Service of Palliative Care, Institut Catalá d'Oncologia, Barcelona, Spain.
BMC Palliat Care. 2013 Nov 7;12(1):41. doi: 10.1186/1472-684X-12-41.
Although pain is frequently experienced by patients with cancer, it remains under-treated. The primary aim of this study was to estimate the prevalence of cancer-related neuropathic pain (CRNP) in patients with chronic pain who attended an outpatient clinic for standard care in Europe (irrespective of the reason or stage of the cancer). The secondary aims of this study were to characterise pain and cancer in patients with CRNP (including treatment) and to evaluate the usefulness of the painDETECT (PD-Q) screening tool to help physicians identify a potential neuropathic component of cancer-related pain.
An observational, non-interventional, cross-sectional, multi-centre study of adult patients with cancer using patient and physician case report forms (CRFs). Patients with CRNP were identified by physicians' clinical assessments after examining the completed PD-Q.
A total of 951 patients visiting outpatient clinics across Europe were enrolled in this study between August 2010 and July 2011. Of these, 310 patients (32.60%; 95% confidence interval 29.62, 35.58) were identified as having CRNP. Twenty-nine of 39 (74.4%) physicians who completed the CRF relating to the PD-Q considered it a useful tool to help detect CRNP in daily practice and 28 of 39 (71.8%) indicated that they would use this tool in the future for most or some of their patients. Data from physicians before and after review of the completed PD-Qs showed a shift in clinical opinion (either to positive CRNP diagnosis [yes] or negative CRNP diagnosis [no]) in respect of 142 patients; about half of which (74) were categorised with an initial diagnosis of unknown. Opinions also shifted from a no to a yes diagnosis in 10 patients and from a yes to a no diagnosis in 51 patients.
Approximately one-third of adults with cancer experiencing chronic pain attending outpatient clinics as part of routine care were considered to have CRNP in the opinion of the physicians after considering scores on the PD-Q. While physicians did not consider the PD-Q to be a useful tool for all patients, shifts in diagnosis before and after the use of this tool indicate that it may help physicians identify CRNP, especially where there is initial uncertainty.
尽管癌症患者经常经历疼痛，但疼痛的治疗仍不充分。本研究的主要目的是评估在接受标准治疗的欧洲慢性疼痛门诊就诊的癌症患者中（无论癌症的原因或阶段如何），癌症相关神经性疼痛（CRNP）的发生率。本研究的次要目的是描述 CRNP 患者的疼痛和癌症特征（包括治疗），并评估疼痛 DETECT（PD-Q）筛查工具在帮助医生识别癌症相关疼痛的潜在神经性成分方面的有用性。
本研究为观察性、非干预性、横断面、多中心研究，纳入使用患者和医生病例报告表（CRF）的成年癌症患者。通过医生在检查完 PD-Q 后进行临床评估，确定 CRNP 患者。
2010 年 8 月至 2011 年 7 月期间，共有 951 名在欧洲门诊就诊的患者入组本研究。其中，310 名（32.60%；95%置信区间 29.62，35.58）患者被确定为患有 CRNP。39 位完成 PD-Q 相关 CRF 的医生中有 29 位（74.4%）认为该工具在日常实践中有助于检测 CRNP，且 28 位（71.8%）表示将来会将该工具用于大多数或部分患者。与 PD-Q 完成前后的医生数据相比，142 名患者的临床意见发生转变（要么是 CRNP 阳性诊断[是]，要么是 CRNP 阴性诊断[否]）；其中约一半（74 名）被初始诊断为未知。意见从否到是诊断转变了 10 例，从是到否诊断转变了 51 例。
在考虑 PD-Q 评分后，约三分之一在常规治疗下作为门诊患者的癌症慢性疼痛成年患者被医生认为患有 CRNP。尽管医生认为 PD-Q 并非所有患者都有用，但使用该工具前后的诊断转变表明，该工具可能有助于医生识别 CRNP，特别是在初始存在不确定性的情况下。
