Rosemann Thomas, Joos Stefanie, Koerner Thorsten, Heiderhoff Marc, Laux Gunter, Szecsenyi Joachim
Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany.
Eur Spine J. 2006 Nov;15(11):1737-41. doi: 10.1007/s00586-006-0068-1. Epub 2006 Feb 7.
Despite dissuasive recommendations, intramuscular (i.m.) injections of NSAIDS are still a widespread treatment of acute pain in General Practice as well as among orthopaedic physicians. Most physicians argue that patients who are used to receive NSAIDS i.m. would insist on this application mode while being convinced of its therapeutic superiority for pain relief. Therefore, the aim of the study was to find out if patients' decision can be influenced towards an oral application by receiving a simple information leaflet. An information leaflet, providing information about the risks of NSAIDS particularly in case of i.m. application was provided to 161 patients with acute low back pain. Decision in favour or against i.m. application of NSAIDS was documented. Severity of disease was assessed by the Roland Morrison pain questionnaire and visual analogue scale (VAS) at the first visit and again 3-5 days later. From May to December 2004, 161 patients, visiting their GP (13 practices) with acute pain and demanding an injection were included in the study. After reading the information leaflet, 139 of the 161 (86.3%) patients decided for an oral application instead of receiving an injection of NSAIDS as in the past. This effect was statistically significant (P</=0.01). Of the initial 161 patients, 156 could be re-evaluated and no significant differences in the VAS and the Roland Morris Score between the patients with oral and i.m. application mode could be found. Only 2 patients of the 139 who decided for oral application indicated that they would opt for an i.m. injection next time. Our study demonstrates that patients' decision can be influenced even in case of severe pain by providing adequate information on a short information leaflet. The results should help to reduce physicians' fear of losing patients when not following their demand for i.m. injections and therefore enable a safer pain treatment.
尽管有劝阻性建议，但在全科医疗以及骨科医生中，肌肉注射非甾体抗炎药（NSAIDS）仍是治疗急性疼痛的一种广泛应用的方法。大多数医生认为，习惯接受肌肉注射NSAIDS的患者会坚持这种用药方式，同时坚信其在缓解疼痛方面的治疗优势。因此，本研究的目的是探究通过提供一份简单的信息手册，是否能影响患者选择口服给药。向161例急性下背痛患者提供了一份信息手册，其中介绍了NSAIDS的风险，尤其是肌肉注射时的风险。记录了患者对是否接受肌肉注射NSAIDS的决定。在首次就诊时以及3 - 5天后，通过罗兰·莫里森疼痛问卷和视觉模拟量表（VAS）评估疾病的严重程度。2004年5月至12月，161例因急性疼痛前来就诊全科医生（13个诊所）并要求注射的患者被纳入研究。阅读信息手册后，161例患者中有139例（86.3%）决定改为口服给药，而不是像过去那样接受NSAIDS注射。这种效果具有统计学意义（P≤0.01）。在最初的161例患者中，156例可以进行重新评估，口服给药和肌肉注射给药方式的患者在VAS和罗兰·莫里斯评分方面未发现显著差异。在决定口服给药的139例患者中，只有2例表示下次会选择肌肉注射。我们的研究表明，即使在疼痛严重的情况下，通过在简短的信息手册中提供充分的信息，也可以影响患者的决定。这些结果应有助于减少医生因不遵循患者肌肉注射的要求而担心失去患者的顾虑，从而实现更安全的疼痛治疗。
