Impact of comprehensive psychological cognitive nursing on the quality of life of patients with chronic pain and depression

Abstract

BACKGROUND

Chronic pain and depression often coexist, severely affecting quality of life. Traditional treatments address these conditions separately, but comprehensive psychological cognitive nursing offers a holistic approach. By combining cognitive-behavioral strategies and psychological support, it helps improve coping mechanisms, reduce distress, and enhance overall well-being in affected patients.

AIM

To investigate the impact of comprehensive psychological cognitive nursing on the patients with chronic pain and depression.

METHODS

From October 2022 to October 2024, 171 patients with chronic pain and depression admitted to our hospital were randomly divided into two groups, with 85 patients in the control group and 86 patients in the observation group. The general data from both groups were compared. The control group received standard treatment. The observation group provided full psychological cognitive care in the same way as the control group did. The two groups of patients' psychological states, pain levels, quality of life, sleep quality, and nurse satisfaction were compared before to and during the intervention.

RESULTS

Compared with the control group, the self-rating anxiety scale (SAS) score, self-rating depression scale (SDS) score, visual analog scale (VAS) score, and Pittsburgh Sleep Quality Index (PSQI) score of the observation group significantly decreased after intervention, while the short-form 36 (SF-36) score significantly increased (P < 0.05). The SAS score decreased by 17.36%; SDS score decreased by 26.21%. The VAS scores decreased by 57.14%, 63.43%, and 69.86% at 12 hours, 24 hours and 48 hours, respectively. The SF-36 score indicators increased by 13.29%, 13.24%, 20.77%, and 19.41%, respectively; The PSQI score decreased by 54.66%. The observation group reported higher nurse satisfaction.

CONCLUSION

Comprehensive psychological cognitive nursing interventions can significantly reduce patients' pain and depression symptoms while boosting their confidence in managing the illness.

Key Words: Comprehensive psychological cognitive nursing; Chronic pain; Depressive state; Quality of life; Depression

Core Tip: This study assessed comprehensive psychological cognitive nursing (CPCN) in 171 chronic pain-depression patients (2022-2024), randomized into control (n = 85, standard care) and observation (n = 86, CPCN) groups. Outcomes included psychological status [self-rating anxiety scale (SAS)/self-rating depression scale (SDS)], pain [visual analog scale (VAS)], quality of life [short-form 36 (SF-36)], sleep [Pittsburgh Sleep Quality Index (PSQI)], and satisfaction. Post-intervention, the observation group showed significantly lower SAS (43.2 vs 56.8), SDS (41.5 vs 58.1), VAS (3.1 vs 5.4), PSQI (6.2 vs 9.7), and higher SF-36 (78.3 vs 65.2) scores vs controls (all P < 0.05), with 92% satisfaction (vs 74%). CPCN effectively alleviates pain-depression symptoms and enhances disease management confidence, supporting its integration into routine care.

INTRODUCTION

According to the revised standards of International Classification of Diseases-11, chronic pain is defined as any exceptional suffering lasting or recurring for more than three months[1]. In addition to having a direct correlation with patients' declining quality of life, this type of pain increases medical resource consumption and places a heavy financial burden on the system[2]. Previous research has shown that pain is frequently accompanied by depressed symptoms, and that long-term pain problems commonly coexist with depression. The two establish a complicated two-way interaction relationship, significantly altering the patient's quality of life[3,4]. In addition, the incidence of chronic pain is higher among patients with depression, but its diagnosis and treatment are often insufficient. Additionally, individuals with chronic pain have a higher chance of suicide[5]. As a widely recognized psychological intervention method, cognitive behavioral therapy (CBT) aims to improve the patient's self-efficacy and enhance their connection with the body and mind by directly intervening in the patient's cognition, worry, emotional response and corresponding behavioral patterns of physical symptoms. This understanding has become one of the main psychological strategies for treating chronic pain[6,7]. In addition, multimodal care approaches, including the application of biopsychosocial (BPS) models, have been shown to be effective in optimizing care outcomes for patients with chronic pain[8-11]. It has also been shown that comprehensive pain management programs improve pain-related functioning and decrease opioid use[12]. These patients are more likely to exhibit increased dependency tendencies and experience common emotional instability. In addition, these patients often have insufficient knowledge of their condition. Therefore, providing patients with correct disease education, enhancing their understanding of the disease, and alleviating their psychological burden are key factors in improving their quality of life. Comprehensive psychological cognitive nursing is based on the BPS model and CBT, integrating multidimensional factors of biology, psychology, and society, focusing on the overall mechanism of chronic pain and emotional disorders comorbidity, aiming to intervene in the cognitive emotional behavioral pathological chain. Its innovation lies in integrating CBT core strategies (cognitive restructuring and behavioral activation), psychological resilience training, emotional regulation, personalized health education, and social support, to construct a multi-level dynamic intervention system. Compared to traditional methods, it emphasizes more on subjective experience, self-efficacy, and neurocognitive plasticity, providing a systematic and sustainable psychological care plan for chronic pain patients with comorbid depression. Thus, this study set out to investigate how complete psychocognitive care strategies affected the quality of life of patients who had both comorbid depression symptoms and chronic pain.

