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      Impacto de la intervención psicológica grupal en los pacientes tributarios de radiofrecuencia convencional Translated title: Impact of group psychological intervention on conventional radiofrecuency tributary patients

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          Abstract

          RESUMEN Introducción: La radiofrecuencia (RF) convencional es una de las técnicas invasivas más utilizadas para tratar diversos síndromes de dolor. Sin embargo, algunos estudios reflejan la necesidad de un abordaje más amplio para conseguir una recuperación global del paciente. En el ámbito de la psicología se han propuesto tratamientos multicomponentes que integran distintas técnicas para abarcar la experiencia dolorosa en su totalidad. Desde este proyecto se propone una intervención psicológica grupal, de corte cognitivo conductual, dirigida a pacientes con patología lumbar propuestos para una RF convencional con el objetivo de incrementar el beneficio terapéutico de esta técnica. Objetivo: El objetivo principal de este estudio es evaluar la eficacia de la intervención propuesta mediante la evaluación de las variables tratadas en la misma. Material y método: Se trata de un diseño cuasiexperimental con grupo control en la que la muestra final está formada por 30 pacientes. Se formaron los dos grupos por autoselección. Tras la evaluación basal, al grupo experimental se le asignó un horario de las sesiones. Mientras que al grupo control se le informó que se realizaría una nueva evaluación psicométrica a los dos meses de la primera, coincidiendo con el final de la intervención psicológica y la segunda evaluación del grupo experimental. Tras un mes de la radiofrecuencia se volvió a evaluar a ambos grupos. Resultados: La intensidad del dolor, en ambos grupos aumentó a los dos meses de ser propuestos para radiofrecuencia y disminuyó de forma significativa después de un mes tras la misma. Tanto la importancia del dolor como el nivel de discapacidad disminuyeron de forma significativa en el grupo que participó en la intervención tras la misma y tras la RF. Sin embargo, en el grupo control no se dio esta disminución ni siquiera tras la RF. En el grupo experimental la calidad de vida aumenta en todas sus dimensiones respecto a la medición basal tanto tras la intervención como tras la RF. No ocurre así en el grupo control, en el que se observa disminución significativa, hasta el triple en el caso de "rol físico" o mantenimiento relativo de algunas puntuaciones. Es más, excepto en salud general, vitalidad y salud mental, en el resto de las dimensiones del cuestionario la puntuación obtenida tras la RF es menor que la basal. El grupo experimental reflejó mayor nivel de afrontamiento activo tras la intervención psicológica y tras la RF. Además, las puntuaciones de este grupo en Resiliencia se mantuvieron estables durante el periodo de evaluación. Conclusiones: Los pacientes que participaron en la intervención psicológica previa a la RF obtuvieron un mayor beneficio terapéutico. Estando comprobada la eficacia de la RF para la reducción de la intensidad del dolor, no parece mejorar ni el nivel de discapacidad ni la calidad de vida respecto a la medición basal. Poniendo de manifiesto la necesidad de crear protocolos válidos y reales de intervención multidisciplinar para esta patología.

          Translated abstract

          ABSTRACT Introduction: Conventional radiofrequency (RF) is one of the most widely used invasive techniques for treating various pain syndromes. However, some studies reflect the need for a more comprehensive approach to achieve overall patient recovery. In the field of psychology, multi-component treatments, that integrate different techniques to cover the entire pain experience, have been proposed. This project submits a group psychological intervention, of cognitive-behavioral nature, directed to patients with lumbar pathology, candidates for conventional RF, in orden to increase the therapeutic benefit of this technique. Objective: The main objective of this study is to evaluate the effectiveness of the proposed intervention by assessing the variables addressed in it. Material and method: This is a quasi-experimental design, with a control group, with a final sample of 30 patients. The two groups were formed by self-selection. After the baseline evaluation, the experimental group was assigned a schedule of sessions. However, the control group was informed that a new psychometric evaluation would be carried out two months after the first one, coinciding with the end of the psychological intervention and the second evaluation of the experimental group. One month after the radio frequency, both groups were re-evaluated. Results: Pain intensity in both groups increased within 2 months of being proposed for radiofrequency and decreased significantly after 1 month of it. Both the importance of pain and the level of disability decreased significantly in the group participating in the intervention after the intervention and after the RF. However, in the control group there was no such decrease even after RF. The percentage of quality of life dimensions increased in the patients of the experimental group, being in all cases higher after RF than in the baseline measurement. This is not the case in the control group, where a significant decrease is observed, up to three times in the case of "physical role" or relative maintenance of some scores. Moreover, except in general health, vitality and mental health, in the rest of the dimensions of the questionnaire the score obtained after RF is lower than the baseline. The experimental group reflected a higher level of active coping after psychological intervention and after RF. In addition, the scores of this group in Resilience remained stable during the assessment period. Conclusions: Patients who participated in the psychological intervention prior to the RF obtained higher therapeutic benefit. The effectiveness of RF in reducing pain intensity has been proven, but it does not appear to improve the level of disability or quality of life compared to baseline measurement. This shows the need to create valid and real protocols of multidisciplinary intervention for this pathology.

