A multicenter study of attitudinal barriers to cancer pain management
A multicenter study of attitudinal barriers to cancer pain management
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DOI：
10.1007/s00520-017-3791-8
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发表时间：
2017-11-01
影响因子：
3.1
通讯作者：
Klepstad, Pal
中科院分区：
文献类型：
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作者：
Gunnarsdottir, Sigridur;Sigurdardottir, Valgerdur;Klepstad, Pal
本研究的目的是在三个欧洲国家接受强效阿片类药物治疗疼痛的大样本患者中，研究癌症疼痛管理的态度障碍及其与疼痛、镇痛药使用、临床和人口变量以及生活质量的关系。本研究的参与者是来自德国、冰岛和挪威六个中心的555名18岁及以上的癌症患者。所有患者接受强效阿片类药物治疗至少72小时。数据通过障碍问卷- ii、简短疼痛量表和欧洲癌症研究与治疗组织QLQ-C30收集。结果患者平均（SD）年龄为61.68岁（12.35岁），男性占53%。最常见的诊断是胃肠道、肺癌、前列腺癌和乳腺癌。从诊断到开始阿片类药物治疗的平均（SD）时间分别为32.24（44.55）个月和4.97（9.64）个月。平均（SD）疼痛严重程度为3.19(1.93)，在0到10的范围内，46.5%的人报告最严重的疼痛为7或更高。在0-5的范围内，态度障碍的平均标准差为1.95(0.82)，对成瘾的恐惧是各国最强的障碍，标准差为2.85（1.49）。障碍得分随年龄增长而增加，男性高于女性。较高的障碍评分与较高的疼痛严重程度和干扰以及较低的表现状态相关，但与总体健康-生活质量无关。服用阿片类药物时间较短的患者报告了更高的障碍。结论在阿片类药物治疗的癌性疼痛患者中，态度障碍较为常见，且与疼痛控制效果较差有关。
Purpose The purpose of this study was to examine attitudinal barriers to cancer pain management and their relationship to pain, analgesic use, clinical, and demographic variables, as well as QOL, in a large sample of patients receiving strong opioids for pain in three European countries.Methods Participants in the present study were 555 patients with cancer, 18 years and older recruited from six centers in Germany, Iceland, and Norway. All had received strong opioids for at least 72 h. Data was collected with the Barriers Questionnaire-II, the Brief Pain Inventory, and the European Organization for Research and Treatment of Cancer QLQ-C30.Results The mean (SD) age of patients was 61.68 (12.35) years and 53% were men. Most common diagnoses were gastrointestinal, lung, prostate, and breast cancer. The mean (SD) time from diagnosis was 32.24 (44.55) and 4.97 (9.64) months from start of opioid therapy. Mean (SD) pain severity was 3.19 (1.93) on a 0 to 10 scale, and 46.5% reported worst pain of 7 or higher. Attitudinal barriers had a mean (SD) of 1.95 (0.82) on a 0-5 scale, with fear of addiction as the strongest barrier across countries 2.85 (1.49). Barrier scores increased with age, and were higher among men than women. Higher barrier scores were associated with higher pain severity and interference, and lower performance status, but not with global health-QOL. Patients who had been on opioids for a shorter time reported higher barriers.Conclusions Attitudinal barriers are frequent in cancer pain patients on opioids and are associated with less effective pain control.