Portenoy R K, Payne D, Jacobsen P
Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY 10003, USA.
Pain. 1999 May;81(1-2):129-34. doi: 10.1016/s0304-3959(99)00006-8.
Few surveys have been performed to define the characteristics and impact of breakthrough pain in the cancer population. In this cross-sectional survey of inpatients with cancer, patients responded to a structured interview (the Breakthrough Pain Questionnaire) designed to characterize breakthrough pain, and also completed measures of pain and mood (Memorial Pain Assessment Card (MPAC)), pain-related interference in function (Brief Pain Inventory (BPI)), depressed mood (Beck Depression Inventory (BDI)), and anxiety (Beck Anxiety Inventory (BAI)). Of 178 eligible patients, 164 (92.2%) met the criteria for controlled background pain. The median age was 50.6 years (range 26 to 77 years), 52% were men, and 80.6% were Caucasian. Tumor diagnoses were mixed, 75% had metastatic disease, 65% had pain caused directly by the neoplasm, and a majority had mixed nociceptive-neuropathic pain. The median Karnofsky Performance Status score was 60 (range 40 to 90). Eighty-four (51.2%) patients had experienced breakthrough pain during the previous day. The median number of episodes was six (range 1 to 60) and the median interval from onset to peak was 3 min (range 1 s to 30 min). Although almost two-thirds (61.7%) could identify precipitants (movement 20.4%; end-of-dose failure 13.2%), pain was unpredictable in a large majority (78.2%). Patients with breakthrough pain had more intense (P < 0.001) and more frequent (P < 0.01) background pain than patients without breakthrough pain. Breakthrough pain was also associated with greater pain-related functional impairment (difference in mean BPI. P < 0.001), worse mood (mood VAS, P < 0.05; BDI, P < 0.001), and more anxiety (BAI, P < 0.001). Multivariate analysis confirmed that breakthrough pain independently contributed to impaired functioning and psychological distress. These data confirm that cancer-related breakthrough pain is a prevalent and heterogeneous phenomenon. The presence of breakthrough pain is a marker of a generally more severe pain syndrome, and is associated with both pain-related functional impairment and psychological distress. The findings suggest the need for further studies of breakthrough pain and more effective therapeutic strategies.
很少有调查来确定癌症患者中爆发性疼痛的特征和影响。在这项针对癌症住院患者的横断面调查中，患者对旨在描述爆发性疼痛特征的结构化访谈（爆发性疼痛问卷）做出了回应，并且还完成了疼痛和情绪测量（纪念疼痛评估卡（MPAC））、疼痛对功能的相关干扰（简明疼痛量表（BPI））、抑郁情绪（贝克抑郁量表（BDI））以及焦虑（贝克焦虑量表（BAI））。在178名符合条件的患者中，164名（92.2%）符合背景疼痛得到控制的标准。中位年龄为50.6岁（范围26至77岁），52%为男性，80.6%为白种人。肿瘤诊断情况各异，75%患有转移性疾病，65%的疼痛由肿瘤直接引起，大多数患者患有混合性伤害感受性 - 神经病理性疼痛。卡诺夫斯基功能状态评分的中位数为60（范围40至90）。84名（51.2%）患者在前一天经历过爆发性疼痛。发作次数的中位数为6次（范围1至60次），从发作到峰值的中位间隔时间为3分钟（范围1秒至30分钟）。尽管近三分之二（61.7%）的患者能够识别诱发因素（活动占20.4%；剂量末期失效占13.2%），但绝大多数患者（78.2%）的疼痛是不可预测的。与没有爆发性疼痛的患者相比，有爆发性疼痛的患者背景疼痛更强烈（P < 0.001）且更频繁（P < 0.01）。爆发性疼痛还与更严重的疼痛相关功能损害（平均BPI差异，P < 0.001）、更差的情绪（情绪视觉模拟评分，P < 0.05；BDI，P < 0.001）以及更多的焦虑（BAI，P < 0.001）相关。多变量分析证实，爆发性疼痛独立导致功能受损和心理困扰。这些数据证实，与癌症相关的爆发性疼痛是一种普遍且异质性的现象。爆发性疼痛的存在是一般更严重疼痛综合征的一个标志，并与疼痛相关的功能损害和心理困扰都有关联。研究结果表明需要对爆发性疼痛进行进一步研究以及更有效的治疗策略。
