College of Nursing, Wayne State University, Detroit, Michigan 48202, USA.
Cancer Nurs. 2013 May-Jun;36(3):229-35. doi: 10.1097/NCC.0b013e3182664c95.
Cancer pain is an unmitigated clinical phenomenon. Despite available guidelines, variability exists in treating cancer pain.
The objective of this study was to describe prevalence and severity of pain and the pharmacotherapy (opioid, nonopioid, adjuvant analgesics) in outpatients treated for breast cancer. Adequacy of pharmacological pain treatments, the predictors, and impact were also examined.
This descriptive study consisted of 114 chemotherapy outpatients from urban and rural settings. Pain and quality of life were self-reported by patients; treatment-related information was obtained from medical records. Based on the World Health Organization analgesic ladder, adequacy of pharmacological pain management (acceptable or inadequate analgesia) was computed using the Pain Management Index; the most potent analgesic was prescribed relative to the patient's reported pain.
Although patients were commonly treated with traditional analgesics, more than half (52.3%) received inadequate analgesia. Those who received inadequate analgesia reported more pain, greater pain interferences (P = .003), and more symptoms (P = .043). Those who received adjuvant analgesics reported more pain, greater interference (P = .018), more symptoms (P = .032), and lower functioning (P = .029). Nonadvanced disease stages and more comorbidities were strong predictors of inadequate analgesia.
There is a lack of congruence between the strength of analgesia and the patient's pain level. The addition of adjuvant analgesics did not reduce pain severity or improve quality of life.
The risks and benefits of coadministration of traditional and adjuvant analgesics need to be determined. Other treatment modalities in conjunction with pharmacological treatment are needed, considering negative effects of adjuvant analgesics on pain and quality of life.
癌症疼痛是一种无法缓解的临床现象。尽管有可用的指南，但在治疗癌症疼痛方面存在差异。
本研究的目的是描述接受乳腺癌治疗的门诊患者的疼痛发生率、严重程度以及药物治疗（阿片类药物、非阿片类药物、辅助镇痛药物）。还检查了药物治疗的充分性、预测因素和影响。
本描述性研究包括来自城市和农村环境的 114 名化疗门诊患者。疼痛和生活质量由患者自我报告；治疗相关信息从病历中获得。根据世界卫生组织的镇痛阶梯，使用疼痛管理指数计算药物治疗疼痛管理的充分性（可接受或镇痛不足）；根据患者报告的疼痛，开具最有效的镇痛药物。
尽管患者通常接受传统的镇痛药物治疗，但超过一半（52.3%）患者的镇痛不足。接受镇痛不足的患者报告疼痛更严重、疼痛干扰更大（P=0.003）、症状更多（P=0.043）。接受辅助镇痛药物治疗的患者报告疼痛更严重、干扰更大（P=0.018）、症状更多（P=0.032）、功能下降（P=0.029）。非晚期疾病阶段和更多的合并症是镇痛不足的强烈预测因素。
镇痛强度与患者的疼痛水平之间存在不一致。辅助镇痛药物的加入并没有减轻疼痛的严重程度或改善生活质量。
需要确定传统和辅助镇痛药物联合使用的风险和益处。考虑到辅助镇痛药物对疼痛和生活质量的负面影响，需要结合药物治疗使用其他治疗方法。
