Niscola Pasquale, Cartoni Claudio, Romani Claudio, Brunetti Gregorio Antonio, D'Elia Gianna Maria, Cupelli Luca, Tendas Andrea, de Fabritiis Paolo, Mandelli Franco, Foà Robin
Haematology Division, Tor Vergata University, Sant'Eugenio Hospital, Rome, Italy.
Ann Hematol. 2007 Sep;86(9):671-6. doi: 10.1007/s00277-007-0296-4. Epub 2007 Apr 21.
We report on epidemiology, features, outcome, and domiciliary management of pain in patients with advanced hematological malignancies followed by an experienced hospital-based home care (HC) team. Out of 469 patients, 244 (52%) experienced a total of 284 pain syndromes. Pain intensity was rated from mild to moderate in 31% and from moderate to severe in 69% of them. The diagnosed pain mechanisms were deep somatic in 56%, superficial somatic in 15%, visceral 14%, mixed 8%, and neuropathic in 7% of pain syndromes, respectively. Incident pain was observed in 38% of all pain syndromes. In every diagnostic group, deep somatic pain was prevalent. Moreover, 85% of visceral pain syndromes were observed in patients affected by non-Hodgkin's lymphoma (NHL). In addition, out of 284 pain syndromes, 150 (51%) were caused by bone involvement. The most frequent recognized pain provocative mechanisms were bone marrow expansions, osteolysis, lymph node enlargement, and mucositis. In our experience, an approach based on the association of causal therapies and analgesics allows optimal control of most pain syndromes. Therefore, pain is a major problem in patients affected by advanced hematological malignancies, and its management can be effective and feasible when carried out by a skilled HC team.
我们报告了由经验丰富的医院居家护理（HC）团队随访的晚期血液系统恶性肿瘤患者疼痛的流行病学、特征、结局及居家管理情况。在469例患者中，244例（52%）共出现284种疼痛综合征。其中31%的患者疼痛强度为轻度至中度，69%为中度至重度。在诊断出的疼痛机制中，56%为深部躯体性疼痛，15%为浅表躯体性疼痛，14%为内脏性疼痛，8%为混合性疼痛，7%为神经性疼痛综合征。在所有疼痛综合征中，38%观察到新发疼痛。在每个诊断组中，深部躯体性疼痛最为普遍。此外，85%的内脏性疼痛综合征见于非霍奇金淋巴瘤（NHL）患者。另外，在284种疼痛综合征中，150种（51%）由骨受累引起。最常见的公认疼痛激发机制是骨髓扩张、骨质溶解、淋巴结肿大和黏膜炎。根据我们的经验，基于因果治疗与镇痛药联合的方法可实现对大多数疼痛综合征的最佳控制。因此，疼痛是晚期血液系统恶性肿瘤患者的一个主要问题，由专业的HC团队进行管理时，疼痛管理可以有效且可行。
