Center for Patient Safety, Dana-Farber Cancer Institute, Boston, Massachusetts 02215-5450, USA.
Cancer. 2012 Dec 15;118(24):6278-86. doi: 10.1002/cncr.27673. Epub 2012 Jun 6.
Although pain is common among patients with advanced cancer, little is known about longitudinal variability in pain intensity. For this report, the authors examined variability in pain intensity over 24 months among ambulatory patients with advanced stage cancers, associations between patient characteristics and within-patient pain variability, and the relation of pain variability to overall survival.
The sample comprised 949 patients with solid tumors who received care and reported pain scores in at least 3 different months within 24 months of their initial stage IV diagnosis during the period from 2004 to 2006. Pain intensity was measured using a scale ranging from 0 (no pain) to 10 (worst pain). Pain variability was defined as the standard deviation of the maximum monthly pain scores and was dichotomized at the 50th percentile into high and low variability groups.
Considerable between-patient differences in pain variability (range, 0-5.77) were observed. Nonwhites, patients with a stage IV cancer diagnosed within the previous 3 months, and those with moderate or severe pain at baseline were more likely to experience high pain variability. Although patients with head and neck cancer generally had the highest pain variability, the intensity of their pain typically decreased over the disease course. High pain variability with worsening pain trajectory was associated with increased risk of death.
Longitudinally, pain intensity was highly variable among patients with stage IV cancer. Minority patients, newly diagnosed patients, patients with head and neck cancer, and patients with moderate or severe pain at baseline were at higher risk of large fluctuations in pain intensity.
尽管晚期癌症患者普遍存在疼痛，但人们对疼痛强度的纵向变化知之甚少。在本报告中，作者研究了 949 名晚期癌症门诊患者在 24 个月内的疼痛强度变化，患者特征与个体内疼痛变化之间的关联，以及疼痛变化与总生存的关系。
本样本包括 949 名患有实体瘤的患者，他们在 2004 年至 2006 年期间的初始 IV 期诊断后至少在 3 个不同月份内接受了治疗并报告了疼痛评分。疼痛强度使用 0（无痛）至 10（最痛）的量表进行测量。疼痛变化定义为最大月疼痛评分的标准差，并在第 50 百分位数处分为高和低变化组。
观察到患者之间的疼痛变化存在相当大的差异（范围为 0-5.77）。非白人、在过去 3 个月内诊断为 IV 期癌症的患者以及基线时中度或重度疼痛的患者更有可能经历高疼痛变化。尽管头颈部癌症患者通常具有最高的疼痛变化，但他们的疼痛通常会随着疾病过程而减轻。疼痛变化较大且疼痛轨迹恶化与死亡风险增加相关。
纵向来看，IV 期癌症患者的疼痛强度变化很大。少数民族患者、新诊断的患者、患有头颈部癌症的患者以及基线时中度或重度疼痛的患者，疼痛强度波动的风险更高。
