Multi-disciplinary interventions for chronic pain involving education: A systematic review

Background
There have been growing recommendations to include education in multi-disciplinary interventions targeting chronic pain management. However, effects of this strategy on short- and long-term self-management of chronic pain, remain largely unexplored.
Objectives
1. To provide an updated overview of studies that report on the impact of patient education in multi-disciplinary interventions, on self-management of chronic pain; 2. To explore associations between education and chronic pain self-management techniques; and 3. To identify the format and duration of suitable chronic pain interventions targeted at patient self-management.
Methods
Design: Narrative systematic literature review of randomised or controlled study designs. Data Sources: PubMed, CINAHL, EMBASE, PsycINFO. Participants: Adult patients with chronic pain of any aetiology participating in multi-disciplinary programs that included education. Main outcome measures: Assessments of level of pain, function, quality of life, self-efficacy, self-management, and any other relevant assessments. Study Appraisal and Synthesis Methods: PRISMA guidelines, Cochrane Risk of Bias tool, and TIDieR model.
Results
Database searching identified 485 potential papers. After removal of duplicates, and irrelevant articles by title and abstract, 120 full-text articles were reviewed and 27 studies were included in this systematic review. Studies were predominantly from the United States (n = 8; 29.6%). Over one hundred outcome measures were identified across all studies, with significant variation also observed in terms of how chronic pain duration was defined, and how education was delivered to participants. Overall, positive benefits of education were reported.
Conclusions
Education, as part of multi-disciplinary programs, is likely to improve self-management and self-efficacy in people with chronic pain of any aetiology. Heterogeneity in terms of: chronic pain duration; educational resources; healthcare professionals; and outcome measures, were identified as limitations. Further research, in the form of Randomised Controlled Trials addressing these limitations, is recommended.

研究背景
当前，越来越多的研究建议将健康教育纳入针对慢性疼痛管理的多学科干预方案中。然而，此类策略对慢性疼痛短期与长期自我管理的影响，目前仍鲜有系统性探索。

研究目标
1. 系统梳理现有关于多学科干预中患者教育对慢性疼痛自我管理影响的相关研究，提供最新综述；
2. 探究患者教育与慢性疼痛自我管理技能之间的关联；
3. 明确适用于患者自我管理的慢性疼痛干预方案的形式与时长。

研究方法
研究设计：针对随机对照或对照类研究的叙述性系统文献综述。
数据来源：PubMed、CINAHL、EMBASE、PsycINFO。
研究对象：罹患任意病因慢性疼痛的成年患者，且参与包含健康教育的多学科干预项目。
主要结局指标：疼痛程度、功能状况、生活质量、自我效能感、自我管理水平及其他相关指标的评估。
研究评价与合成方法：采用PRISMA（系统综述与荟萃分析优先报告条目）指南、Cochrane风险偏倚工具（Cochrane Risk of Bias tool）以及TIDieR模型（TIDieR model）。

研究结果
数据库检索共筛选出485篇潜在相关文献。剔除重复文献及通过标题和摘要判定为不相关的文献后，对120篇全文文献进行了评审，最终纳入27项研究进行本系统综述。纳入研究主要来自美国（n=8，占比29.6%）。所有研究中共涉及百余种结局指标，且在慢性疼痛病程的定义方式以及健康教育的实施形式上均存在显著异质性。总体而言，研究报告了健康教育所带来的积极效益。

研究结论
作为多学科干预项目的组成部分，健康教育或可改善任意病因慢性疼痛患者的自我管理能力与自我效能感。本研究发现的局限性包括：慢性疼痛病程定义、健康教育资源、医疗专业人员配置以及结局指标选择等方面存在异质性。建议未来开展针对上述局限性的随机对照试验（Randomised Controlled Trials），以推进相关研究。