[[alternative]]The Effectiveness of Auricular Massage for Neuropathic Pain in Patients with Spinal Cord Injury

Abstract

[[abstract]]本研究目的旨在探討脊髓損傷患者神經痛、焦慮及睡眠品質之狀態，脊髓損傷患者神經痛、焦慮及睡眠品質之相關性，耳穴按摩對脊髓損傷後神經痛、焦慮及睡眠品質之成效。研究以文獻查證及專家效度設計耳穴貼壓方案，採實驗型、重複測量設計。以方便取樣於北區某醫學中心神經修復病房進行研究。選案條件為自覺有神經痛症狀且使用TCA、BZD或GABA類藥物治療神經痛；脊髓損傷患者，受傷時間超過一個月；接受脊髓相關手術，手術後超過一個月；能用國、台語溝通；未使用氧療法或呼吸輔助器；未被診斷精神疾病或認知障礙；未長期服用安眠藥；耳廓及周圍皮膚無感染、損傷；無動暈症病史者；未合併有神經肌肉疾病及其他重大傷病者；且同意參與本研究計畫。合乎收案條件脊髓損傷病人共48位由收案的先後順序依隨機分派表分派至實驗組、對照組各24位，本研究為雙盲實驗設計，受試個案及資料收集者不知被分至實驗或對照組，研究者知道個案為實驗或對照組。耳穴貼壓處置方案，實驗組取頸椎(胸椎或腰椎)、內分泌點、神門穴及腦點等四穴位。對照組取聽宮、便秘點、耳門及聽會等四穴位，每天按壓三次，每次每穴持續按壓一至二分鐘，或按壓處有明顯脹痛、全身有溫感等得氣感受共進行七天。測量工具包括基本資料、神經性疼痛量表、醫院焦慮與憂鬱量表、匹茲堡睡眠品質量表及視覺類比量表。資料收集共進行10次，取得個案同意書後，收集各研究工具前測，介入措施執行後每日進行視覺類比量表後測，介入措施執行第七天進行各研究工具後測，第八至九天進行視覺類比量表後測。資料以SPSS 17.0版套裝軟體進行建檔與分析，統計分析包括平均值、標準差、卡方檢定、t檢定、以皮爾森積差相關、ANCOVA及GEE。本研究共收案脊髓損傷病人48位，男性36位、女性12位；損傷部位：頸椎34人(70.8%)、胸椎6人(12.5%)、腰椎8人(16.7%)；多為交通意外。本研究結果可知脊髓損傷病人有中高程度的神經痛，其中以麻刺痛最嚴重、其次為麻木感受、平常疼痛不舒服的情形、疼痛有多嚴重的感受、疼痛因氣候變化而增加、僵硬痛、撫摸疼痛部位是否敏感、疼痛因碰觸而增加、電擊痛、射痛、灼熱痛、擠壓痛。56.25%病人具輕度以上焦慮感受，25%為輕微焦慮感受(8~10分)、22.92%為中度焦慮感受、8.33%重度焦慮感受；70.83%病人具輕度以上憂鬱感受共有34位，37.5%為輕微憂鬱感受、27.08%為中度憂鬱感受、6.25%為重度憂鬱感受，本研究結果顯示70.83%研究對象有睡眠困擾。脊髓損傷病人神經性疼痛與憂鬱狀態及睡眠品質相關，焦慮狀態與憂鬱狀態相關，憂鬱與睡眠品質相關。耳穴貼壓方案對改善神經性疼痛、情緒及睡眠品質未達顯著成效。耳穴貼壓方案對脊髓損傷病人自覺疼痛感受、麻木感受及睡眠品質有顯著成效。[[abstract]]AbstractThe purpose of this study is to examine the effectiveness of auricular massage for neuropathic pain, moods and quality of sleep in patients with spinal cord injury. The study uses an experimental randomized control trial. Sampling criteria are patient elder than 18 years old, diagnosis as spinal cord injury combining neuropathic pain, clear mental status, able to communicate, no DSM IV diagnosis and no other neurological disorder. Forty eight patients are randomized into an experiment group or a comparison group. Auricular massage program lasts for one week. The auricular massage program includes 4 sites over ear area and conducted three times per day. Measurements are Neuropathic Pain Questionnaire(NPQ)、Hospital Anxiety and Depression Scale(HADS)、Pittsburgh Sleep Quality Index (PSQI) and Visual Analogue Scale(VAS). Data are collected at baseline, day one to day nine following the intervention. Data are analyzed by using the SPSS 17.0 statistical packages. Statistical methods applied are means, standard deviation, frequency, chi-square, t-test, ANCOVA and GEE. There are 36 male and 12 female patients in this clinical trial, 34 (70.8%) injury on cervical, 6 (12.5%) thoracic and 8 (16.7%) lumbar. This research reveals spinal cord injury patient has a). medium-to-high level neuropathic pain, including tingling pain、numbness、how unpleasant is your usual pain、how overwhelming is your usual pain、increased pain due to weather changes constant、freezing pain、overly sensitive to touch、increased pain due to touch、electric pain 、shooting pain、burning 、squeezing pain; b). anxiety at 56.25% (27 patients), 12 patients in mild, 11 patients in moderate and 4 patients in severe, c). depression at 70.83%(34 patients) , 18 patients in mild, 13 patients in moderate and 3 patients in severe and d). poor quality of sleep at 78.83%. This research also reveals that neuropathic pain and depression are co-related with quality of sleep, anxiety co-related with depression, and depression co-related with quality of sleep. The result of this study demonstrates that patient in the experimental group has significantly improved their pain, numbness and quality of sleep