Hjermstad M J, Gibbins J, Haugen D F, Caraceni A, Loge J H, Kaasa S
Department of Oncology, Ullevaal University Hospital, Oslo.
Palliat Med. 2008 Dec;22(8):895-903. doi: 10.1177/0269216308095701. Epub 2008 Sep 17.
At present, there is no universally accepted cancer pain assessment tool for use in palliative care (PC). The European Palliative Care Research Collaborative (EPCRC), therefore, aims to develop an international consensus-based computerised pain assessment tool. As part of this process, we have performed (1) a literature review on pain assessment tools for use in the PC and (2) an international expert survey to gain information on the relevant dimensions for pain assessment in PC. 230 publications were identified, only six met the inclusion criteria. Three further articles were identified through manual searching, totalling 11 different pain assessment tools. Nine tools were multidimensional. Pain intensity was assessed in seven, using various numerical/verbal rating scales (NRS/VRS); five tools focused on pain management. Three publications did not identify the rationale for the need to develop a new tool, and the selection procedure for items/dimensions was not described in six tools. Patient and/or professional expert groups were involved in the development of five tools and only two tools were extensively validated or cross-culturally tested. Thirty-two experts (71%) completed the expert survey and identified 'intensity', 'temporal pattern', 'relief/exacerbation', 'pain quality' and 'location' as the five most relevant dimensions. Most preferred assessment of 'pain intensity' was by NRS rather than VRS. Time windows extending 24 h were regarded as less relevant. Development of PC pain assessment tools seems to be a continuous process, which does not adhere to systematic guidelines, thus does not contribute to a universally accepted tool. No tool contained all relevant dimensions as defined by the experts. Many tools focused on particular dimensions, suggesting that specific research interests may drive the tool development process. Extensive literature reviews, expert and patient input and clinical studies are a needed approach in the development of a new consensus-based pain assessment tool.
目前，尚无一种在姑息治疗（PC）中被普遍接受的癌症疼痛评估工具。因此，欧洲姑息治疗研究协作组（EPCRC）旨在开发一种基于国际共识的计算机化疼痛评估工具。作为该过程的一部分，我们进行了（1）一项关于姑息治疗中使用的疼痛评估工具的文献综述，以及（2）一项国际专家调查，以获取有关姑息治疗中疼痛评估相关维度的信息。共识别出230篇出版物，只有6篇符合纳入标准。通过手工检索又识别出3篇文章，总计11种不同的疼痛评估工具。9种工具是多维的。7种工具使用各种数字/语言评定量表（NRS/VRS）评估疼痛强度；5种工具侧重于疼痛管理。3篇出版物未明确开发新工具的必要性的理论依据，6种工具未描述项目/维度的选择程序。患者和/或专业专家小组参与了5种工具的开发，只有2种工具经过了广泛验证或跨文化测试。32位专家（71%）完成了专家调查，并确定“强度”“时间模式”“缓解/加重”“疼痛性质”和“部位”为五个最相关的维度。对“疼痛强度”的最优选评估方式是NRS而非VRS。延长至24小时的时间窗被认为相关性较低。姑息治疗疼痛评估工具的开发似乎是一个持续的过程，该过程未遵循系统的指南，因此无助于形成一种被普遍接受的工具。没有一种工具涵盖专家定义的所有相关维度。许多工具侧重于特定维度，这表明特定的研究兴趣可能推动工具的开发过程。广泛的文献综述、专家和患者的投入以及临床研究是开发一种新的基于共识的疼痛评估工具所需的方法。