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          Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC).

          Resilience may be viewed as a measure of stress coping ability and, as such, could be an important target of treatment in anxiety, depression, and stress reactions. We describe a new rating scale to assess resilience. The Connor-Davidson Resilience scale (CD-RISC) comprises of 25 items, each rated on a 5-point scale (0-4), with higher scores reflecting greater resilience. The scale was administered to subjects in the following groups: community sample, primary care outpatients, general psychiatric outpatients, clinical trial of generalized anxiety disorder, and two clinical trials of PTSD. The reliability, validity, and factor analytic structure of the scale were evaluated, and reference scores for study samples were calculated. Sensitivity to treatment effects was examined in subjects from the PTSD clinical trials. The scale demonstrated good psychometric properties and factor analysis yielded five factors. A repeated measures ANOVA showed that an increase in CD-RISC score was associated with greater improvement during treatment. Improvement in CD-RISC score was noted in proportion to overall clinical global improvement, with greatest increase noted in subjects with the highest global improvement and deterioration in CD-RISC score in those with minimal or no global improvement. The CD-RISC has sound psychometric properties and distinguishes between those with greater and lesser resilience. The scale demonstrates that resilience is modifiable and can improve with treatment, with greater improvement corresponding to higher levels of global improvement. Copyright 2003 Wiley-Liss, Inc.
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            The need for a new medical model: a challenge for biomedicine

            G. Engel (1977)
            The dominant model of disease today is biomedical, and it leaves no room within tis framework for the social, psychological, and behavioral dimensions of illness. A biopsychosocial model is proposed that provides a blueprint for research, a framework for teaching, and a design for action in the real world of health care.
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              Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis.

              Low-back pain is a common and costly problem. We estimated the effectiveness of a group cognitive behavioural intervention in addition to best practice advice in people with low-back pain in primary care. In this pragmatic, multicentre, randomised controlled trial with parallel cost-effectiveness analysis undertaken in England, 701 adults with troublesome subacute or chronic low-back pain were recruited from 56 general practices and received an active management advisory consultation. Participants were randomly assigned by computer-generated block randomisation to receive an additional assessment and up to six sessions of a group cognitive behavioural intervention (n=468) or no further intervention (control; n=233). Primary outcomes were the change from baseline in Roland Morris disability questionnaire and modified Von Korff scores at 12 months. Assessment of outcomes was blinded and followed the intention-to-treat principle, including all randomised participants who provided follow-up data. This study is registered, number ISRCTN54717854. 399 (85%) participants in the cognitive behavioural intervention group and 199 (85%) participants in the control group were included in the primary analysis at 12 months. The most frequent reason for participant withdrawal was unwillingness to complete questionnaires. At 12 months, mean change from baseline in the Roland Morris questionnaire score was 1.1 points (95% CI 0.39-1.72) in the control group and 2.4 points (1.89-2.84) in the cognitive behavioural intervention group (difference between groups 1.3 points, 0.56-2.06; p=0.0008). The modified Von Korff disability score changed by 5.4% (1.99-8.90) and 13.8% (11.39-16.28), respectively (difference between groups 8.4%, 4.47-12.32; p<0.0001). The modified Von Korff pain score changed by 6.4% (3.14-9.66) and 13.4% (10.77-15.96), respectively (difference between groups 7.0%, 3.12-10.81; p<0.0001). The additional quality-adjusted life-year (QALY) gained from cognitive behavioural intervention was 0.099; the incremental cost per QALY was 1786 pound sterling, and the probability of cost-effectiveness was greater than 90% at a threshold of 3000 pound sterling per QALY. There were no serious adverse events attributable to either treatment. Over 1 year, the cognitive behavioural intervention had a sustained effect on troublesome subacute and chronic low-back pain at a low cost to the health-care provider. National Institute for Health Research Health Technology Assessment Programme. Copyright 2010 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                dolor
                Revista de la Sociedad Española del Dolor
                Rev. Soc. Esp. Dolor
                Inspira Network Group, S.L (Madrid, Madrid, Spain )
                1134-8046
                December 2020
                : 27
                : 6
                : 349-360
                Affiliations
                [2] orgnameConsorcio Hospital General Universitario de Valencia España
                [3] orgnameUniversitat de València España
                [1] Valencia orgnameFundación Valenciana para el Tratamiento del Dolor, FUNDOLOR España
                Article
                S1134-80462020000600005 S1134-8046(20)02700600005
                10.20986/resed.2020.3830/2020
                59aba582-8eb8-4aed-beeb-44930b87f477

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 25 June 2020
                : 19 September 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 27, Pages: 12
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                SciELO Spain

                Categories
                Originales

                radiofrequency,terapia cognitivo conductual,Chronic back pain,psychology,psychological intervention,cognitive behavioral therapy,Dolor crónico lumbar,radiofrecuencia,psicología,intervención psicológica

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