| Objective:Through the research and development of a pain rehabilitation management system of integrated traditional Chinese and western medicine to achieve the diagnosis of major pathological factors of pain and TCM syndrome differentiation,as well as the best physical factor treatment prescription and TCM adjustment program recommendations,and ultimately achieve accurate,personalized,intelligent pain rehabilitation Management.Methods:This study is divided into three parts.The first part is the theoretical framework construction of the pain rehabilitation management system of integrated traditional Chinese and western medicine.The second part is the research and development of the pain rehabilitation management system of integrated traditional Chinese and western medicine.The third part is the preliminary verification of the clinical efficacy of the pain rehabilitation management system of integrated traditional Chinese and western medicine.1.Theoretical framework construction of pain rehabilitation management system of integrated traditional Chinese and western medicine: this part adopts literature research combined with Delphi method to construct the pathological factor diagnosis and physical factor treatment program of pain,as well as the entry database of disease differentiation and adjustment program of traditional Chinese medicine.(1)Literature research follows the principle of evidence-based medicine,in strict accordance with the process of searching literature,the literature is classified and sorted according to the definition of pain,diagnosis classification,treatment,to form a knowledge base,and further to describe the description of pain symptoms and signs,as well as laboratory indicators,imaging indicators and treatment programs related to pain through literature review.(2)Delphi method: Delphi expert consultation questionnaire was designed according to the results of literature research,and two rounds of expert consultation feedback and re-consultation were conducted.We make statistical analysis of the basic situation of the experts and the degree of their positivity,authority,concentration and coordination.According to the literature review and Delphi expert consultation results,the pathological factor diagnosis and physical factor treatment program of pain,as well as the entry database of TCM disease differentiation and TCM adjustment program were determined.2.Development of the pain rehabilitation management system of integrated traditional Chinese and western medicine: based on the theoretical framework of pain rehabilitation management system of integrated traditional Chinese and western medicine,the computer uses the learning algorithm of Bayesian network to study automatically.It analyses the relationship and data characteristics between the medical record information such as symptoms,signs,laboratory indicators,imaging indicators,tongue images,pulse signs and the "diagnosis of pain pathological factors" and "syndrome differentiation of diseases and diseases of traditional Chinese medicine",determines the probability distribution according to the statistics of data,and forms the shell of the diagnosis of pain pathological factors and disease of TCM syndrome differentiation of Bayesian network structure and the prior probability tables.Then,a web-based browser/server mode and native app pain rehabilitation management system of integrated traditional Chinese and western medicine were developed using computer network engineering related technologies.3.Preliminary verification of clinical efficacy on pain rehabilitation management system of integrated traditional Chinese and western medicine: 240 patients with pain were included in a randomized parallel control study,randomly divided into two groups: 120 patients in the systematic treatment group and 120 patients in the empirical treatment group.The systemic treatment group received one physical-factor treatment prescription recommended by the system(ultrasonic therapy for inflammatory pain,transcranial magnetic stimulation for functional pain,transcranial magnetic stimulation for neuropathic pain,transcranial magnetic stimulation for neuropathic pain,and transcranial magnetic stimulation for neuropathic pain),as well as the regulation scheme of traditional Chinese medicine(the regulation principle of cold syndrome: wenjing sanhan,Recuperation principle of heat syndrome,clearing heat and detoxification,Phlegm syndrome recuperation principle: phlegm dehumidification,Principle of regulating blood stasis: activating blood and removing blood stasis,Principle of regulating qi stagnation: qi depression,Principle of regulating qi deficiency: invigorating spleen and qi,Principle of regulating blood deficiency syndrome: invigorating qi and giving birth to blood,Nourishing principle of Yin deficiency syndrome: nourishing Yin and replenishing deficiency,Yang deficiency syndrome nursing principle: warm Yang to fill deficiency.According to the experience of rehabilitation