O'Brien Joanne, Keaveny Joseph, Pollard Valerie, Nugent Linda Elizabeth
Author Affiliations: Registered Advanced Nurse Practitioner (Ms O'Brien) and Consultant (Drs Keaveny and Pollard), Department of Pain Medicine, Beaumont Hospital, Dublin, Ireland; and Lecturer (Dr Nugent), RCSI School of Nursing And Midwifery, Royal College of Surgeons in Ireland, Dublin.
Clin Nurse Spec. 2017 May/Jun;31(3):157-162. doi: 10.1097/NUR.0000000000000296.
PURPOSE/AIMS: The purpose of this study was to examine the management of patient's neuropathic pain with capsaicin 8% in a nurse-led clinic when administered by 1 registered advanced nurse practitioner without physician supervision.
A longitudinal, single-group, descriptive research design was used to assess pain scores and quality of life 3 times over 3 months after treatment.
Patients with a diagnosis of neuropathic pain were assessed and treated with capsaicin 8% by 1 advanced nurse practitioner with prescriptive authority in a nurse-led clinic. Pain scores were collected at baseline, and self-assessed pain, activity level, and quality of life were assessed at 1 week, 4 weeks, and 3 months after treatment. Twenty-four patients were recruited, and data were analyzed using Friedman's test. In post hoc analysis, Wilcoxon signed-rank test was used with Bonferroni correction.
Pain scores differed from pretreatment to posttreatment at each of the 3 time points, at rest (χ3 = 20.54, P = .001) and on movement (χ3 = 23.644, P = .001), and remained significant after Bonferroni correction. Overall, 62.5% (n = 15) of patients achieved at least a 30% reduction in self-reported pain at rest from pretreatment to 3 months, and 54% (n = 13) achieved the same reduction in pain on movement. Most improvements in patient's quality of life occurred between 1 and 4 weeks. Patient satisfaction was high, with 83% stating that they would be happy to have the treatment repeated.
Single-dose capsaicin 8% decreased neuropathic pain after being administered in an outpatient setting by an experienced registered advanced nurse practitioner. Further multicenter research led by advanced nurse practitioners is needed to support high-quality, safe treatment of neuropathic pain with high-concentration capsaicin in nurse-led chronic pain clinics.
目的/目标：本研究的目的是在由一名注册高级执业护士在无医生监督的情况下于护士主导的诊所中使用8%辣椒素治疗患者神经性疼痛时，对其治疗管理情况进行研究。
采用纵向单组描述性研究设计，在治疗后的3个月内分3次评估疼痛评分和生活质量。
诊断为神经性疼痛的患者在护士主导的诊所中由一名具有处方权的高级执业护士使用8%辣椒素进行评估和治疗。在基线时收集疼痛评分，并在治疗后1周、4周和3个月时评估自我评估的疼痛、活动水平和生活质量。招募了24名患者，并使用弗里德曼检验进行数据分析。在事后分析中，使用带有邦费罗尼校正的威尔科克森符号秩检验。
在3个时间点的每个时间点，静息时（χ3 = 20.54，P = 0.001）和活动时（χ3 = 23.644，P = 0.001）的疼痛评分从治疗前到治疗后均有差异，在邦费罗尼校正后仍具有显著性。总体而言，62.5%（n = 15）的患者从治疗前到3个月静息时自我报告的疼痛至少减轻了30%，54%（n = 13）的患者活动时疼痛减轻了相同程度。患者生活质量的大多数改善发生在1至4周之间。患者满意度较高，83%的患者表示愿意再次接受该治疗。
在门诊环境中，由经验丰富的注册高级执业护士给予单剂量8%辣椒素可减轻神经性疼痛。需要由高级执业护士主导进行进一步的多中心研究，以支持在护士主导的慢性疼痛诊所中使用高浓度辣椒素对神经性疼痛进行高质量、安全的治疗。