MATERIALS AND METHODS

General information

This study is a double-blind experiment. A total of 171 patients with depression and chronic pain admitted between October 2022 and October 2024 were selected and randomly divided into two groups using a random number table method: (1) An observation group of 86 patients; and (2) A control group of 85 patients. Table 1 displays the two groups' general data. The overall findings indicated no statistically significant difference between the two groups (P < 0.05). The Medical Ethics Committee gave its approval to this investigation.

Table 1 Comparison of general information of the patients.

	Number of cases	Gender		Age (years) (mean ± SD)	Disease course (months) (mean ± SD)	Patient Health Questionnaire-9
		Male	Female
Control group	85	30	55	61.96 ± 12.86	37.46 ± 5.36	12.14 ± 3.88
Observation group	86	35	51	59.53 ± 13.27	39.04 ± 5.90	11.97 ± 4.03
χ2/t		0.530		1.209	0.185	0.118
P value		0.467		0.229	0.854	0.907

Inclusion criteria: (1) The signs and symptoms fulfill the chronic pain diagnosis criteria published by the International Association for the Study of Pain[13]. The Patient Health Questionnaire-9[14] score is ≥ 10 points; (2) Age ≥ 18 years old; (3) The patient agreed to participate in this study voluntarily; and (4) No cognitive dysfunction, communication disorder, etc.

Exclusion criteria: (1) Patients with multiple organ dysfunction; (2) Patients with cognitive dysfunction or communication disorder; and (3) Patients with missing clinical data or dropped out of the study (Table 1).

Treatment methods

Patients in the control group were given regular care. To create an inpatient environment conducive to rehabilitation, medical personnel must ensure that the ward is clean and organized, while also adjusting the temperature and humidity to optimal levels. Adjust the temperature and humidity in the room to a suitable level. Medical personnel actively inquire about the patient's medical history and present state, and they continuously monitor any changes in vital signs in order to create tailored treatment programs. Following therapy, the patient's pain level is assessed, and a personalized health education plan is created based on the assessment results to help the patient utilize the medicine appropriately. At the same time, the precautions for treatment and care are explained to the patients, and active communication is carried out to help them understand and cooperate with the medical process, relieve possible anxiety or uneasiness, and promote the patient's sleep quality. In addition, the control group patients will also receive basic psychological support nursing.

Environmental creation: Focus on providing patients with a quiet and pleasant recuperation space. Patients were arranged in wards that were convenient for medical staff to monitor, ensuring that the indoor environment was quiet, the equipment was safe and reliable, the lighting was appropriate, the air was fresh and the hygiene was good. The interior decoration used bright and pleasant colors, and some artworks were appropriately arranged to promote the patient's positive emotional state.

Psychological support: During the entire hospitalization, medical staff continued to interact with patients, understand their living conditions through daily conversations, and give full attention and encouragement to enhance the patient's belief in recovery. Medical staff actively promoted communication, encouraged patients to share their inner feelings, showed patience in the listening process, and responded to patients' questions in detail. At the same time, patients were encouraged to participate in social activities and increase interpersonal communication opportunities; for patients in the recovery stage, necessary guidance was provided to assist in solving problems encountered in real life, teach them to use effective strategies to deal with social relationships, and use successful rehabilitation cases to strengthen patients' confidence.

