其他摘要 | 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. |
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