疼痛對癌症病人的情緒衝擊

The Emotional Effects of Pain in Oncology Patients

背景：癌症疼痛的處理面對很多的挑戰，癌症病人面對疼痛衍生的情緒衝擊，可能影響藥物處置的成效，增加疼痛處理的複雜性，在癌痛控制過程中情緒處理扮演重要角色。目的：本文旨在探討癌症病人的疼痛感受及其對情緒狀態的衝擊。方法:採描述性相關性研究，使用簡明疼痛量表(0-10計分)及醫院焦慮憂鬱量表，取北部某教學醫院共109位癌症疼痛病人為研究對象。結果：病人焦慮平均得分為7.38(SD=4.29)，憂鬱平均得分為10.50(SD=3.95)。最劇烈疼痛程度為6.81(SD=0.24)，最輕疼痛程度為1.75(SD=0.18)，平均疼痛程度為4.14(SD=0.21)，現在疼痛程度為2.53(SD=0.21)，日常生活受影響程度為3.50。鼻咽癌病人(F=3.02至4.01,p<.05)、有宗教信仰者(t=-2.00,p<.05)、與他人同住者(t=-2.07至-2.24,p<.05)、經濟來源倚賴他人者(t=-2.18,p<.05)有顯著較高的疼痛感受。病人的焦慮與疼痛感受(r=.19至.23,p<.05)及疼痛干擾(r=.33,p<.001)呈顯著正相關，而病人的憂鬱與疼痛感受(r=.19,p<.05)及疼痛干擾(r=.23,p<.05)亦呈顯著正相關。結論/實務應用：本研究結果顯示癌症病人疼痛的心理面向經驗，建議疼痛控制除藥物介入，應涵蓋情緒之評估處理，護理教育養成過程，應培育護生及相關專業人員多層面癌痛評估及處理之概念。

Background: Pain management faces many challenges. Emotional experience of pain by oncology patients often impacts the efficacy of pharmacological agents and therefore increases the complexity of pain control. Emotional support plays a key role in the pain management of cancer patients. Purpose: The aim of this study is to understand the perception and emotional impact of pain in cancer patients. Methods: The cross-sectional study included 109 oncology patients experiencing pain at a teaching hospital in Taipei, Taiwan. The research instruments included the Brief Pain Inventory-Chinese (BPI-Chinese, 0-10) and the Hospital Anxiety and Depression Scale-Chinese (HADS-Chinese). Results: Patients reported an average anxiety score of 7.38 (SD= 4.29) and a depression score of 10.50 (SD= 3.95). Patients reported a mean score of 6.81 (SD= 0.24) for the most severe pain experienced, while the mean score for the least amount of pain was 1.75 (SD= 0.18). The mean current pain was 2.53 (SD= 0.21), and the average pain intensity was 4.14 (SD= 0.21). The degree of influence on everyday life was 3.50 (SD= 0.22). Patients with nasopharyngeal cancer (F= 3.02 to 4.01, p<.05), religious patients (t= -2.00, p<.05), patients living with others (t= -2.07 to -2.24, p<.05), and patients financially supported by others (t= -2.18, p<.05) experienced a higher level of perceived pain when compared to other patients. In addition, anxiety demonstrated a significantly positive relationship with pain perception (r= .19 to .23, p<.05) and pain interference (r= .33, p<.001). Depression also demonstrated a significant positive relationship with pain perception (r = 0.19, p <.05) and pain interference (r= .23, p<.05). Conclusions: This study reports the psychological experience of pain in cancer patients and recommends emotional support in addition to pharmacological agents for effective pain control. Nursing education should further emphasize the importance of multidisciplinary pain management.