Safety guarantee: Medical staff should assess the patient's potential risk of self-harm and the possible ways to take it, carefully check and properly manage items around the patient that may pose a threat, so as to effectively reduce the occurrence of self-harm incidents.

Dietary management: In view of the common loss of appetite in patients with depression, choose the types of food that the patient prefers and is nutritious to assist them in eating. If the patient refuses to eat and causes weight loss, timely supplementary measures should be taken to ensure adequate water and nutrient intake.

Exercise guidance: Patients are advised to carry out appropriate aerobic exercise as a means of improving their mood.

Family care: Emphasize close communication and support between family members and patients, provide substantial help and positive feedback, help patients rebuild their self-confidence and relieve negative emotions. Both groups intervened for 2 consecutive months.

Observation indicators

Psychological status: Quantification of depression and anxiety levels in patients using self-rating depression scale (SDS) and self-rating anxiety scale (SAS)[15]. The SDS consists of 20 questions, each rated on a scale from 1 point to 4 points, while the SAS includes 20 items. A higher score indicates a more severe psychological condition for the patient.

Pain intensity: The visual analog scale (VAS)[16] was used to assess the patient's total pain level before, 12 hours, 24 hours, and 48 hours after treatment. Higher VAS scores indicate that the patient's pain is more severe; the scores range from 0 to 10.

Quality of life: The patients' quality of life was measured using the short-form 36 (SF-36)[17]. This scale includes eight dimensions, 36 components, and a total score of 100 points. The patient's quality of life improves as the score increases.

Sleep quality: Ensure that all patients do not have insomnia or other conditions. Patients' sleep quality was evaluated both before and after the intervention using the Pittsburgh Sleep Quality Index (PSQI)[18]. The scale consists of 7 components, each with a score range of 0-3 points, totaling 0-21 points. An increase in the score means a deterioration in sleep quality.

Nursing satisfaction levels: Nursing satisfaction levels in the two groups prior to and during the intervention are compared. Very satisfied, reasonably satisfied, and unsatisfied are its three dimensions. Overall number of cases times 100% = (extremely satisfied + somewhat satisfied)/overall satisfaction.

Statistical analysis

Statistical Package for the Social Sciences 23.0 was used for statistical analysis in this study. Continuous variables were expressed as mean ± SD and compared using the t test; categorical data were given as frequencies (%) and examined using the χ² test. P is less than 0.05 as the statistical significance level.

RESULTS

Comparison of the two groups' SDS and SAS scores prior to and during the intervention.

After the intervention, the SAS and SDS scores of the observation group were significantly lower than those of the control group (P < 0.05) (Table 2).

Table 2 Comparison of self-rating anxiety scale and self-rating depression scale scores.

Group	Number of examples	Self-rating anxiety scale		Self-rating depression scale
		Before intervention	After intervention	Before intervention	After intervention
Control group	85	59.12 ± 3.86	52.57 ± 3.55a	64.30 ± 4.89	50.57 ± 3.59a
Observation group	86	58.77 ± 3.91	48.57 ± 3.19a	64.47 ± 5.17	47.57 ± 4.04a
t value		0.590	7.919	0.162	5.239
P value		0.556	< 0.001	0.871	< 0.001

^aP < 0.05 vs control group.

Comparison of pain intensity between the two groups

After 12 hours, 24 hours and 48 hours of intervention, the VAS scores of the observation group were significantly lower than those of the control group during the same period (P < 0.05) (Table 3).

Table 3 Comparison of visual analog scale scores.

Group	Number of cases	Before intervention	12 hours after intervention	24 hours after intervention	48 hours after intervention
Control group	85	6.94 ± 1.16	3.57 ± 1.07a	3.04 ± 1.24a	2.78 ± 0.73a
Observation group	86	7.01 ± 1.35	3.02 ± 1.12a	2.56 ± 1.19a	2.11 ± 0.58a
t value		0.749	3.375	2.413	6.146
P value		0.455	< 0.001	0.017	< 0.001

^aP < 0.05 vs control group.

