McHugh G A, Luker K A, Campbell M, Kay P R, Silman A J
School of Nursing, Midwifery and Social Work, University of Manchester, Oxford Road, Manchester M13 9PL, UK.
Rheumatology (Oxford). 2007 Apr;46(4):631-7. doi: 10.1093/rheumatology/kel355. Epub 2006 Oct 14.
To investigate the level of pain control, treatment and service provision amongst individuals with end-stage lower limb osteoarthritis who were on the waiting list for hip or knee joint replacement.
A total of 105 patients on a waiting list for primary knee or hip replacement from a regional orthopaedic centre in the UK were recruited. The study was longitudinal and based on direct interviews at baseline and 6 months, with a postal questionnaire at 3 months. Data were collected on pain by a visual analogue scale (VAS) and the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index. In addition, medication and the use of services and treatments were recorded.
Participants experienced high levels of pain as measured by VAS [mean 7.0; 95% confidence interval (CI) 6.6-7.5] and WOMAC pain (mean 11.2; 95% CI 10.6-11.9). The majority of participants (78, 74%) was taking analgesics more than once a day. Primary care utilization was variable. Of the 74 (70%) participants who had consulted their GP in the previous 3 months, 41 (55%) had not discussed their pain or osteoarthritis during these consultations. Just below one-third of participants (31, 30%) reported to have received information on osteoarthritis.
Pain appears to be difficult to manage in individuals with end-stage lower limb osteoarthritis. Individuals appeared not to be taking appropriate levels of analgesia in relation to levels of pain. Improvements are required in the provision of information on pain and osteoarthritis. Patients would benefit from more proactive management by health professionals (especially by GPs).
调查在等待髋关节或膝关节置换手术的终末期下肢骨关节炎患者中疼痛控制、治疗及服务提供的情况。
从英国一个地区骨科中心招募了105名等待初次膝关节或髋关节置换手术的患者。该研究为纵向研究，基于基线时和6个月时的直接访谈，并在3个月时进行邮寄问卷调查。通过视觉模拟量表（VAS）和西安大略和麦克马斯特大学（WOMAC）骨关节炎指数收集疼痛数据。此外，记录用药情况以及服务和治疗的使用情况。
通过VAS测量（平均7.0；95%置信区间[CI] 6.6 - 7.5）以及WOMAC疼痛评分（平均11.2；95% CI 10.6 - 11.9）发现，参与者经历了高水平的疼痛。大多数参与者（78名，74%）每天服用镇痛药超过一次。初级医疗保健的利用率各不相同。在过去3个月中咨询过全科医生（GP）的74名（70%）参与者中，41名（55%）在这些咨询中未讨论过他们的疼痛或骨关节炎。略低于三分之一（31名，30%）的参与者报告收到过有关骨关节炎的信息。
终末期下肢骨关节炎患者的疼痛似乎难以控制。就疼痛程度而言，患者似乎未服用适当剂量的镇痛药。在提供有关疼痛和骨关节炎的信息方面需要改进。患者将受益于医疗专业人员（尤其是全科医生）更积极主动的管理。
