癌症病人經定期評估及治療後的疼痛改善：某醫學中心的一項前瞻性研究

Pain Improvement of Cancer Patients After Regular Assessments and Treatments: A Prospective Study in a Medical Center

背景：在台灣，仍然缺乏關於良好疼痛管理（GPM）的臨床資料。本研究的目的是調查GPM的有效性和可行性。方法：自2018年6月1日至2018年12月31日，前瞻性納入48位中至重度疼痛病人。以數字評分量表評估疼痛。在剛住院時使用Douleur Neuropathique 4問卷。初次入院時，入院後第24±4小時，48±4小時和72±4小時使用包括六個核心品質指標的修訂版《美國疼痛學會患者結果調查表》。結果：男26例，女22例。照護治療後，整體病人的疼痛得到顯著改善。有6名病人未達到疼痛控制333指標。研究結束後，病人分為兩組：疼痛控制良好組（NRS＜4，n＝42）。和控制不良組（NRS≥4，n＝6）。只有一名神經疼痛病人。在四個時間點，控制不佳組的情緒影響評分略高於控制良好組。疾病嚴重度及藥物副作用對疼痛影響不明顯。結論：實施GPM對中度至重度癌症疼痛有效且可行。如果控制不好，可考慮心理諮詢和必要介入措施。

Background: Clinical practice data about good pain management (GPM) implementation is still lacking in Taiwan. The purpose of this study is to investigate the effectiveness and feasibility of GPM. Methods: From June 1, 2018 to December 31, 2018, a total of 48 patients with moderate to severe pain were included in the analyses prospectively. Pain intensity was evaluated by using the numerical rating scale (NRS). Presence of neuropathic pain was evaluated by using the Douleur Neuropathique 4 questionnaire. The Revised American Pain Society Patient Outcome Questionnaire, including six core quality indicators, was filled out during initial admission, 24±4 hours, 48±4 hours, and 72±4 hours after admission. Results: There were 26 males and 22 females. The types of cancer were mainly pancreatic cancer (37.5%), head and neck cancer (16.6%) and gastric cancer (16.6%). Our patients experienced a significant pain improvement after regular assessments and pain medication adjustment (p< 0.05; Table 3, Figure 1). Six patients failed to reach the 333 index of cancer pain control. After completion of the study, our patients were divided into two groups: well-controlled group (NRS<4, n=42) and poorly-controlled group (NRS≥4, n=6). The average age was 55.0 in well-controlled group and 53.5 in poorly-controlled group. Only one patient was eligible for neuropathic pain. In the poorly-controlled group, the emotional impact severity scores were slightly higher than those of the well-controlled group at the four survey time points (Figure 4). The impacts of disease severity and drug side effects on pain were unremarkable (Figure 3, Figure 5). Conclusion: Our study suggest GPM implementation is effective and feasible for moderate to severe cancer pain. If the patient's pain is not well controlled, psychological counseling and necessary interventions might be considered.