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克服癌症疼痛管理中的障碍。

Overcoming barriers in cancer pain management.

机构信息

From Kangdong Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea.

出版信息

J Clin Oncol. 2014 Jun 1;32(16):1727-33. doi: 10.1200/JCO.2013.52.4827. Epub 2014 May 5.

Abstract

Pain is a devastating symptom of cancer that affects the quality of life of patients, families, and caregivers. It is a multidimensional symptom that includes physical, psychosocial, emotional, and spiritual components. Despite the development of novel analgesics and updated pain guidelines, cancer pain remains undermanaged, and some patients with moderate to severe pain do not receive adequate pain treatment. Inadequate pain management can be attributed to barriers related to health care professionals, patients, and the health care system. Common professional-related barriers include poor pain assessment, lack of knowledge and skill, and the reluctance of physicians to prescribe opioids. Patient-related barriers include cognitive factors, affective factors, and adherence to analgesic regimens. System-related barriers such as limits on access to opioids and the availability of pain and palliative care specialists present additional challenges, particularly in resource-poor regions. Given the multidimensional nature of cancer pain and the multifaceted barriers involved, effective pain control mandates multidisciplinary interventions from interprofessional teams. Educational interventions for patients and health care professionals may improve the success of pain management.

摘要

疼痛是癌症的一种毁灭性症状,会影响患者、家属和照护者的生活质量。它是一种多维度的症状,包括身体、心理社会、情感和精神方面。尽管新型镇痛药和更新的疼痛指南不断发展,但癌症疼痛仍未得到充分管理,一些中重度疼痛患者未得到充分的疼痛治疗。疼痛管理不足可归因于与医疗保健专业人员、患者和医疗保健系统相关的障碍。常见的与专业相关的障碍包括疼痛评估不佳、知识和技能缺乏以及医生不愿开阿片类药物。与患者相关的障碍包括认知因素、情感因素和对镇痛方案的依从性。系统相关的障碍,如阿片类药物获取限制和疼痛及姑息治疗专家的可用性,在资源匮乏地区带来了额外的挑战。鉴于癌症疼痛的多维度性质和涉及的多方面障碍,有效的疼痛控制需要多学科团队的跨专业干预。针对患者和医疗保健专业人员的教育干预措施可能会提高疼痛管理的成功率。

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