Larsson Annika, Wijk Helle
Sahlgrenska Academy, Institute of Health Care Sciences, Gothenburg University/Sahlgrenska University Hospital, Sweden, Göteborg, Sweden.
Pain Manag Nurs. 2007 Mar;8(1):12-6. doi: 10.1016/j.pmn.2006.12.001.
Cancer pain is a difficult symptom for patients to handle, causing patients extreme discomfort and a decreased quality of life. To support independent pain control for patients with refractory pain while staying in their home, an intrathecal approach for continuous pain management with patient-controlled extra doses from an external pump was implemented. Pain management was supported by a structured guideline for the nursing interventions: To enhance the understanding of how the patients experienced their pain and the continuous pain management at the end of life, a pilot study was conducted. The study followed a qualitative design with unstructured tape-recorded interviews. Three themes emerged from the analysis: (1) The pain was dreadful, reminding the patient of the cancer and the uncertainty of the future; (2) the need to reveal and conceal pain coexisted; and (3) the pain management and structured guideline contributed positively to gain a new perspective on health in which pain did not play the central role. The conclusion is that patients need to communicate their experiences of the pain to manage the pain adequately, while at the same time they need to conceal it to manage their everyday environment. Forthcoming research will focus on the relation between the pain and the way patients experience cancer and on the experience and specific needs of their family.
癌痛是患者难以应对的症状，会给患者带来极度不适并降低生活质量。为了支持难治性疼痛患者居家期间实现独立的疼痛控制，实施了一种鞘内给药方法，通过外部泵进行持续疼痛管理，并可由患者自控追加剂量。疼痛管理得到了护理干预结构化指南的支持：为了增强对患者如何体验疼痛以及临终时持续疼痛管理的理解，开展了一项试点研究。该研究采用定性设计，进行非结构化的录音访谈。分析得出了三个主题：（1）疼痛令人恐惧，使患者联想到癌症和未来的不确定性；（2）袒露与隐瞒疼痛的需求并存；（3）疼痛管理和结构化指南有助于积极地获得一种关于健康的新视角，其中疼痛并非核心要素。结论是，患者需要交流他们的疼痛体验以充分应对疼痛，与此同时，他们需要隐瞒疼痛以应对日常环境。后续研究将聚焦于疼痛与患者体验癌症的方式之间的关系，以及患者家庭的体验和特殊需求。