physicians or therapists,the experiential treatment group adopted one of the eight physical factors in the previous literature.Two groups of subjects received treatment once a day,five times a week,a total of 4 weeks.Before and after the intervention and 1 month after the follow-up,the short-form of Mc Gill Pain Questionnaire(SF-MPQ),Pittsburgh Sleep Quality Index(PSQI),self-rating Depression Scale(SDS),self-rating Anxiety Scale were used Scale(SAS),36-item Short From Health Survey(SF-36)and Patients' Global Impression of Change(PGIC)assessed pain intensity,sleep quality,emotional state and quality of life of the subjects.Result:1.Through literature research and Delphi expert consultation method,we sort out the classification of pain pathological factors and its diagnostic items,physical factors treatment prescriptions corresponding to pain pathological factors;pain Chinese medicine classification,TCM pain syndrome differentiation entries,TCM pain adjustment program.(1)Pathological diagnosis items of pain Through literature research and Delphi expert consultation,16 items of inflammatory pain diagnosis,39 items of neuropathic pain diagnosis,9 items of cancerous pain diagnosis and 9 items of functional pain diagnosis were sorted out.(2)Therapeutic prescription of physical factors corresponding to pathological factors of pain Through literature research and Delphi expert consultation method,the treatment prescription of physical factors of inflammatory pain was sorted out: Ultrasonic therapy,low-intensity laser therapy,transcutaneous electric nerve stimulation therapy.Physical factors of neuropathic pain treatment prescription:transcutaneous electric nerve stimulation therapy.Physical factors for the treatment of cancer pain prescription: transcutaneous electric nerve stimulation therapy.Physical factor therapy for functional pain: repetitive transcranial magnetic stimulation.(3)TCM syndrome differentiation items of pain: The syndrome differentiation items of cold syndrome were sorted out through literature research and Delphi expert consultation(10items),The items of heat syndrome differentiation(25),Items of syndrome differentiation of phlegm(10 items),blood stasis syndrome of the dialectical entries(20),Syndrome differentiation entries of qi stagnation(11),Syndrome differentiation items of qi deficiency(14 items),Syndrome differentiation items of blood deficiency syndrome(6 items),Syndrome differentiation of Yin deficiency(11 items),Syndrome differentiation of Yang deficiency(15items).(4)Adjustment programs of TCM for pain: Through literature review,9 adjustment programs of traditional Chinese medicine for different diseases of pain aresorted out.Recuperation principle of heat syndrome: clearing heat and detoxification,phlegm syndrome recuperation principle: phlegm dehumidification,principle of regulating blood stasis:activating blood and removing blood stasis,principle of regulating qi stagnation: qi depression,principle of regulating qi deficiency: invigorating spleen and qi,principle of regulating blood deficiency syndrome: invigorating qi and giving birth to blood,nourishing principle of Yin deficiency syndrome: nourishing Yin and replenishing deficiency,Yang-deficiency syndrome recuperation principle: warm Yang deficiency.2.Based on the theoretical framework of pain rehabilitation management system of integrated traditional Chinese and western medicine,and using the bayesian network learning algorithm for automatic learning,we developed a web-based browser/server mode and native app for pain rehabilitation management system of integrated traditional Chinese and western medicine.It lays a foundation for the realization of precise,personalized and intelligent clinical pain rehabilitation.3.Preliminary verification of clinical efficacy of pain rehabilitation management system of integrated traditional Chinese and western medicine:3.1 Baseline conditions: Subjects in the two groups had balanced baselines and were comparable(P>0.05).3.2 All pain-related indicators were significantly improved after 4 weeks of treatment in both groups compared with that before treatment(P<0.05).(1)Pain intensity:After 4 weeks of treatment,the total score of SF-MPQ in the two groups was smaller than that in the empirical treatment group,and there was a significant difference between the two groups before and after treatment(P<0.05).Compared between groups,SF-MPQ total score in the systematic treatment group was smaller than that in the empirical treatment group,with a significant difference between groups(P<0.05).At the time of follow-up,the total SF-MPQ scores of the two groups were all lower than those before treatment,and there were significant differences between the two groups before and after treatment(P<0.05).Compared between groups,SF-MPQ total score in the systematic treatment group was smaller than that in the empirical treatment group,with a significant difference between groups(P<0.05).The SF-MPQ total score was significantly different between the two groups(P<0.05).