從實證觀點談「按摩處置」對於癌痛病人之成效

The Effects of a Massage Intervention in Patients with Cancer Pain: An Evidence-Based Approach

25%新診斷癌症病人、33%接受癌症治療及75%惡性化病人於患病過程經歷中度到重度的疼痛，其會嚴重影響到病人的活動力及生活品質，透過教導病人及家屬非侵入性護理疼痛處置—「按摩」，最能發揮腫瘤護理人員於疼痛處置中的角色及功能。按摩可能透過閘門控制理論、促進副交感神經活動、改變身體化學物質、產生機械性效應及促進睡眠之機轉達到緩解疼痛，同時，按摩對於癌症病人其它生理及心理症狀不適、降低壓力或提升免疫力有其正向效益。為了符合實證護理及達到按摩之最大效益，經過訓練之護理人員或家屬，須確實遵守標準化安全性評估及按摩流程、環境準備、考量合適之按摩時段、方式及時間長短、按摩合併其它輔助治療，臨床實務者才能將「按摩」有效性轉譯應用於臨床照護中，進而提升對癌痛病人及其家屬之照護品質。

Pain occurs in approximately 25% of patients with newly diagnosed cancer, 33% of patients undergoing cancer treatment, and 75% of patients in the advanced stages of cancer. Pain may disrupt activities of daily living and degrade quality of life. Educating patients and their caregivers about non-pharmacological pain management (i.e., massage) is a function of oncology nursing. Massage is one intervention used in pain relief. A number of pain-relief-related mechanisms of massage have been posited including: gate control, the promotion of para-sympathetic activity, influence on body chemistry, mechanical effects, and the promotion of restorative sleep. In addition to pain relief, massage has been shown to positively affect both physical and psychological-related symptom distress, to decrease stress, and to improve immunity. In order to reflect evidence-based nursing principles and achieve optimal efficacy, trained nurses or caregivers must follow standardized safety and massage protocols as well as establish an appropriate therapeutic environment, set an appropriate massage duration, use appropriate techniques, and consider the concurrent use of appropriate complementary alternative medicine techniques/therapies. As a result, clinicians may effectively translate current research evidence into best practices and improve the pain management efficacy of cancer patients and their caregivers.