PAIN AND ITS TREATMENT IN OUTPATIENTS WITH METASTATIC CANCER
PAIN AND ITS TREATMENT IN OUTPATIENTS WITH METASTATIC CANCER
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DOI：
10.1056/nejm199403033300902
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发表时间：
1994-03-03
影响因子：
158.5
通讯作者：
PANDYA, KJ
中科院分区：
文献类型：
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作者：
CLEELAND, CS;GONIN, R;PANDYA, KJ
背景和方法。癌症患者的疼痛往往得不到充分的治疗。共有1308名来自54个治疗地点的转移性癌症门诊患者隶属于东部肿瘤协作组，他们在前一周内对疼痛的严重程度、疼痛相关功能障碍的程度和止痛药物的缓解程度进行了评分。他们的医生将疼痛归因于各种因素，描述了治疗方法，并估计了疼痛对患者功能的影响。我们使用世界卫生组织制定的指南评估处方镇痛药物的充分性，研究影响镇痛是否充分的因素，并确定镇痛不足对患者疼痛缓解和功能状态的影响。结果67%的患者（1308例中的871例）报告称，他们在研究前一周内每天都有疼痛或服用镇痛药物，36%（1308例中的475例）的疼痛严重到足以损害他们的功能。42%的疼痛患者（我们有完整信息的597名患者中的250名）没有得到足够的止痛治疗。在主要治疗少数民族的中心就诊的患者疼痛管理不足的可能性是其他地方治疗的患者的三倍。患者和医生在判断患者疼痛严重程度方面的差异预示着疼痛管理不充分（比值比，2.3）。预测疼痛管理不足的其他因素包括医生未归因于癌症的疼痛（比值比，1.9），更好的体能状态（比值比，1.8），70岁或以上的年龄（比值比，2.4）和女性（比值比，1.5）。镇痛不充分的患者报告疼痛缓解较少，疼痛相关的功能损害更大。结论.尽管已发表的疼痛管理指南，许多癌症患者有相当大的疼痛，并接受不充分的镇痛。
Background and Methods. Pain is often inadequately treated in patients with cancer. A total of 1308 outpatients with metastatic cancer from 54 treatment locations affiliated with the Eastern Cooperative Oncology Group rated the severity of their pain during the preceding week, as well as the degree of pain-related functional impairment and the degree of relief provided by analgesic drugs. Their physicians attributed the pain to various factors, described its treatment, and estimated the impact of pain on the patients' ability to function. We assessed the adequacy of prescribed analgesic drugs using guidelines developed by the World Health Organization, studied the factors that influenced whether analgesia was adequate, and determined the effects of inadequate analgesia on the patients' perception of pain relief and functional status. Results. Sixty-seven percent of the patients (871 of 1308) reported that they had had pain or had taken analgesic drugs daily during the week preceding the study, and 36 percent (475 of 1308) had pain severe enough to impair their ability to function. Forty-two percent of those with pain (250 of the 597 patients for whom we had complete information) were not given adequate analgesic therapy. Patients seen at centers that treated predominantly minorities were three times more likely than those treated elsewhere to have inadequate pain management. A discrepancy between patient and physician in judging the severity of the patient's pain was predictive of inadequate pain management (odds ratio, 2.3). Other factors that predicted inadequate pain management included pain that physicians did not attribute to cancer (odds ratio, 1.9), better performance status (odds ratio, 1.8), age of 70 years or older (odds ratio, 2.4), and female sex (odds ratio, 1.5). Patients with less adequate analgesia reported less pain relief and greater pain-related impairment of function. Conclusions. Despite published guidelines for pain management, many patients with cancer have considerable pain and receive inadequate analgesia.