Chronic pain is often accompanied by negative emotions,and the progression of negative emotions may further impede pain relief.Both chronic pain and negative emotions are closely associated with reward/motivation circuits.Treatment with acupuncture is effective for the relief of pain and emotional disorders,although the acupoint combinations vary.Thus,this study aimed to elucidate the relationship of chronic pain and emotional disorders with the reward/motivation circuits.In association with the theory on "seven emotional factors that cause pain" in traditional Chinese medicine,the potential effect mechanism of "spirit-regulation with acupuncture" for the relief of chronic pain and negative emotions was explored.The findings suggest that chronic pain and its related negative emotions may be effectively relieved with acupuncture after optimizing its acupoint combination based on "spirit-regulation".However,the role of reward/motivation circuits for negative emotions in the relief of chronic pain with acupuncture needs to be demonstrated.
目的观察超早期介入关节活动对乳腺癌腋窝淋巴结清扫术后患者肩关节功能恢复的影响。方法选取2018年8月-2019年12月武汉大学中南医院甲状腺乳腺外科收治的乳腺癌腋窝淋巴结清扫术后患者100例,将其随机分为早期活动组与超早期活动组,每组各50例。两组均按指南推荐进行早期康复干预,早期活动组和超早期活动组患者分别在术后第7天和第3天开始接受肩关节主动活动训练,3次/d,5 d/周,持续4周。比较两组患者术后3 d、1周、2周的疼痛值、引流量变化及术后1、2、3周的肩关节活动度变化,并分别通过Constant-Murley评分表和健康调查简表(The Medical Outcomes Study 36-item Short-form Health Survey,SF-36)比较两组患者术后1、3、6、12周肩关节功能、生活质量的变化。结果超早期活动组患者在术后3 d、1周、2周时的疼痛值和引流量与早期活动组比较差异无统计学意义(P>0.05)。超早期活动组患者在术后1、2、3周时的肩外展、屈曲、外旋活动度明显优于早期活动组(P<0.05),术后1周时肩内旋活动度优于早期活动组(P<0.05)。超早期活动组患者在术后1、3、6、12周时的Constant-Murley评分分别为(25.9±4.3)、(55.4±5.3)、(64.6±4.5)、(73.3±4.6)分,明显优于早期活动组[(21.3±3.8)、(48.9±7.8)、(57.3±4.7)、(70.7±3.0)分],差异有统计学意义(P<0.05);SF-36量表评分与早期活动组比较差异无统计学意义(P>0.05)。结论超早期关节活动可显著改善乳腺癌腋窝淋巴结清扫术后患者肩关节活动度和肩关节功能,且未增加早期引流量、疼痛,对后期生活质量无明显影响,值得临床推广应用。
