Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, D-10117, Berlin, Germany.
Eur J Pain. 2012 Mar;16(3):439-46. doi: 10.1002/j.1532-2149.2011.00029.x. Epub 2011 Dec 19.
Current knowledge about the quality and appropriateness of pharmacological pain treatment in nursing home residents (NHR), particularly in NHR with moderate to severe cognitive impairment, is poor.
This observational cross-sectional study assessed pain treatment in a random sample of NHR with or without cognitive impairment from nursing homes in Germany. Prescribed drugs, pain intensity and frequency, diagnoses, and surgical procedures and injuries during the last 4 weeks were documented. Quality and appropriateness of pain medication were assessed by analysis of pain medications and the Pain Medication Appropriateness Scale (PMAS) score (S(PMAS) ), with a cut-off value of >67% indicating appropriate pain treatment.
A total of 321 residents (62% women) were studied, including 152 (47%) with severe cognitive impairment. The most frequently prescribed analgesics were dipyrone, fentanyl, tramadol and ibuprofen. The mean S(PMAS) was 48.5 ± 1.5 (range, -33 to +100). Residents with prescribed scheduled analgesics had a significantly better S(PMAS) than patients without such treatment (S(PMAS) 58 ± 1.5 vs. 37 ± 2.5, p < 0.01). NHR without current pain had significantly better S(PMAS) than residents suffering from pain (S(PMAS) 47 ± 1.9 vs. 59 ± 4.2, p = 0.01). With an S(PMAS) of 69 ± 1.5, residents (n = 106) with scheduled pain medication plus PRN analgesics achieved the highest scores in the population. Overall, similar results were found in NHR with and in NHR without cognitive impairment.
Our study points to a significant deficit in pain treatment in German NHR, including NHR with or without cognitive impairment.
目前对于养老院居民（NHR），特别是中重度认知障碍的 NHR 中，药物止痛治疗的质量和适宜性知之甚少。
本观察性横断面研究评估了德国养老院中伴有或不伴有认知障碍的 NHR 的随机样本中的疼痛治疗情况。记录了过去 4 周内的处方药物、疼痛强度和频率、诊断以及手术程序和损伤情况。通过分析疼痛药物和疼痛药物适宜性量表（PMAS）评分（S（PMAS））评估疼痛药物的质量和适宜性，S（PMAS）＞67%表示疼痛治疗适宜。
共纳入 321 名居民（62%为女性），其中 152 名（47%）存在严重认知障碍。最常开的镇痛药是双氯芬酸、芬太尼、曲马多和布洛芬。平均 S（PMAS）为 48.5±1.5（范围-33 至+100）。接受定期镇痛治疗的患者 S（PMAS）明显高于未接受此类治疗的患者（S（PMAS）58±1.5 比 37±2.5，p＜0.01）。无当前疼痛的 NHR 的 S（PMAS）明显高于有疼痛的居民（S（PMAS）47±1.9 比 59±4.2，p=0.01）。接受定期镇痛药物和 PRN 镇痛药的 NHR（n=106）S（PMAS）为 69±1.5，在人群中得分最高。总体而言，认知障碍和无认知障碍的 NHR 中均有类似的结果。
我们的研究表明，德国养老院 NHR 的疼痛治疗存在显著缺陷，包括有或无认知障碍的 NHR。
