors related to sexual satisfaction among patients presenting for evaluation of chronic pain. Methods Researchers used a hierarchical multiple regression analysis to model potential predictors of sexual satisfaction. Variables analyzed were demographic features, medical history, average pain severity, depressed mood, anxiety, and perceived significant other support. Data collection involved administration of retrospective questionnaires and chart review. The sample included male and female participants (N = 134) presenting for evaluation at a multidisciplinary pain rehabilitation clinic. Results Medical history (i.e., medical conditions, surgical history, and medications) and clinical self-report variables (i.e., pain severity, depressed mood, anxiety, and perceived significant other support) were associated with sexual satisfaction. In this sample, antidepressant use and higher pain severity were unique predictors of lower sexual satisfaction. Married marital status and higher levels of perceived significant other support were predictive of greater sexual satisfaction. Discussion Findings highlight the importance of understanding the unique impact of biopsychosocial variables on the sexual satisfaction of patients presenting for evaluation at a multidisciplinary pain rehabilitation clinic. Further exploration of protective factors that account for sexual satisfaction among individuals with chronic pain may help inform screening, referrals, and treatment.
性满意度是生活质量的一个重要方面。慢性疼痛、抑郁和焦虑以及人际关系问题都会增加性生活困难的风险。人们对性功能障碍的风险因素和其他问题(如医疗条件、疼痛严重程度和药物副作用)如何影响慢性疼痛患者的性满意度知之甚少。本研究采用生物-心理-社会框架,探讨了与前来接受慢性疼痛评估的患者的性满意度相关的因素。方法 研究人员采用分层多元回归分析法对性满意度的潜在预测因素进行建模。分析的变量包括人口统计学特征、病史、平均疼痛严重程度、抑郁情绪、焦虑以及感知到的重要他人的支持。数据收集包括发放回顾性问卷和病历审查。样本包括在多学科疼痛康复诊所接受评估的男性和女性参与者(N = 134)。结果 病史(即病症、手术史和用药)和临床自我报告变量(即疼痛严重程度、抑郁情绪、焦虑和感知到的重要他人支持)与性满意度有关。在该样本中,使用抗抑郁药和疼痛严重程度较高是预测性满意度较低的独特因素。已婚婚姻状况和感知到的重要他人支持水平越高,性满意度越高。讨论 研究结果凸显了了解生物心理社会变量对在多学科疼痛康复诊所接受评估的患者性满意度的独特影响的重要性。进一步探索慢性疼痛患者性满意度的保护性因素可能有助于为筛查、转诊和治疗提供依据。
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引用次数: 0
Controlling fetal stress for preventing adverse health conditions in neonates and children 控制胎儿压力,预防新生儿和儿童出现不良健康状况
Pub Date : 2024-04-04 DOI: 10.3389/fpain.2024.1265069
V. Calcaterra, Gianvincenzo Zuccotti, G. Pelizzo
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引用次数: 0
Virtual reality–guided mindfulness for chronic pain in cancer survivors: protocol for the virtual mind study—a single-group feasibility trial 虚拟现实指导下的正念治疗癌症幸存者的慢性疼痛:虚拟心灵研究协议--单组可行性试验
Pub Date : 2024-04-04 DOI: 10.3389/fpain.2024.1291374
Mohamad Baydoun, Zen Gajtani, Michaela Patton, A. McLennan, Stephen Cartwright, Linda E Carlson
Background Chronic cancer-related pain (CRP) can have a significant negative impact on quality of life. Mindfulness is hypothesized to mitigate chronic CRP by regulating both physical and emotional resistance to pain. In recent years, there has been interest in the use of virtual reality (VR) to deliver mindfulness meditation. VR provides an immersive and engaging environment, which may enhance one's focused attention to present-moment experiences, potentially making mindfulness less effortful and more efficacious for individuals with chronic pain. There has been little research in this area for people with a history of cancer. Objective The aim of this mixed methods study is to evaluate the feasibility of a VR-guided mindfulness (VRGM) intervention offered to adult cancer survivors with chronic CRP. Methods This mixed methods feasibility study will employ a single-arm, pretest-posttest design with semistructured interviews. In total, 15 cancer survivors will be enrolled in a 6-week home-based intervention that consists of 10–15 min of daily VRGM practice. The primary outcome is feasibility as assessed by accrual rates, retention in the study, intervention adherence, questionnaire completion, and side effect rates. Participants will be assessed on psychosocial outcome measures (i.e., pain, sleep, depressive and anxiety symptoms, fatigue, quality of life, and mindfulness) before and after the intervention, and 6 weeks post intervention (follow-up). Changes in pain will be described in relation to levels of immersion and presence in the virtual environment, trait mindfulness, and amount of VRGM practice. Qualitative information will provide subjective detail on participants’ experience with VRGM to complement quantitative data. This study has been approved by the Health Research Ethics Board of Alberta Cancer Committee (HREBA.CC-20-0411). Conclusions This novel intervention provides a potential alternative treatment to pharmacological pain management. Results from this study may inform future larger VGRM trials for chronic CRP to help reduce suffering in people with cancer. Study findings will be disseminated through open access publications, traditional conference presentations, professional cancer organizations, and social media platforms.
背景 慢性癌症相关疼痛(CRP)会对生活质量产生严重的负面影响。据推测,正念可以通过调节身体和情绪对疼痛的抵抗力来减轻慢性 CRP。近年来,人们对使用虚拟现实(VR)进行正念冥想产生了兴趣。VR 提供了一种身临其境、引人入胜的环境,可以增强人们对当下体验的专注力,从而有可能使慢性疼痛患者的正念冥想更省力、更有效。在这方面,针对癌症患者的研究还很少。目的 本项混合方法研究旨在评估向患有慢性 CRP 的成年癌症幸存者提供 VR 引导正念(VRGM)干预的可行性。方法 这项混合方法可行性研究将采用单臂、前测-后测设计,并进行半结构化访谈。共有 15 名癌症幸存者将参加为期 6 周的家庭干预,包括每天 10-15 分钟的 VRGM 练习。主要结果是可行性,评估指标包括加入率、研究保留率、干预坚持率、问卷完成率和副作用发生率。在干预前后和干预后 6 周(随访),将对参与者进行心理社会结果测量(即疼痛、睡眠、抑郁和焦虑症状、疲劳、生活质量和正念)评估。疼痛的变化将与虚拟环境中的沉浸和临场感水平、正念特质和 VRGM 练习量相关联。定性信息将提供参与者对 VRGM 体验的主观细节,以补充定量数据。本研究已获得艾伯塔癌症委员会健康研究伦理委员会的批准(HREBA.CC-20-0411)。结论 这种新型干预为药物止痛提供了一种潜在的替代治疗方法。这项研究的结果可为今后针对慢性 CRP 的更大规模 VGRM 试验提供参考,从而帮助减轻癌症患者的痛苦。研究结果将通过公开出版物、传统会议演讲、专业癌症组织和社交媒体平台进行传播。
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引用次数: 0
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Frontiers in Pain Research
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