病人疼痛特質與疼痛信念對手術後使用止痛藥物之影響

Effects of Patient's Pain Characteristics and Beliefs on Application of Postoperative Analgesics

本研究目的為探討胃部術後病患；（1）使用藥物因應其疼痛問題的現況，（2）對疼痛及麻醉性止痛藥的信念，及（3）診斷特質與對麻醉性止痛藥及術後疼痛之信念對其使用止痛藥因應術後疼痛間之相關性。本研究採橫斷式相關性研究設計，以北部四所教學醫院中126名曾接受胃部術後病思為對象，以疼痛評估表、疼痛及麻醉性止痛藥信念量表－手術疼痛版、簡易疼痛因應策略量表之藥物因應子量表進行結構性問卷訪談，資料以描述性統計、Spearman相關及逐步迴歸分析。結果顯示（1）本研究個案之平約疼痛強度為輕度，而最痛疼痛強度則介於中等至嚴重之間；（2）個案普遍有負向的疼痛及麻醉性止痛藥疼痛信念，尤其有偏高的忍耐疼痛信念；（3）有愈高的最痛疼痛強度及平均疼痛強度、診斷為癌症者、愈正向的疼痛及麻醉性止痛藥信念，則較會使用止痛藥因應其術後疼痛。本研究結果支持疼痛信念、疼痛強度及診斷別均是影響其術後使用止痛藥的因素，因此臨床照護中應同時評估及處理該相關因素，以促進病人更有效地使用止痛藥。

This research aims to study, in postoperative gastric patients: (1) Their actual use of drugs in response to pain, (2) Beliefs about pain and opioid analgesics, and (3) Correlation between their individual diagnosis and beliefs about opioid analgesics and postoperative pain, and their application of analgesics for postoperative pain. A cross-sectional descriptive design and purposive sampling were applied in this research to conduct structured questionnaire interviews using the Pain Assessment Form (PAF), Pain and Opioid Analgesics Beliefs Scale-Surgical Pain Version (POABS-SP) and Brief Pain Coping Inventory-Pharmacological Pain Coping (BPCI-PPC) with postoperative gastric patients at four teaching hospitals in northern Taiwan. Descriptive statistics and Spearman correlative and stepwise regression were used for data analysis and a total of 126 patients were interviewed. The results of some individual cases in this research show that: (1) patients sensed small “pain intensity cm average and moderate to severe worst pain intensity’, (2) patients generally had negative pain beliefs, especially beliefs about higher tolerance to pain, about pain and opioid analgesics, and (3) patients with high worst pain intensity and pain intensity on average, who had been diagnosed with cancer or who had positive beliefs about pain and opioid analgesics would be more likely to use analgesics for postoperative pain relief. The research results also support the view that pain beliefs, pain intensity and diagnosis type are influential factors for the application of analgesics after surgery. Therefore, it is necessary to evaluate and also to deal with these related factors during clinical care so as to allow patients to use analgesics more effectively.