Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada M4N 3M5.
J Pain Symptom Manage. 2010 Feb;39(2):259-67. doi: 10.1016/j.jpainsymman.2009.07.005.
The Pain Management Index (PMI) is a simple index linking the usual severity of cancer pain with the category of medication prescribed to treat it. Medication categories are derived from the World Health Organization's "analgesic ladder" approach to cancer pain, and the PMI is an indicator of the extent to which the medication prescribed corresponds to the recommended categories for mild, moderate, and severe pain.
The aim of this study was to assess prevalence of inadequate pain management in an outpatient palliative radiotherapy clinic using the PMI.
All patients with bone metastases referred for palliative radiotherapy from 1999 to 2006 were retrospectively analyzed for patient-rated pain scores (0-10 scale) and analgesic consumption. Pain scores were assigned 0, 1, 2, and 3 when patients reported no pain (0), mild (1-4), moderate (5-6), or severe pain (7-10), respectively. Analgesic scores of 0, 1, 2, and 3 were assigned when patients were prescribed no pain medication, nonopioids, "weak" opioids, and "strong" opioids, respectively. The PMI score was calculated by subtracting the pain score from the analgesic score. A negative PMI score was considered an indicator of potentially inadequate pain management by the prescriber. Descriptive statistics, Pearson's r correlation, and univariate and multivariate logistic regression analysis were used to determine the relationship of PMI over time, and the relationship with predictive factors.
One thousand patients were included from January 1999 to December 2006. A negative PMI was calculated for 25.8% of patients at initial consultation. Prevalence of negative PMI significantly increased over years (P<0.0001). Higher Karnofsky Performance Status (P<0.0001) and breast primary cancer site (P<0.0001) were significantly associated with negative PMI after adjusting for year variable.
Despite publication of numerous cancer pain management guidelines, undermedication appears to be a persistent problem for patients with painful bone metastases referred for radiotherapy.
疼痛管理指数（PMI）是一个简单的指数，将癌症疼痛的通常严重程度与用于治疗它的药物类别联系起来。药物类别源自世界卫生组织的“癌症疼痛镇痛阶梯”方法，PMI 是衡量所开药物与轻度、中度和重度疼痛推荐类别的对应程度的指标。
本研究旨在使用 PMI 评估姑息性放疗门诊中治疗不足的疼痛管理的发生率。
对 1999 年至 2006 年间因骨转移而接受姑息性放疗的所有患者进行回顾性分析，评估患者自评疼痛评分（0-10 分）和镇痛药消耗情况。当患者报告无疼痛（0）、轻度（1-4）、中度（5-6）或重度疼痛（7-10）时，疼痛评分分别赋值为 0、1、2 和 3。当患者开无疼痛药物、非阿片类药物、“弱”阿片类药物和“强”阿片类药物时，分别赋值为 0、1、2 和 3。PMI 评分通过从镇痛评分中减去疼痛评分来计算。负的 PMI 评分被认为是医生开具药物不足的潜在指标。采用描述性统计、Pearson r 相关、单变量和多变量逻辑回归分析来确定 PMI 随时间的关系，以及与预测因素的关系。
1999 年 1 月至 2006 年 12 月期间共纳入 1000 例患者。25.8%的患者在初次就诊时计算出负的 PMI。负的 PMI 的发生率随着时间的推移显著增加（P<0.0001）。经过年份变量调整后，较高的 Karnofsky 表现状态（P<0.0001）和乳腺癌原发部位（P<0.0001）与负的 PMI 显著相关。
尽管发布了许多癌症疼痛管理指南，但对于因骨转移而接受放疗的患者来说，药物不足似乎仍然是一个持续存在的问题。
Zotero 插件