Expectation of a Decrease in Pain Affects the Prognosis of Pain in Cancer Patients: a Prospective Cohort Study of Response to Morphine
Expectation of a Decrease in Pain Affects the Prognosis of Pain in Cancer Patients: a Prospective Cohort Study of Response to Morphine
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DOI：
10.1007/s12529-017-9644-5
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发表时间：
2017-08-01
影响因子：
2.7
通讯作者：
Nakagawa, Kazuhiko
中科院分区：
文献类型：
--
作者：
Matsuoka, Hiromichi;Yoshiuchi, Kazuhiro;Nakagawa, Kazuhiko
目的癌症疼痛是一种多维体验，包括生理、感觉、情感、认知、行为和社会文化维度。很少有前瞻性研究考察患者对疼痛改善的期望与疼痛预后之间的关系。这项前瞻性研究的目的是调查在阿片类药物治疗的不同类型癌症患者中，患者对疼痛减轻的期望是否与吗啡治疗后的疼痛强度有关。受试者是计划用吗啡治疗癌症疼痛的患者，他们每天服用非类固醇抗炎药。吗啡治疗按标准方法进行，包括滴定(NCCN指南(TM)，成人癌痛)。以疼痛强度数值评定量表(NRS)(第8天)为因变量，疼痛减少期望值(第1天)、肿瘤类型、患者年龄、性别、PS(第1天)、儿茶酚-O-甲基转移酶基因分型、医院焦虑抑郁量表总分(第1天)、疼痛强度NRS(第1天)为自变量进行简单回归分析。以疼痛强度NRS(第8天)为因变量，疼痛减少期望值(第1天NRS)及协变量为自变量进行多元回归分析，在简单回归模型中p值为0.05。共纳入100例有基线数据的患者，97例(51%女性)符合纳入标准。疼痛减轻期望值高的患者第8天NRS的疼痛强度显著降低(p=0.001)。非药物因素，如对疼痛治疗的期望，也可能是治疗癌症疼痛的重要因素，这可能与医生的沟通能力有关。
Purpose Cancer pain is a multidimensional experience that includes physiological, sensory, affective, cognitive, behavioral, and sociocultural dimensions. Few prospective studies have examined the relationship between a patient's expectation of pain improvement and the pain prognosis. The aim of this prospective study was to investigate whether patients' expectation to pain reduction was associated with pain intensity after morphine treatment in opioid treatment-na < ve patients with various types of cancer.The subjects were patients scheduled for cancer pain treatment with morphine who were taking nonsteroidal anti-inflammatory drugs daily. Morphine treatment was performed according to the standard method, including titration (NCCN Guidelines (TM), Adult Cancer Pain). Simple regression analysis was performed between pain intensity numerical rating scale (NRS) (day 8) as the dependent variable, expectation of pain decrease NRS (day 1), tumor types, and the following covariates as independent variables: patients' characteristics such as age, gender, PS (day 1), genotype of catechol-O-methyltransferase, total scores of Hospital Anxiety and Depression Scale (day 1), and pain intensity NRS (day 1). Multiple regression analysis was performed using forced entry methods with pain intensity NRS (day 8) as the dependent variable, and expectation of pain decrease NRS (day 1) and the covariates as independent variables that had a p value < 0.05 in the simple regression models.A total of 100 patients with baseline data were included, and 97 patients (51% female) met the inclusion criteria. Patients with a high expectation of pain decrease NRS had a significantly lower pain intensity NRS (day 8) (p = 0.001).Non-pharmacological factors such as expectations for pain treatment could also be important factors to treat cancer pain, which might be associated with communication skills in physicians.