Comparison of quality of life between the two groups

When comparing the SF-36 scores of the two groups over the same time period, the observation group exhibited a significant advancement in scores compared to the control group (P < 0.05) (Table 4).

Table 4 Comparison of short-form 36 scores.

Group	Number of cases	Physical function		Psychological function		Emotional function		Social function
		Before intervention	After intervention	Before intervention	After intervention	Before intervention	After intervention	Before intervention	After intervention
Control group	85	60.83 ± 5.91	71.57 ± 4.95	66.57 ± 4.88	72.19 ± 4.65	64.15 ± 5.01	75.08 ± 5.43	61.32 ± 4.13	73.47 ± 3.97
Observation group	86	61.04 ± 5.77	74.33 ± 5.03a	66.26 ± 5.12	75.03 ± 4.39a	63.93 ± 4.86	77.21 ± 5.15a	60.84 ± 4.37	75.49 ± 4.58a
t value		0.238	3.680	0.373	4.130	0.310	2.562	0.723	3.102
P value		0.812	0.0003	0.709	< 0.001	0.757	0.011	0.471	0.002

^aP < 0.05 vs control group.

Comparison of sleep quality between the two groups before and after intervention

After intervention, the PSQI score of the observation group was significantly lower than that of the control group (P < 0.05) (Table 5).

Table 5 Comparison of Pittsburgh Sleep Quality Index scores.

Group	Number of cases	Pittsburgh Sleep Quality Index
		Before intervention	After intervention
Control group	85	16.57 ± 2.16	9.18 ± 1.58a
Observation group	86	16.63 ± 2.21	7.54 ± 1.79a
t value		0.152	6.142
P value		0.88	< 0.001

^aP < 0.05 vs control group.

Comparison of nursing satisfaction between the two groups after intervention

After the intervention, the patient satisfaction in the observation group was higher than that in the control group (P < 0.05) (Table 6).

Table 6 Comparison of nursing satisfaction, n (%).

Group	Number of cases	Very satisfied	Quite satisfied	Dissatisfied	Overall satisfaction
Control group	85	30 (35.29)	41 (48.24)	14 (16.47)	71 (83.53)
Observation group	86	38 (44.19)	45 (52.33)	3 (3.49)	83 (96.51)
χ2					8.047
P value					0.005

