Choinière M, Melzack R, Rondeau J, Girard N, Paquin M J
Burn Centre, Hôtel-Dieu of Montreal, Quebec, Canada.
J Trauma. 1989 Nov;29(11):1531-9. doi: 10.1097/00005373-198911000-00013.
This study examined the characteristics of pain experienced by burned patients. Sources of inter-individual variations were also studied and the interrelationships between anxiety, depression, and pain were investigated. Forty-two adult patients hospitalized for burn injuries participated in the study. The McGill Pain Questionnaire and a visual analogue scale were employed to measure the pain experienced at rest and during therapeutic procedures. Anxiety and depression levels were assessed with the Spielberger State Anxiety Inventory, the Beck Depression Inventory, and visual analogue scales. The results showed that the pain varies greatly from patient to patient and undergoes wide fluctuations over time in each patient. The greatest pain is usually experienced during therapeutic procedures, the patients reporting significantly more pain on these occasions than at rest. Variations in pain severity were not related to socio-demographic characteristics of the patients, the length of time elapsed since the injury, or the quantity of analgesics administered. The extent of the burns was a significant predictor of pain but only in the first week after the injury. High levels of anxiety or depression were not necessarily associated with higher pain scores during therapeutic procedures but the patients who were more anxious or depressed tended to report more pain when at rest. These results are discussed in relation to pain management strategies, with particular emphasis on the need for the analgesic therapy to be highly individualized and frequently adjusted.
本研究调查了烧伤患者所经历疼痛的特征。还研究了个体间差异的来源,并调查了焦虑、抑郁与疼痛之间的相互关系。42名因烧伤住院的成年患者参与了该研究。采用麦吉尔疼痛问卷和视觉模拟量表来测量静息时以及治疗过程中的疼痛。使用斯皮尔伯格状态焦虑量表、贝克抑郁量表和视觉模拟量表评估焦虑和抑郁水平。结果显示,患者之间的疼痛差异很大,且每位患者的疼痛随时间波动很大。通常在治疗过程中疼痛最为剧烈,患者在这些情况下报告的疼痛明显多于静息时。疼痛严重程度的差异与患者的社会人口学特征、受伤后的时间长短或给予的镇痛药数量无关。烧伤程度是疼痛的一个重要预测因素,但仅在受伤后的第一周如此。在治疗过程中,高水平的焦虑或抑郁不一定与更高的疼痛评分相关,但焦虑或抑郁程度较高的患者在静息时往往报告更多疼痛。结合疼痛管理策略对这些结果进行了讨论,特别强调了镇痛治疗需要高度个体化并经常调整。