针药治疗抑郁症残留疼痛症状的疗效对照研究

A comparative study on the efficacy of acupuncture in the treatment of residual pain symptoms of depression

目的探讨针药治疗抑郁症残留疼痛症状的疗效,以及对其预后的影响。方法将2014年1月～2016年12月期间在我院临床心理科治疗的108例经过急性期治疗残留躯体疼痛的抑郁症患者随机分成两组,针药组(针刺联合度洛西汀或阿米替林治疗,56例)和单药组(单药度洛西汀或阿米替林治疗,52例),比较治疗前和治疗后2周、8周简易McGill疼痛量表(the short-form of McGill pain questionaire,SF-MPQ)、汉密尔顿抑郁量表17项(Hamilton depression scale,HAMD17)评估疗效和预后。结果治疗2周末针药组SF-MPQ 5个维度评分均有下降,较治疗前有显著差异(P<0.01),单药组除现有疼痛强度PPI外其余较治疗前均有显著下降(P<0.05),治疗2周末两组间5个维度针药组均较单药组更低,差异均有统计学意义(P<0.05);治疗8周末两组SF-MPQ 5个维度评分均较治疗前有显著下降(P<0.01),针药组在PRI感觉分、PRI总分、VAS评分3个维度较单药组有更为明显的下降,差异具有统计学意义(P<0.05),而两组间在PRI情感分、PPI评分两个维度上差异无统计学意义(P>0.05)。治疗2周末、8周末针药组HAMD评分均较单药组显著降低(P<0.05或P<0.01)。治疗8周末针药组痊愈率79.6%,单药组痊愈率58.3%,两组痊愈率比较有显著差异(P<0.05)。1年末随访,1年内针药组复发率16.0%,单药组复发率34.9%,两组间差异有统计学意义(χ2=4.429,P<0.05)。结论针药治疗抑郁症残留疼痛症状比单药治疗更为有效,能较好的缓解疼痛、改善抑郁并降低复发率。

Objective To investigate the efficacy of acupuncture on the treatment of residual pain symptoms of depression and its prognosis.Methods108depression patients undergoing acute somatic pain in the acute phase who were treated with clinical psychology treatment in our hospital from January2014to December2016were randomly divided into two groups,including the acupuncture group treated with acupuncture combined with duloxetine or amitriptyline(n=56)and single-agent group treated with single-dose doxyzine or amitriptyline(n=52).The evaluation efficacy and prognosis of short-form of McGill pain questionaire(SF-MPQ)and the Hamilton Depression Scale(HAMD17)were compared before treatment and at2weeks,8weeks after treatment.Results The five-dimensional score of SF-MPQ in the acupuncture group at the2weeks of treatment decreased,which was significantly different from that before treatment(P<0.01).The single-drug group showed significant decrease compared with before treatment except the existing pain intensity PPI(P<0.05).The five-dimensional score in the acupuncture group were lower than that of the single-agent group at the end of the two weeks of treatment,and the difference was statistically significant(P<0.05).The five-dimensional score of SF-MPQ in the two groups at8weeks after treatment decreased compared with that before treatment(P<0.01).There was a significant decrease in the PRI sensory score,PRI total score and VAS score in the acupuncture group compared with that in the single-drug group.The difference was statistically significant(P<0.05).There was no significant difference in the two dimensions of PRI sentiment score and PPI score between the two groups(P>0.05).The HAMD scores of the acupuncture group at the2nd and8th weekend were significantly lower than those of the single drug group(P<0.05or P<0.01).At the end of the8weeks,the cure rate of the injection group was79.6%,and the cure rate of the single drug group was58.3%.There was a significant difference between the two groups in the cure rate(P<0.05).In the follow-up at the end of1year,the recurrence rate was16.0%in the acupuncture group and34.9%in the single drug group.The difference between the two groups was statistically significant(χ^2=4.429,P<0.05).Conclusion Acupuncture is more effective in treating residual pain in depression than single drug therapy,which can better relieve pain,improve depression and reduce recurrence rate.