Chaplin J M, Morton R P
Department of Otolaryngology Head and Neck Surgery, Green Lane Hospital, Green Lane, Auckland, New Zealand.
Head Neck. 1999 Sep;21(6):531-7. doi: 10.1002/(sici)1097-0347(199909)21:6<531::aid-hed6>3.0.co;2-m.
Little is known about the epidemiology of pain in head and neck cancer, the effects of curative treatment on this pain, and the impact that pain experience may have on patients' quality of life (QL).
The prevalence and severity of pain was studied in 93 patients who were first seen with a diagnosis of head and neck cancer, were treated, and remained disease free at two years. QL assessment utilised the life-satisfaction scale and the General Health Questionnaire as specific measures. Pain was assessed by a linear analogue scale anchored by words and numbers.
Forty-eight percent had head and neck pain when first seen, whereas only 25% and 26% had such pain at 12 and 24 months. Approximately 8% of patients rated the pain as "severe" when first seen, whereas 3% had severe pain at 12 months and 4% at 2 years. The prevalence of shoulder and arm pain increased from 14% at diagnosis to 37% at a year and 26% at 24 months, but the percentage of patients with severe pain at any stage postoperatively was only 5% and 2%, respectively. Any pain (pain in either in the head and neck or shoulder and arm or both) at 2 years was strongly predicted by earlier posttreatment pain (at 3 months or at 12 months.) Shoulder and arm pain at 2 years was strongly correlated with surgical treatment of the neck, although no difference in pain experience was noted between those who had radical neck dissections and those who had more conservative procedures. There was no correlation between radiotherapy to the neck and subsequent shoulder and arm pain. Pain had an adverse effect on the general well-being and psychological distress of head and neck cancer patients who were free of disease.
Pain is common among those presenting with curable head and neck cancer. Pain can be reduced by curative treatment but neck dissection may cause increased shoulder and arm pain. Ongoing pain is predictable and impacts adversely on patients QL.
关于头颈癌疼痛的流行病学、根治性治疗对这种疼痛的影响以及疼痛体验对患者生活质量（QL）的影响，人们了解甚少。
对93例初诊为头颈癌、接受治疗且两年后无疾病的患者的疼痛患病率和严重程度进行了研究。QL评估采用生活满意度量表和一般健康问卷作为具体测量方法。疼痛通过由文字和数字标定的线性模拟量表进行评估。
初诊时48%的患者有头颈疼痛，而在12个月和24个月时分别只有25%和26%的患者有此类疼痛。初诊时约8%的患者将疼痛评为“严重”，而在12个月时为3%，2年时为4%。肩臂疼痛的患病率从诊断时的14%增加到1年时的37%和24个月时的26%，但术后任何阶段严重疼痛的患者百分比分别仅为5%和2%。两年时的任何疼痛（头颈或肩臂或两者疼痛）都可由早期治疗后疼痛（3个月或12个月时）强烈预测。两年时的肩臂疼痛与颈部手术治疗密切相关，尽管在接受根治性颈清扫术的患者和接受更保守手术的患者之间未观察到疼痛体验的差异。颈部放疗与随后的肩臂疼痛之间无相关性。疼痛对无疾病的头颈癌患者的总体幸福感和心理困扰有不利影响。
疼痛在可治愈的头颈癌患者中很常见。根治性治疗可减轻疼痛，但颈清扫术可能导致肩臂疼痛增加。持续性疼痛是可预测且对患者QL有不利影响。
