اثر بخشي فرا شناخت‌ درماني بر فاجعه‌ سازي درد و كيفيت زندگي بيماران مبتلا به درد مزمن

The Effects of Metacognitive Therapy on Pain Catastrophizing and Quality of Life in Patients With Chronic Pain

زمينه و هدف: درد باعث دوري از محركات خطرناك و ناخوشايند مي‌شود و از اين طريق در حفظ حيات انسان نقش حفاظتي مهمي ايفا مي‌كند. هدف پژوهش حاضر اثربخشي فراشناخت‌درماني بر فاجعه‌سازي درد و كيفيت زندگي بيماران مبتلا به درد مزمن شهر اهواز بود. روش‌بررسي: روش پژوهش از نوع آزمايشي بود و از طرح پيش‌آزمون-پس‌آزمون با گروه گواه و پيگيري استفاده شد. جامعهٔ آماري را بيماران بيشتر از سي سال مبتلا به درد مزمن تشكيل دادند كه در سال 1397 به مراكز درماني شهر اهواز مراجعه داشتند. سي بيمار به‌صورت نمونه‌گيري هدف‌مند به‌عنوان نمونه انتخاب شدند. سپس به‌طور تصادفي در گروه‌هاي آزمايشي و گواه (هر گروه پانزده نفر) قرار گرفتند. براي گروه آزمايش نُه جلسه درمان فردي 90دقيقه‌اي برگزار شد؛ درحالي‌كه گروه گواه مداخله‌اي دريافت نكرد. براي جمع‌آوري داده‌ها، پرسشنامهٔ فاجعه‌سازي درد (ساليوان و همكاران، 1995) و پرسشنامهٔ كيفيت زندگي (وير و شربورن، 1995) به‌كار رفت. در گروه‌ها پيش‌آزمون و پس‌آزمون اجرا شد. در نهايت دو ماه بعد از اجراي پس‌آزمون، در مرحلهٔ پيگيري، اقدامات مذكور بار ديگر انجام پذيرفت. داده‌ها با استفاده از روش اندازه‌گيري‌هاي مكرر با نرم‌افزار‌هاي SPSS نسخهٔ 23 و R3.5.3 تجزيه‌وتحليل شدند. يافته‌ها: نتايج نشان داد، درمان فراشناخت موجب كاهش فاجعه‌سازي درد و افزايش كيفيت زندگي در بيماران مبتلا به درد مزمن شده است (0٫05>p). نتيجه‌گيري: آموزش راهبردهاي فراشناخت مي‌تواند در كاهش فاجعه‌سازي درد و افزايش كيفيت زندگي بيماران مبتلا به درد مزمن مؤثر باشد؛ لذا استفاده از اين درمان به متخصصان توصيه مي‌شود.

Background & Objectives: Pain leads to avoiding dangerous and unpleasant stimuli; thus, it plays a significant protective role in preserving human life. A pain with low severity that lasts for more than a month is called chronic pain. Chronic pain generates enormous and distressing issues, such as demoralization, emotional disorders, personal restrictions, social and professional activities restriction, increased drug use, repeated referrals to the healthcare centers, and the spread of disease impact to other parts of the patient's life. Most of the patients with chronic pain, despite receiving pharmacotherapy, experience pain. Besides, if they are unable to compromise with the condition, their quality of life could be significantly affected. Furthermore, pain catastrophizing consists of the exaggerated negative attitude to actual or anticipated pain experience that increases the pain intensity, distress, and disability in patients with chronic pain. Psychological therapies assist the patient to efficiently cope with pain and its associated symptoms. Moreover, the active participation of patients could enhance their sense of self–efficacy concerning the ability to prevent and control pain. Subsequently, this process reduces the pain–induced inability. The metacognitive approach, instead of including challenging with dysfunctional thoughts and beliefs about chronic pain, involves communicating with thoughts in a manner that prevents individuals from resisting pain and enables them to eliminate inconsistent thinking strategies about anxiety. The current study aimed to explore the effects of metacognitive therapy on pain relief and quality of life in patients with chronic pain. Methods: This was an experimental study with pretest–posttest–follow–up and a control group design. The research statistical population consisted of patients aged >30 years with chronic pain who referred to medical centers in Ahvaz City, Iran, in 2019. In total, 30 patients who met the study inclusion criteria were selected through the purposive sampling method. Then, the study subjects were randomly assigned to the experimental and control groups (n=15/group). The experimental group received nine 90–minute individual treatment sessions; however, the control group received no intervention. The study inclusion criteria included the age range of 30–65 years, experiencing chronic pain, the ability to attend meetings and collaborate on performing home tasks, no severe psychiatric disorders, no history of attending other psychological therapy or training, and no alcohol or drug use. Additionally, the ethical considerations, such as describing the research purpose to the study participants, patient satisfaction, and confidentiality of research data were met in this research project. To collect data, the McGill Pain Questionnaire (MPQ) (Melsak, 1997), the Quality of Life Questionnaire (QoLQ) (Weir & Sherborne, 1992), and the Pain Catastrophizing Scale (PCS) (Sullivan et al., 1995) were implemented. At the beginning and end of the group meetings, pretest and posttest assessments were conducted. Eventually, 2 months after the posttest run, all of the study inventories were re–performed as the follow–up step. The protocol used in this study was based on the Adrian Wells approach. The obtained data were analyzed using frequent measurement methods in SPSS and R 3.5.3 software at a significance level of 0.05. Results: The present study findings revealed that metacognitive therapy education significantly impacted the studied dependent variables in the research subjects. Moreover, there was a significant difference between the experimental and control groups in terms of pain catastrophizing and quality of life (p<0.001). On the other hand, the results show that the time effect factor affected (p<0.001). Therefore, pain catastrophizing and quality of life demonstrated a significant change over time in the experimental group, compared with the controls. As a result, metacognitive treatment significantly reduced pain catastrophizing and increased quality of life in the explored patients with chronic pain (p<0.001). Conclusion: The obtained data proposed that metacognitive therapy provided a positive and considerable effect on reducing pain catastrophizing and improving the quality of life in the investigated patients with chronic pain. Consequently, it is recommended that metacognitive strategies be used as a formal treatment protocol in healthcare and counseling centers. This intervention should be presented by therapists who have received the necessary training throughout the country.