(2)After 4 weeks of treatment and 1 month of follow-up,SF-MPQ scores of the two groups were compared.The scores of "Pain Rating Index(PRI)","Present Pain Index(PPI)" and "Visual Analogue Scale(VAS)" were significantly different after 4 weeks of treatment than before treatment(P<0.05).At the end of treatment,PRI,PPI and VAS scores were compared between the systematic treatment group and the empirical treatment group(P<0.05).During the follow-up,PRI,PPI and VAS scores of the two groups were all lower than before treatment,and there were significant differences before and after treatment(P<0.05).Intergroup comparison showed that all scores of the treatment group were smaller than those of the experienced treatment group,with significant differences between the groups(P<0.05).There were significant differences in SF-MPQ scores before and after treatment and during follow-up between the two groups(P<0.05).3.2 Secondary outcome indicators(1)Sleep quality: The total PSQI score of the two groups after 4 weeks of treatment was lower than that before treatment,and there was a significant difference before and after treatment(P<0.05).After 4 weeks of treatment,the total score of sleep quality in the systematic treatment group was less than that in the empirical treatment group,and there was a significant difference between the two groups(P<0.05).During the follow-up,the total scores of sleep quality of the two groups were all lower than those before and after treatment,and there were significant differences between the two groups before and after treatment(P<0.05).Compared with the control group,the total score of sleep quality at 1 month follow-up was smaller in the experimental group than in the control group,with significant differences between the groups(P<0.05).The total score of sleep quality was significantly different between the two groups before and after treatment and during follow-up(P<0.05).(2)Emotional state(SDS,SAS):SDS and SAS scores of the two groups decreased after 4weeks of treatment compared with that before treatment,and the difference before and after treatment was statistically significant(P<0.05).After 4 weeks of treatment,there was no significant difference in SDS and SAS scores between the two groups(P>0.05).During the follow-up,SDS and SAS scores of the two groups were lower than those before and after treatment,and the difference before and after treatment was statistically significant(P<0.05).During the follow-up,there was no significant difference in SDS and SAS scores between the two groups(P>0.05).After 4 weeks of treatment,SDS and SAS scores of the two groups were compared,and there were significant differences between the two groups(P<0.05).During the follow-up,there was no significant difference in SDS and SAS scores between the two groups(P>0.05).(3)Quality of life: The total SF-36 score of the two groups increased after 4 weeks of treatment compared with that before treatment,and the difference between before and after treatment was statistically significant(P<0.05).After 4 weeks of treatment,the total score of SF-36 in the systemic treatment group was greater than that in the empirical treatment group,with a significant difference between the two groups(P<0.05).During the follow-up,the total scores of SF-36 in both groups were increased compared with that before treatment,and the difference between before and after treatment was statistically significant(P<0.05).At the time of follow-up,there were significant differences in the total scores of sf-36 between the two groups(P<0.05).After 4 weeks of treatment,SF-36 total score difference between the two groups was significantly different(P<0.05).At the time of follow-up,there was no significant difference in SF-36 total score between the two groups(P>0.05).(4)Patients' Global Impression of Change(PGIC):In terms of overall efficacy evaluation,there were significant differences between the two groups before and after treatment and during follow-up(P<0.05).3.4 Safety evaluation and compliance evaluation: No serious adverse events occurred in the two groups,and there was no significant difference between the two groups(P>0.05).There was no significant difference between the two groups(P>0.05).Conclusion:1.Through the bayesian network self-learning diagnosis algorithm model,the pain rehabilitation management system of integrated traditional Chinese and western medicine can realize the diagnosis of the main pathological factors of pain and the differentiation of TCM diseases,recommend the best physical-factor treatment prescription and TCM adjustment plan,and finally achieve the accurate,personalized and intelligent management of pain rehabilitation.2.The pain rehabilitation management system of integrated traditional Chinese and western medicine is accurate in diagnosis,and the recommended treatment has advantages in pain relief,sleep,mood improvement and quality of life,as well as good safety and compliance. |
PDF Full Text Request