Assessment of pain
Assessment of pain
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DOI：
10.1093/bja/aen103
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发表时间：
2008-07-01
影响因子：
9.8
通讯作者：
Stubhaug, A.
中科院分区：
文献类型：
--
作者：
Breivik, H.;Borchgrevink, P. C.;Stubhaug, A.
有效和可靠的疼痛评估对于临床试验和有效的疼痛管理都是必不可少的。疼痛的性质使客观测量成为不可能。急性疼痛可以可靠地评估，无论是在休息（重要的舒适度）和运动（重要的功能和术后并发症的风险），与一维工具，如数字评级量表或视觉模拟量表。这两种方法在检测疼痛强度变化方面都比口头分类评定量表更有效。在急性疼痛试验中，基线疼痛评估必须确保试验有足够的疼痛强度，以检测有意义的治疗效果。慢性疼痛评估及其对身体，情感和社会功能的影响需要多方面的定性工具和健康相关的生活质量工具。一些疾病和患者特异性功能量表是有用的，如西安大略和麦克马斯特大学骨关节炎，和几个神经性疼痛筛查工具。临床试验中的方法、测量和疼痛评估倡议对慢性疼痛试验结果测量的建议也适用于常规评估。癌症疼痛评估是复杂的许多其他身体和精神症状，如疲劳和抑郁，所有影响生活质量。值得注意的是，慢性疼痛患者报告的生活质量可能与晚期癌症患者一样受到影响。任何疼痛评估都必须考虑其他因素，如认知障碍或痴呆，以及在所研究的特定患者群体中验证的评估工具。
Valid and reliable assessment of pain is essential for both clinical trials and effective pain management. The nature of pain makes objective measurement impossible. Acute pain can be reliably assessed, both at rest (important for comfort) and during movement (important for function and risk of postoperative complications), with one-dimensional tools such as numeric rating scales or visual analogue scales. Both these are more powerful in detecting changes in pain intensity than a verbal categorical rating scale. In acute pain trials, assessment of baseline pain must ensure sufficient pain intensity for the trial to detect meaningful treatment effects. Chronic pain assessment and its impact on physical, emotional, and social functions require multidimensional qualitative tools and health-related quality of life instruments. Several disease- and patient-specific functional scales are useful, such as the Western Ontario and MacMaster Universities for osteoarthritis, and several neuropathic pain screening tools. The Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials recommendations for outcome measurements of chronic pain trials are also useful for routine assessment. Cancer pain assessment is complicated by a number of other bodily and mental symptoms such as fatigue and depression, all affecting quality of life. It is noteworthy that quality of life reported by chronic pain patients can be as much affected as that of terminal cancer patients. Any assessment of pain must take into account other factors, such as cognitive impairment or dementia, and assessment tools validated in the specific patient groups being studied.