正念處置對脊髓損傷疼痛與焦慮之影響：實證個案報告

The Impact of Mindfulness-based Interventions for Pain and Anxiety in Spinal Cord Injury: An Evidence-Based Case Report

神經性疼痛及痙攣是脊髓損傷（spinal cord injury，SCI）常見的合併症，因中樞敏感化及上運動神經元症候群導致，並轉變為慢性疼痛，且常合併有憂鬱、焦慮情緒問題。「正念處置」是將注意力集中在當下的一種非藥物處置，可調節疼痛及情緒。本案例為慢性頸椎損傷，接受中西醫結合及復健治療有疼痛及焦慮問題個案。作者運用實證方法搜尋「正念處置」對SCI疼痛與焦慮之成效。於Cochrane、Embase、Medline、PubMed、CINAHL及華藝等資料庫，設定P: spinal cordinjury；I: mindfulness；C: standard care；O: pain、anxiety之MeSH、Emtree及同義字，於2024年5月12日搜尋自2014年1月至2024年5月中英文實證文獻，經篩選後，共納入2篇系統性文獻回顧及1篇隨機對照試驗文獻，使用最新版CASP工具進行評讀。結果顯示「正念處置」可改善SCI個案的疼痛不愉快及焦慮感。個案經知情同意並介入一周後，焦慮指數從12分降至9分，疼痛量表從6-7分降至4-5分。成效與文獻相符且具可行性。本實證應用案例展現提供整合性照護之可能，期待未來更嚴謹的實證研究應證及本土護理實務推展。

Neuropathic pain and spasticity are common complications of spinal cord injury (SCI), often resulting from central sensitization and upper motor neuron syndrome. These symptoms frequently evolve into chronic pain and are associated with psychological distress, such as depression and anxiety. Mindfulness-based intervention (MBI), a non-pharmacological approach focusing attention on the present moment, may help regulate pain and emotional symptoms. This case involves a patient with chronic cervical SCI experiencing pain and anxiety, receiving integrative medicine and rehabilitation. A literature search was conducted in Cochrane, Embase, MEDLINE, PubMed, CINAHL, and Airiti Library (2014–2024) using P: SCI, I: mindfulness, C: standard care, O: pain/anxiety. Two systematic reviews and one RCT were included and critically appraised using the latest CASP tools. Findings suggest MBI can reduce pain unpleasantness and anxiety in SCI. After one-week intervention with informed consent, the patient's anxiety score decreased from 12 to 9, and pain score from 6–7 to 4–5, aligning with the literature. This case demonstrates the feasibility and potential of integrating MBI into SCI care, warranting further rigorous studies and clinical application in local nursing practice.