认知行为疗法联合文拉法辛治疗躯体形式疼痛障碍的临床观察

Clinical study of cognitive behavior therapy combined with venlafaxine in the treatment of somatoform pain disorder

目的探讨认知行为疗法联合文拉法辛治疗躯体形式疼痛障碍(SPD)的临床疗效。方法将60例躯体形式疼痛障碍患者随机分为研究组(认知行为疗法联合文拉法辛治疗)和对照组(单用文拉法辛治疗),每组30例,观察治疗8周。于治疗前及治疗后第2、4、8周末,采用简易McGill疼痛量表(SF-MPQ)、汉密顿抑郁量表(HAMD)和副反应量表(TESS)分别评定临床疗效(疼痛缓解程度)、抑郁程度和不良反应。结果干预8周后,研究组显效率(66.67%)高于对照组(40.00%),差异有统计学意义(χ2=4.29,P<0.05);HAMD评分和SF-MPQ总分及各因子积分,两组干预后均较干预前下降,第4、8周末,研究组的HAMD、SF-MPQ均低于同期对照组,差异均有统计学意义(t分别=3.04、3.87、2.99、2.90、8.25、2.91、5.18、4.65、6.90、4.67,P均<0.05);两组不良反应总发生率之间的差异无统计学意义(χ2=0.08,P>0.05)。结论认知行为疗法联合文拉法辛治疗躯体形式疼痛障碍疗效确切,比单用文拉法辛治疗效果更好。

Objective To explore efficacy of cognitive behavior therapy combined with venlafaxine in the treatment of the somatoform pain disorder. Methods All 60 patients with somatoform pain disorder were randomly assigned to study groups （treated with cognitive behavior therapy combined with venlafaxine ） and control group （treated with venlafaxine alone） for 8 weeks. Each had 30 cases. Before the treatment and on the 2, 4 and 8 weekend after the treatment, Simple McGill pain scale （SF-MPQ）, Hamilton Depression Scale（HAMD） and Treatment Emergent Side effect Scale（TESS） were used to evaluate the clinical efficacy（degree of pain reducing）, degree of depression and adverse effect respectively. Results After 8 weeks, the efficacy in the study group （66.67%） was significantly higher than that in the control group （40.00%）（χ2=4.29,P0.05）. The scores of HAMD, total and each factor of SF-MPQ in both groups were lower significantly after treatment than those before treatment. So as the scores in the study group than those in the control group after 4 and 8 weeks （t = 3.04,3.87,2.99,2.90,8.25,2.91,5.18,4.65,6.90,4.67,P 0.05）. The incidence of adverse effect had no significant difference between the two groups （χ2=0.08,P0.05）. Conclusions Cognitive therapy combined with venlafaxine is more effective than venlafaxine alone in the treatment of the somatoform pain disorder.