Lundorff L, Peuckmann V, Sjøgren P
Department of Palliative Care, Herning Hospital, Herning, Denmark.
Acta Anaesthesiol Scand. 2008 Jan;52(1):137-42. doi: 10.1111/j.1399-6576.2007.01522.x. Epub 2007 Nov 13.
To evaluate the performance and quality of cancer pain management in hospital settings.
Anaesthesiologists specialised in pain and palliative medicine studied pain management in departments of oncology and surgery. Study days were randomly chosen and patients treated with oral opioids were included. Information regarding pain aetiology and mechanisms, pain medications and opioid side effects were registered from the medical records and by examining patients. Pain intensity was assessed using the Brief Pain Inventory.
In total, 59 cancer patients were included. In 49 (83%) patients pain aetiology was assessed by the physicians of the departments of oncology and surgery. In only 19 (32%) patients they assessed pain mechanisms. The median oral morphine dose was 120 mg/day (range: 10-720 mg/day). Seventy-eight per cent of patients received opioids at adequate regular intervals according to the duration of action. In 88% of the patients supplemental short-acting oral opioids were given on demand and the median supplemental oral dose was 16.5% of the daily dose. Seven patients with neuropathic pain received adjuvant drugs, whereas six patients with non-neuropathic pain received adjuvant drugs. Regarding opioid side effects only constipation and nausea were treated in the majority of the patients. Average pain intensity in the last 24 h for the total number of patients (n=59) < or =5 cm was 88.1% (confidence interval 77.1-95.1).
Cancer pain was prevalent in opioid-treated patients in hospital settings: however, focussing on average pain intensity, the outcome seems favourable compared with other countries. Pain mechanisms were seldom examined and adjuvant drugs were not specifically used for neuropathic pain. Opioid dosing intervals and supplemental opioid doses were most often adequate. However, opioid side effects were highly prevalent and most side effects were left untreated.
评估医院环境中癌症疼痛管理的绩效和质量。
专门从事疼痛与姑息医学的麻醉医师对肿瘤内科和外科的疼痛管理进行研究。随机选择研究日，纳入接受口服阿片类药物治疗的患者。从病历及检查患者中记录有关疼痛病因和机制、止痛药物及阿片类药物副作用的信息。使用简明疼痛量表评估疼痛强度。
共纳入59例癌症患者。49例（83%）患者的疼痛病因由肿瘤内科和外科医生评估。仅19例（32%）患者的疼痛机制得到评估。口服吗啡的中位剂量为120毫克/天（范围：10 - 720毫克/天）。78%的患者根据作用持续时间以适当的规律间隔服用阿片类药物。88%的患者按需给予补充短效口服阿片类药物，补充口服剂量的中位数为日剂量的16.5%。7例神经性疼痛患者接受了辅助药物治疗，而6例非神经性疼痛患者接受了辅助药物治疗。关于阿片类药物副作用，大多数患者仅接受了便秘和恶心的治疗。患者总数（n = 59）中，过去24小时平均疼痛强度≤5厘米的患者占88.1%（置信区间77.1 - 95.1）。
在医院环境中，阿片类药物治疗的患者中癌症疼痛普遍存在；然而，就平均疼痛强度而言，与其他国家相比结果似乎较好。疼痛机制很少被检查，辅助药物未专门用于神经性疼痛。阿片类药物给药间隔和补充阿片类药物剂量大多是合适的。然而，阿片类药物副作用非常普遍，大多数副作用未得到治疗。
