Oldenmenger Wendy H, Sillevis Smitt Peter A E, van Dooren Silvia, Stoter Gerrit, van der Rijt Carin C D
Department of Medical Oncology, Erasmus MC, P.O. Box 5201, 3008 AE Rotterdam, The Netherlands.
Eur J Cancer. 2009 May;45(8):1370-80. doi: 10.1016/j.ejca.2009.01.007. Epub 2009 Feb 7.
The aim of this paper is to identify the major barriers hindering adequate pain management and critically review interventions aiming to overcome them. We searched relevant literature on PubMed published between January 1986 and April 2007. The most frequently mentioned barriers for both patients and professionals were knowledge deficits, inadequate pain assessment and misconceptions regarding pain. Four interventions were identified: patient education, professional education, pain assessment and pain consultation. These interventions were never combined in multidisciplinary study protocols. Most RCTs included small groups of patients and reported no power analysis. Studies on professional education and pain assessment did not evaluate patients' outcomes. In 5 of 11 RCTs on patient education, pain intensity decreased statistically significantly. In two RCTs on pain consultation, patients' pain decreased statistically significantly, although the adequacy of pain treatment did not change. In conclusion, international guidelines on multidisciplinary interventions in pain management are partly substantiated by clinical trials.
本文旨在确定阻碍充分疼痛管理的主要障碍，并批判性地审视旨在克服这些障碍的干预措施。我们检索了1986年1月至2007年4月期间发表在PubMed上的相关文献。患者和专业人员最常提到的障碍是知识缺陷、疼痛评估不足以及对疼痛的误解。确定了四种干预措施：患者教育、专业教育、疼痛评估和疼痛咨询。这些干预措施从未在多学科研究方案中结合使用。大多数随机对照试验纳入的患者群体较小，且未报告功效分析。关于专业教育和疼痛评估的研究未评估患者的结局。在11项关于患者教育的随机对照试验中，有5项试验的疼痛强度有统计学显著下降。在两项关于疼痛咨询的随机对照试验中，患者的疼痛有统计学显著减轻，尽管疼痛治疗的充分性没有改变。总之，疼痛管理多学科干预的国际指南部分得到了临床试验的证实。
