Patient-related barriers to pain management in ambulatory AIDS patients
Patient-related barriers to pain management in ambulatory AIDS patients
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DOI：
10.1016/s0304-3959(98)00018-9
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发表时间：
1998-05-01
期刊：
影响因子：
7.4
通讯作者：
Funesti-Esch, J
中科院分区：
文献类型：
--
作者：
Breitbart, W;Passik, S;Funesti-Esch, J
一些研究表明，艾滋病患者的疼痛治疗严重不足，特别是阿片类药物很少被处方。然而，到目前为止，还没有系统的尝试，以检查患者相关的障碍，艾滋病疼痛的管理。本研究使用障碍问卷（Ward et al.，Pain，52（1993）319-324），并评估了性别、种族和其他人口统计学差异对这些障碍的认可。我们调查了199例门诊艾滋病患者，从纽约市的许多地点招募，作为正在进行的门诊艾滋病患者疼痛和生活质量研究的一部分。除了获得人口统计学和医学数据外，我们还进行了一些自我报告问卷调查，包括简明疼痛量表（BPI）、简明症状指数（BSI）、贝克抑郁量表（BDI）和记忆症状评估量表（MSAS）。疼痛管理的障碍进行了评估，使用修改版本的障碍问卷（BQ），包括原来的27个问题，从这个自我报告的工具，沿着与额外的12个项目开发的艾滋病人群。结果表明，最常认可的BQ项目是关于止痛药成瘾潜力和与阿片类药物给药（如注射）或副作用（如恶心，便秘）相关的身体不适的项目。年龄、性别或HIV传播风险因素与BQ总分之间无相关性;然而，白人患者支持的BQ项目显著少于非白人患者，受教育年限与BQ评分呈负相关。BQ评分也与身体症状数量（MSAS）和几种心理困扰自我报告指标（BSI全球困扰指数，BDI总分）评分显著相关。患者相关障碍（即BQ总分）与疼痛治疗不足显著相关（通过疼痛管理指数测量），并在logistic回归分析中显著增加治疗不足的预测，即使在控制性别，教育和IDU传播风险因素的影响后。这些数据表明，与患者相关的疼痛管理障碍可能会增加艾滋病相关疼痛治疗不足的可能性。(C)1998年国际疼痛研究协会。出版社：Elsevier Science B. V.
A number of studies have demonstrated that pain is dramatically undertreated among patients with AIDS and that opioids in particular are rarely prescribed. To date, however, there has been no systematic attempt to examine patient-related barriers to the management of pain in AIDS. This study examines potential patient-related barriers to pain management in patients with AIDS using the Barriers Questionnaire (Ward et al., Pain, 52 (1993) 319-324), and assesses gender, racial, and other demographic differences in the endorsement of these barriers. We surveyed 199 ambulatory patients with AIDS, recruited from numerous sites in New York City, as part of an ongoing study of pain and quality of life in ambulatory AIDS patients. In addition to obtaining demographic and medical data, we administered a number of self-report questionnaires including the Brief Pain Inventory (BPI), the Brief Symptom Index (BSI), the Beck Depression Inventory (BDI), and the Memorial Symptom Assessment Scale (MSAS). Barriers to pain management were assessed using a modified version of the Barriers Questionnaire (BQ), including the original 27 questions from this self-report instrument along with an additional 12 items developed for an AIDS population. Results indicated that the most frequently endorsed BQ items were those concerning the addiction potential of pain medications and physical discomfort associated with opioid administration (e.g. injections) or side effects (e.g. nausea, constipation). There were no associations between age, gender, or HIV transmission risk factor and total scores on the BQ; however, Caucasian patients endorsed significantly fewer BQ items than did non-Caucasian patients and years of education was negatively correlated with BQ scores. Scores on the BQ were also significantly correlated with number of physical symptoms (MSAS) and scores on several self-report measures of psychological distress (the BSI Global Distress Index, BDI total scores). Patient related barriers (i.e. BQ total scores) were significantly associated with undertreatment of pain (as measured by the Pain Management Index), and added significantly to the prediction of undertreatment in a logistic regression analysis, even after controlling for the impact of gender, education and IDU transmission risk factor. These data suggest that patient-related barriers to pain management may add to the already considerable likelihood of undertreatment of AIDS-related pain. (C) 1998 International Association for the Study of Pain. Published by Elsevier Science B.V.