慢性疼痛に対する認知-行動療法的アプローチ

概要

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In cognitive-behavioral programs designed for chronic pain patients, Iittle is known about the mechanism of psychological changes which occur during therapy, though the idea that pain behaviors are decreased is widely accepted. We have conducted a three-week outpatient program for twenty-three musculoskeletal chronic pain patients. We compared pre- and post-treatment values of VAS (visual analogue scale). MMPI profiles, and SDS scores of all patients in order to investigate what happens from a psychological point of view. Responses to each item of the MMPI and SDS were also examined to distinguish whether they had changed after the program. We found that VAS values, MMPI F, Hs, D, Hy, Pd, Sc, MAS scores, and total SDS scores had decreased significantly, whereas MMPI Lb and As had not change. Patients significantly changed their answers to 12 items of the MMPI and 6 items of the SDS, mainly concerning somatic preoccupation and depressed mood. We conclude that a programmed reconditioning exercise alters the incapacitated body image and that the change of cognition of pain in chronic pain patients improves their depressive state. We suggest that this approach may amend the mental as well as the physical status of chronic pain patients though further research focused on detailed cognitive changes, and long-term follow-up of this program are needed.
日本心身医学会の論文
1993-12-01