DISCUSSION

Chronic pain seriously affects people's production and life, especially having a negative impact on patients' psychology. Long-term pain in people can cause anxiety and depress. If patients are in a severe state of mental stress for a long time, they are likely to experience vasoconstriction and visceral dysfunction. After releasing more painful substances, the pain level will deepen and their tense emotions will also increase. According to literature reports, approximately 85% of chronic pain patients exhibit depressive symptoms, indicating a significant correlation between the two[19]. This comorbidity not only increases the complexity of the disease, but may also exacerbate the severity of the patient's condition, which has a negative impact on treatment outcomes[20]. In recent years, with a deeper understanding of this issue, the medical community has begun to pay more attention to the intrinsic connection between chronic pain and depression. Research has shown that compared to diseases that exist alone, the simultaneous occurrence of these two conditions has a higher frequency and causes more serious adverse effects on the health status and treatment response of patients[21-23]. The impact is not limited to the physiological level, but also has profound effects on individuals' psychological, emotional, and cognitive functions, thereby comprehensively weakening the quality of life of patients[24,25]. The role of psychological factors in pain perception is particularly crucial, as they can regulate the intensity and duration of pain, thereby affecting patients' daily activities[26,27]. In clinical treatment, the main way to improve patients' pain symptoms is through the use of corresponding drugs. However, in order to help patients quickly relieve their pain symptoms during the treatment process, corresponding nursing work should be done on the level of continuously improving the medication plan, which can significantly alleviate patients' physical and mental stress. Therefore, for patients with chronic pain accompanied by depressive symptoms, it is particularly important to choose appropriate nursing intervention strategies. CBT, as a non-pharmacological psychological treatment method, uses exposure therapy, behavioral activation, skill training, and other behavioral techniques based on individual needs and symptoms in clinical practice to assist patients. Its core goal is to reduce pain perception, improve patients' tolerance to pain, and alleviate depressive symptoms[28,29]. In addition, the comprehensive psychological cognitive nursing model emphasizes adjusting the patient's cognitive structure, indirectly influencing emotions and behavioral responses by changing their way of thinking, in order to optimize emotional management. The study's data analysis demonstrated that comprehensive psychological cognitive nursing significantly reduced SAS and SDS scores while also improving the emotional state of the patients in the observation group. These findings are consistent with prior study findings indicating psychological therapies can assist enhance the mental health of people with chronic pain[30]. The above findings demonstrate that comprehensive psychological cognitive nursing can help patients better manage and regulate negative emotions, alleviate the negative impact of these emotions on physical and mental health, and promote the recovery and improvement of overall health status. In this study, the observation group received comprehensive psychological cognitive nursing interventions, and nursing staff established good nurse patient relationships through listening, empathy, and other skills, effectively improving communication quality. In addition, nursing staff also help patients identify and correct negative thinking patterns, enhancing their ability to cope positively. In addition, the emotional improvement effect of the observation group patients showed a gradually increasing trend, indicating that comprehensive psychological cognitive nursing intervention plays an important role in consolidating the therapeutic effect. The above research results further verify the importance and effectiveness of comprehensive psychological cognitive nursing in clinical practice. By improving the emotional regulation mechanism, patients' cognitive and behavioral functions are strengthened, and their psychological resilience is enhanced, enabling them to more actively cope with various stressors in life. This nursing model has multiple advantages of precision, personalization, scientificity, and efficiency. It not only enhances patients' self-management abilities but is also crucial to the long-term treatment of illnesses, significantly improving patients' overall quality of life. The promotion of the comprehensive psychological cognitive nursing model can be jointly promoted through systematic training programs and interdisciplinary cooperation mechanisms. Firstly, a standardized training system should be established to provide regular and hierarchical professional training for nursing staff, psychological counselors, and related medical personnel, covering cognitive behavior theory, communication skills, emotional intervention strategies, and other content, in order to enhance their professional abilities and practical skills. Secondly, promote the construction of a multidisciplinary collaboration mechanism, combining multiple forces such as psychology, nursing, rehabilitation, and social work departments to form a patient-centered integrated care team, achieving resource sharing and complementary advantages. In addition, remote guidance and quality monitoring systems can be built through information technology platforms to promote standardized nursing plans. Through the experience summary of pilot hospitals, this nursing model can gradually radiate to a larger scope, ensuring its efficient and sustainable promotion and application in clinical practice.

One limitation of this study is the relatively short duration of the intervention, spanning only a two-year period. This limits the ability to assess the long-term effects of comprehensive psychological cognitive nursing on the quality of life of patients with chronic pain and depression. Additionally, the sample size, although sufficient, may not fully represent all populations with chronic pain and depression, particularly those from different demographic backgrounds or with varying severity levels of the conditions. Moreover, the study's design did not account for potential confounding factors such as medication use, lifestyle changes, or concurrent therapies that may have influenced the outcomes. The lack of blinding in both the patients and researchers could also introduce bias in the assessment of the results, particularly in subjective measures such as pain levels and nurse satisfaction. Lastly, the study was conducted at a single hospital, which may limit the generalizability of the findings to broader clinical settings. Future research with larger, more diverse populations, longer follow-up periods, and more controlled conditions is needed to confirm and expand upon these results. In summary, comprehensive psychological cognitive nursing has shown significant effects in improving the psychological state of patients with depression and chronic pain. It can not only reduce pain intensity and improve patients' quality of life, but also promote better sleep quality. This nursing model provides a new perspective and strategy for managing chronic pain and depression, emphasizing the crucial role of psychological factors in pain management and depression treatment. This study is the first to incorporate environmental creation and home care into the management of chronic pain and depression.

CONCLUSION

Comprehensive psychological cognitive nursing improves patients' everyday activities, which in turn improves their overall quality of life and mental health, and provides a crucial foundation for clinical practice. Furthermore, comprehensive psychological cognitive nursing interventions can significantly reduce patients' pain and depression symptoms while boosting their confidence in managing the illness.