【摘要】：下背痛(low back pain,LBP)是以腰部疼痛為代表的一組癥狀群或癥狀綜合征,患者表現(xiàn)為腰骶臀部疼痛,可伴有下肢放射痛癥狀。LBP在臨床上十分常見,約80%的人在不同時(shí)期會(huì)出現(xiàn)LBP;LBP患者通常會(huì)不自主減少娛樂及健身活動(dòng),同時(shí)多數(shù)患者會(huì)出現(xiàn)一系列心理行為問題,如食欲減退、失眠、冷漠、工作能力下降等,對(duì)其工作、生活造成一定程度影響。慢性LBP的產(chǎn)生是生理學(xué)、心理學(xué)、社會(huì)學(xué)、經(jīng)濟(jì)學(xué)以及人口統(tǒng)計(jì)學(xué)等多種因素相互作用的結(jié)果,單一療法往往治療效果欠佳。而以往研究的LBP所發(fā)生的心理因素僅僅停留在情緒因素(焦慮和抑郁),并沒有對(duì)認(rèn)知因素做進(jìn)一步的研究。近年歐美國(guó)家逐漸將疼痛災(zāi)難化作為疼痛心理學(xué)領(lǐng)域的研究重點(diǎn),研究認(rèn)為疼痛災(zāi)難化可明顯的影響慢性疼痛患者的疼痛感受、心理狀態(tài)、臨床療效及生活質(zhì)量。因此對(duì)于伴有疼痛災(zāi)難化的LBP患者,進(jìn)行心理康復(fù)的進(jìn)一步研究具有重要的價(jià)值。本研究通過疼痛災(zāi)難化問卷(PCS)、疼痛VAS評(píng)分及Oswestry腰痛問卷(ODI)綜合評(píng)估肌電生物反饋放松訓(xùn)練對(duì)LBP伴疼痛災(zāi)難化患者康復(fù)療效的影響,為臨床更合理應(yīng)用心理康復(fù)手段輔助治療LBP伴疼痛災(zāi)難化患者提供參考資料。目的:觀察心理康復(fù)(肌電生物反饋放松訓(xùn)練)對(duì)下背痛伴疼痛災(zāi)難化患者康復(fù)治療效果的影響。方法:1共選取2015年1月至2016年4月在承德醫(yī)學(xué)院附屬醫(yī)院康復(fù)醫(yī)學(xué)科就診的LBP伴疼痛災(zāi)難化的患者50例。采用隨機(jī)數(shù)字表法分為實(shí)驗(yàn)組(23例)、對(duì)照組(27例)。2實(shí)驗(yàn)組采用肌電生物反饋放松訓(xùn)練和心理疏導(dǎo)干預(yù)及常規(guī)康復(fù)治療;對(duì)照組采用心理疏導(dǎo)干預(yù)和常規(guī)康復(fù)治療。于治療前、治療14d后采疼痛災(zāi)難化問卷(PCS)、疼痛視覺模擬評(píng)分量表(VAS)及OSWESTRY(ODI)腰痛問卷對(duì)兩組患者進(jìn)行評(píng)定。結(jié)果:1肌電生物反饋放松訓(xùn)練對(duì)LBP伴疼痛災(zāi)難化患者PCS的影響PCS評(píng)分:治療14d后發(fā)現(xiàn)兩組患者PCS,實(shí)驗(yàn)組(22.74±3.74),對(duì)照組(27.67±3.15),均較治療前改善(P0.05);實(shí)驗(yàn)組患者的改善幅度顯著,與對(duì)照組差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。2肌電生物反饋放松訓(xùn)練對(duì)LBP伴疼痛災(zāi)難化患者疼痛的影響疼痛VAS評(píng)分:治療14d后發(fā)現(xiàn)兩組患者疼痛VAS評(píng)分,實(shí)驗(yàn)組為(2.78±0.52)分,對(duì)照組為(3.48±0.64)分,均較治療前改善(P0.05);實(shí)驗(yàn)組患者的改善幅度顯著,與對(duì)照組差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。3肌電生物反饋放松訓(xùn)練對(duì)LBP伴疼痛災(zāi)難化患者腰椎功能的影響治療14d后發(fā)現(xiàn)兩組患者ODI評(píng)分,實(shí)驗(yàn)組為(14.35±1.77)分,對(duì)照組為(18.81±4.22)分,均較治療前改善(P0.05);實(shí)驗(yàn)組患者的改善幅度顯著,與對(duì)照組差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1肌電生物反饋放松訓(xùn)練能明顯改善LBP患者的疼痛認(rèn)知狀態(tài)、疼痛程度及患者的腰椎功能。2本研究中,按兩個(gè)階段進(jìn)行放松訓(xùn)練,第一階段閾值導(dǎo)向的張力認(rèn)知訓(xùn)練,第二階段放松性下調(diào)訓(xùn)練。本研究結(jié)果證明此研究方法可靠、有效,并且可實(shí)施性強(qiáng)。3肌電生物反饋放松訓(xùn)練對(duì)下背痛伴疼痛災(zāi)難化的患者康復(fù)治療效果有明顯的意義,有必要進(jìn)一步研究LBP與心理因素的臨床相關(guān)性及其如何心理干預(yù)的研究,使LBP的治療方法更系統(tǒng)化,以提高臨床療效。
[Abstract]:Low back pain (LBP) is a group of symptoms or symptomatic syndrome represented by lumbar pain. LBP is very common in clinic. About 80% of the people will have LBP in different periods. LBP patients usually reduce their recreational and fitness activities involuntarily, and most of the patients will have LBP. There will be a series of psychological and behavioral problems, such as loss of appetite, insomnia, apathy, decreased ability to work, and so on, which will affect their work and life to a certain extent. In recent years, European and American countries have gradually made painful catastrophe a research focus in the field of pain psychology. Research shows that painful catastrophe can significantly affect the pain feelings and psychology of patients with chronic pain. This study assessed the effects of EMG biofeedback relaxation training on LBP patients with catastrophic pain by means of PCS, VAS and Oswestry Low Back Pain Inventory (ODI). Objective: To observe the effect of psychological rehabilitation (EMG biofeedback relaxation training) on the rehabilitation of patients with LBP and catastrophic pain. Fifty patients with LBP accompanied by pain catastrophe were randomly divided into experimental group (23 cases) and control group (27 cases). 2 The experimental group was treated with EMG biofeedback relaxation training, psychological counseling intervention and routine rehabilitation therapy; the control group was treated with psychological counseling intervention and routine rehabilitation therapy. After 14 days of treatment, PCS, VAS and OSWESTRY were used to evaluate the effects of EMG biofeedback relaxation training on PCS in LBP patients with catastrophic pain. After 14 days of treatment, VAS score of pain was found in two groups, the experimental group was (2.78 + 0.52) score, and the control group was (3.48 + 0.52) score. After 14 days of treatment, the ODI scores of the two groups were (14.35 1.77) and (18.81 65 Conclusion: 1. EMG biofeedback relaxation training can significantly improve the pain cognition, pain degree and lumbar vertebral function of LBP patients. 2 In this study, relaxation training was carried out in two stages, the first stage. The results of this study show that this method is reliable, effective and practicable. 3 EMG biofeedback relaxation training has a significant effect on the rehabilitation of patients with low back pain and catastrophic pain. It is necessary to further study the clinical significance of LBP and psychological factors. The study of correlation and its psychological intervention has made LBP's treatment more systematic so as to improve its clinical efficacy.
【學(xué)位授予單位】：承德醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R493;R681.5

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本文編號(hào)：2195528