按摩及音樂治療於成人慢性癌痛之實證臨床照護指引發展

The Development of Evidence-Based Clinical Guidelines for Massage and Music Therapy in Adult Patients with Chronic Cancer-Related Pain

背景：疼痛為癌症病人常發生的症狀困擾，對生理、情緒與生活品質造成影響。輔助性非藥物的因應處置，常受關注與應用上的詢問。
目的：以實證為基礎，經嚴謹評析步驟與工具，發展成人慢性癌痛運用按摩與音樂療法非藥物性措施的臨床照護指引與建議。
方法：以教學醫院實證研究中心成員組成指引發展小組，設定癌痛、按摩與音樂療法相關關鍵字，搜尋Embase、Cochrane、CINAHL、PubMed、Web of Science、PsycINFO、CEPS等電子資料庫，經發展者分別獨立進行判讀與綜整，應用GRADEpro GDT評析證據等級，小組分析並考慮利弊平衡和病人偏好與價值觀等因素，擬定臨床照護指引項目證據等級判定與建議形成。
結果：本文共納入按摩療法11篇、音樂療法7篇相關隨機臨床試驗與類實驗研究文獻，發表時間於2000年至2019年。以系統性文獻統整，擬定臨床照護指引具2A、1B與2B的證據強度相關建議共有5項，內容包括按摩或音樂療法的形式、時間與環境安排等。並進行內部與外部專家審查。
結論／實務應用：本照護指引發展整合文獻證據，具臨床專家共識與嚴謹度，推薦於臨床使用。按摩或音樂療法是安全的，能改善部分癌症病人的疼痛，建議作為癌痛輔助支持療法選擇。

Background : Chronic pain is a common symptom and discomfort of adult patients with cancer and would affect patients’physical, psychological and quality of life. Non-pharmacological adjuvant interventions such as massage or music have been often sought and inquired.
Purpose : The aim of the paper was to scrutinize the evidences and to establish clinical guideline recommendations on the use of massage and music therapies for adult patients with chronic cancer-related pain.
Methods : A panel group of members from a teaching-based hospital evidence research center was formed. Using the keywords group“cancer pain”、”massage”and“music therapy”to comprehensive search from Embase、Cochrane、CINAHL、PubMed、Web of Science、PsycINFO、CEPS databases to systematically synthesis the efficacy of massage and music therapies along with using GRADE tool for evaluating the level of evidence and their clinical recommendations for this population. To reach the consensus on the strength of evidence level, our working group initiates discussions on the appropriateness, level of evidence, clinical gains and losses, value and resources of the recommended content.
Results : A total of 11 articles of massage therapy and 7 articles of music therapy included for review; the overall recommended levels included 2A, 1B, and 2B.
Conclusions/Implications for Practice : Massage and music therapy seem to be safe for adult patients in terms of relieving chronic cancer-related pain and the authors recommended them could be considered as auxiliary supportive therapies.