Drayer R A, Henderson J, Reidenberg M
Department of Pharmacology, Cornell University Medical College, New York, NY 10021, USA.
J Pain Symptom Manage. 1999 Jun;17(6):434-40. doi: 10.1016/s0885-3924(99)00022-6.
Pain is often inadequately treated. To evaluate a common method of assessing pain and to identify some barriers to improving pain control, 50 hospitalized patients in pain, their nurses, and their physicians were interviewed about the pain experienced by the patients. The patients' "pain behavior" was assessed and literatures was reviewed to identify the risk for developing iatrogenic drug addiction in patients with no prior history of drug abuse. Doctors and nurses tended to assess pain intensity as less than the patients' assessments. The doctor's and nurse's assessment of the same patient correlated poorly (r = 0.21). Pain behavior correlated weakly (rs = 0.36) with patients' pain scores. Twenty-one patients wanted more pain medicine but often staff would not give more. A common reason was fear of addiction, notwithstanding a literature that iatrogenic addiction hardly ever occurs in usual hospitalized patients. Barriers to better pain control in acutely hospitalized patients include: (1) exaggerated fear of iatrogenic addiction, (2) an attitude among staff that patients exaggerate the intensity of their pain, (3) poor correlation between pain behavior and pain intensity that can mislead staff who rely on pain behavior to assess pain intensity, and (4) a lack of agreement between doctor and nurse in estimating the intensity of a patient's pain. A new way of thinking about patients in pain, assessing pain as either present or absent, is proposed for evaluation. If pain is present, one should attempt to ameliorate it in a manner consistent with the desire of the patient and the acceptability of adverse effects.
疼痛常常得不到充分治疗。为了评估一种常见的疼痛评估方法，并找出改善疼痛控制的一些障碍，我们对50名住院的疼痛患者、他们的护士和医生进行了访谈，询问患者所经历的疼痛情况。对患者的“疼痛行为”进行了评估，并查阅文献以确定无药物滥用史的患者发生医源性药物成瘾的风险。医生和护士倾向于将疼痛强度评估得低于患者的评估。医生和护士对同一患者的评估相关性较差（r = 0.21）。疼痛行为与患者的疼痛评分相关性较弱（rs = 0.36）。21名患者想要更多的止痛药，但工作人员通常不会给予更多。一个常见的原因是担心成瘾，尽管文献表明医源性成瘾在普通住院患者中几乎从未发生过。急性住院患者更好地控制疼痛的障碍包括：（1）对医源性成瘾的过度恐惧；（2）工作人员认为患者夸大疼痛强度的态度；（3）疼痛行为与疼痛强度之间的相关性较差，这可能会误导依赖疼痛行为来评估疼痛强度的工作人员；（4）医生和护士在估计患者疼痛强度方面缺乏一致性。本文提出了一种新的思考疼痛患者的方式，即评估疼痛是否存在，以供评估。如果存在疼痛，应尝试以符合患者意愿和不良反应可接受性的方式缓解疼痛。
