Maria Teresa Greco, University of Milan; Maria Teresa Greco, Anna Roberto, and Oscar Corli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto di Ricerche Farmacologiche "Mario Negri," Milan; Silvia Deandrea, European Commission, Joint Research Centre, Ispra; Elena Bandieri, Azienda Unita Sanitaria Locale di Modena, Modena; and Silvio Cavuto and Giovanni Apolone, IRCCS, Arcispedale "S. Maria Nuova," Reggio Emilia, Italy.
J Clin Oncol. 2014 Dec 20;32(36):4149-54. doi: 10.1200/JCO.2014.56.0383. Epub 2014 Nov 17.
Pain is a frequent symptom in patients with cancer, with substantial impact. Despite the availability of opioids and updated guidelines from reliable leading societies, undertreatment is still frequent.
We updated a systematic review published in 2008, which showed that according to the Pain Management Index (PMI), 43.4% of patients with cancer were undertreated. This review included observational and experimental studies reporting negative PMI scores for adults with cancer and pain published from 2007 to 2013 and retrieved through MEDLINE, Embase, and Google Scholar. To detect any temporal trend and identify potential determinants of undertreatment, we compared articles published before and after 2007 with univariable, multivariable, and sensitivity analyses.
In the new set of 20 articles published from 2007 to 2013, there was a decrease in undertreatment of approximately 25% (from 43.4 to 31.8%). In the whole sample, the proportion of undertreated patients fell from 2007 to 2013, and an association was confirmed between negative PMI score, economic level, and nonspecific setting for cancer pain. Sensitivity analysis confirmed the robustness of results.
Analysis of 46 articles published from 1994 to 2013 using the PMI to assess the adequacy of analgesic therapy suggests the quality of pharmacologic pain management has improved. However, approximately one third of patients still do not receive pain medication proportional to their pain intensity.
疼痛是癌症患者常见的症状，具有重大影响。尽管有阿片类药物和可靠的主要学会的更新指南，但治疗不足仍然很常见。
我们更新了 2008 年发表的一项系统评价，该评价显示，根据疼痛管理指数（PMI），43.4%的癌症患者治疗不足。这项综述包括观察性和实验性研究，报告了 2007 年至 2013 年期间患有癌症和疼痛的成年人的 PMI 评分呈阴性，并通过 MEDLINE、Embase 和 Google Scholar 检索到这些研究。为了检测任何时间趋势并确定治疗不足的潜在决定因素，我们比较了 2007 年之前和之后发表的文章，采用单变量、多变量和敏感性分析。
在 2007 年至 2013 年期间发表的新的 20 篇文章中，治疗不足的比例约下降了 25%（从 43.4%降至 31.8%）。在整个样本中，治疗不足的患者比例从 2007 年降至 2013 年，PMI 评分呈阴性、经济水平和癌症疼痛的非特异性设置之间存在关联。敏感性分析证实了结果的稳健性。
使用 PMI 评估镇痛治疗充足性的 1994 年至 2013 年期间发表的 46 篇文章的分析表明，药物疼痛管理的质量有所提高。然而，大约三分之一的患者仍然没有根据其疼痛强度接受相称的疼痛药物治疗。
