Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Cancer Clinic, St. Olavs Hospital, University Hospital of Trondheim, Trondheim, Norway.
J Pain. 2014 Jan;15(1):59-67. doi: 10.1016/j.jpain.2013.09.011. Epub 2013 Oct 2.
The aim of the present study is to compare physician clinical assessment with patient-rated evaluations in the classification of cancer pain patients into groups with different pain levels, according to the presence of incident/breakthrough pain, neuropathic pain, and psychological distress. Average pain in the previous 24 hours was used as the dependent variable in multivariate linear regression models, and incident/breakthrough pain, neuropathic pain, and psychological distress were tested as regressors; in the assessment of regressors, physicians used the Edmonton Classification System for Cancer Pain, whereas patients used structured self-assessment questionnaires. The amount of variability in pain intensity scores explained by the 2 sets of regressors, physician and patient rated, was compared using R(2) values. When tested in 2 separate models, patient ratings explained 20.3% of variability (95% confidence interval [CI] = 15.2-25.3%), whereas physician ratings explained 6.1% (95% CI = 2.2-9.8%). The higher discriminative capability of patient ratings was still maintained when both regressor sets were introduced in the same model, with R(2) indices of 17.6% (95% CI = 13.0-22.2%) for patient ratings vs 3.4% (95% CI = .9-5.9%) for physician ratings. Patients' self-assessment of subjective symptoms should be integrated in future cancer pain classification systems.
Our results indicate that patient-structured assessment of incident/breakthrough pain, neuropathic pain, and psychological distress significantly contributes to the discrimination of cancer patients with different pain levels. The integration of patient self-assessment tools with more objective clinician assessments can improve the classification of cancer pain.
本研究旨在比较医生临床评估与患者自评在癌症疼痛患者分组中的差异，根据是否存在突发性/爆发性疼痛、神经病理性疼痛和心理困扰，将患者分为不同疼痛程度组。采用多元线性回归模型，以 24 小时平均疼痛为因变量，以突发性/爆发性疼痛、神经病理性疼痛和心理困扰为自变量；在评估自变量时，医生采用埃德蒙顿癌症疼痛分类系统，而患者采用结构化自我评估问卷。使用 R2 值比较两组自变量（医生和患者评估）对疼痛强度评分的可解释变异量。当在两个独立模型中进行测试时，患者评分解释了 20.3%的变异量（95%置信区间[CI] = 15.2-25.3%），而医生评分解释了 6.1%（95%CI = 2.2-9.8%）。当将两组自变量同时引入同一模型时，患者评分的判别能力仍然较高，其 R2 值为 17.6%（95%CI = 13.0-22.2%），而医生评分的 R2 值为 3.4%（95%CI =.9-5.9%）。结论：患者对主观症状的自我评估应纳入未来的癌症疼痛分类系统。观点：我们的研究结果表明，患者对突发性/爆发性疼痛、神经病理性疼痛和心理困扰的结构化评估对区分不同疼痛水平的癌症患者具有重要意义。将患者自我评估工具与更客观的临床医生评估相结合，可以提高癌症疼痛的分类。
