Department of Paediatrics, Paediatric Pulmonology and Paediatric Infectious Diseases, Cystic Fibrosis Centre, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels; Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels; Department of Human Physiology, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
Department of Paediatrics, Paediatric Pulmonology and Paediatric Infectious Diseases, Cystic Fibrosis Centre, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels.
J Pain Symptom Manage. 2018 Mar;55(3):872-880. doi: 10.1016/j.jpainsymman.2017.11.004. Epub 2017 Nov 14.
Reliable identification of lower respiratory tract pathogens is crucial in the management of cystic fibrosis (CF). The multitude of treatments and clinical procedures are a considerable burden and are potentially provoking pain.
As part of another study (NCT02363764), investigating the bacterial yield of three sampling methods, nasal swabs (NSs), cough swabs (CSs), and (induced) sputum samples ([I]SSs), in both expectorating patients (EPs) and non-expectorating patients (NEPs) with CF, the present study aimed to explore the prevalence of respiratory culture sampling-related pain as assessed by self-report within a cohort of children and adults.
Literate patients with CF (aged six years or older) completed a questionnaire on pain perception related to the three aforementioned sampling methods (No/Yes; visual analogue scale for pain [VAS-Pain] [0-10 cm]). In addition, patients were asked to rank these methods by their own preference without taking into account the presumed bacterial yield.
In total, 119 questionnaires were returned. In the EPs-group, CS was most frequently (n%; mean VAS-Pain if pain [range]) reported as painful method: overall (n = 101; 12.9%; 1.8 [0.2-4.8]), children (n = 41; 22.0%; 1.4 [0.2-2.7]), and adults (n = 60; 6.7%; 2.5 [0.5-4.8]). Highest pain intensity scores were observed with NS overall (3.0%; 2.4 [0.3-6.2]) and in children (4.9%; 3.3 [0.3-6.2]), but not in adults (1.7%; 0.6 [-]).NEPs-children (n = 17) reported ISS most frequently and as most painful sampling method (17.6%; 2.0 [1.0-4.0]). The only NEP-adult did not perceive pain. NEPs preferred NS > CS > ISS (61.1%, 33.3%, 5.6%, respectively [P = 0.001]) as primary sampling method, whereas EPs preferred SS > NS > CS (65.7%, 26.3%, 8.1%, respectively [P < 0.0001]). Patients' preference for a specific method inversely correlated to pain perception and intensity in EPs (φ = -0.155 [P = 0.007] and ρ = -0.926 [P = 0.008], respectively), but not in NEPs (φ = -0.226 [P = 0.097] and ρ = -0.135 [P = 0.798], respectively).
A relatively large range of pain experiences was observed in patients with CF during respiratory culture sampling, which underlines the importance of individual pain assessment. Nevertheless, clinicians can confidently choose the sampling method based on validity over patients' preference.
可靠鉴定下呼吸道病原体对于囊性纤维化（CF）的治疗至关重要。众多的治疗和临床程序是相当大的负担，并且可能会引起疼痛。
作为另一项研究（NCT02363764）的一部分，该研究调查了三种采样方法（鼻拭子（NS）、咳嗽拭子（CS）和（诱导）痰样[IS]）在有或无咳痰能力的 CF 患者中的细菌产量，本研究旨在通过对一组儿童和成人的自我报告来探讨与呼吸培养采样相关的疼痛发生率。
有文化的 CF 患者（年龄 6 岁及以上）完成了一份关于三种上述采样方法的疼痛感知问卷（否/是；疼痛的视觉模拟量表[VAS-Pain][0-10cm]）。此外，患者被要求在不考虑预期细菌产量的情况下，按照自己的偏好对这些方法进行排序。
共返回 119 份问卷。在有咳痰能力的患者组中，CS 被报告为最痛苦的方法（总体[n%；如果有疼痛，则 VAS-Pain 平均值[范围]）：总体（n=101；12.9%；1.8[0.2-4.8]）、儿童（n=41；22.0%；1.4[0.2-2.7]）和成人（n=60；6.7%；2.5[0.5-4.8]）。总体而言，NS 观察到的疼痛强度评分最高（3.0%；2.4[0.3-6.2]）和儿童（4.9%；3.3[0.3-6.2]），但成人（1.7%；0.6[-]）则不然。NEPs-儿童（n=17）报告 IS 是最频繁和最痛苦的采样方法（17.6%；2.0[1.0-4.0]）。唯一的 NEP 成人没有感觉到疼痛。NEPs 更喜欢 NS>CS>IS（61.1%、33.3%、5.6%，分别[P=0.001]）作为主要采样方法，而 EPs 更喜欢 SS>NS>CS（65.7%、26.3%、8.1%，分别[P<0.0001]）。患者对特定方法的偏好与有咳痰能力的患者的疼痛感知和强度呈负相关（φ=-0.155[P=0.007]和ρ=-0.926[P=0.008]），但与无咳痰能力的患者无相关性（φ=-0.226[P=0.097]和ρ=-0.135[P=0.798]）。
在 CF 患者进行呼吸培养采样时，观察到了相当大的疼痛体验范围，这突出了个体疼痛评估的重要性。然而，临床医生可以基于有效性而不是患者的偏好有信心地选择采样方法。
