Samuelly-Leichtag Gil, Adler Tsiki, Eisenberg Elon
The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Pain Research Unit, Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel.
Rambam Maimonides Med J. 2019 Jul 18;10(3):e0016. doi: 10.5041/RMMJ.10369.
The World Health Organization's (WHO) guidelines for cancer pain management were intentionally made simple in order to be widely implemented by all physicians treating cancer patients. Referrals to pain specialists are advised if pain does not improve within a short time. The present study examined whether or not a reasonable use of the WHO guideline was made by non-pain specialists prior to referral of patients with cancer-related pain to a pain clinic.
Cancer patients referred to a pain specialist completed several questionnaires including demographics, medical history, and cancer-related pain; the short-form McGill Pain Questionnaire (SF-MPQ); and the Short Form Health Survey SF-12. Data from referral letters and medical records were obtained. Treatments recommended by pain specialists were recorded and categorized as "unjustified" if they were within the WHO ladder framework, or "justified" if they included additional treatments.
Seventy-three patients (44 women, 29 men) aged 55 years (range, 25-85) participated in the study. Their pain lasted for a mean of 6 (1-192) months. Mean pain intensity scores on a 0-10 numerical rating scale were 7 (2-10) at rest and 8 (3-10) upon movement. Most patients complied with their referring physician's recommendations and consumed opioids. Adverse events were frequent. No significant correlation was found between the WHO analgesic medication step used and mean pain levels reported. There were 63 patient referrals (85%) categorized as "unjustified," whereas only 11 patients (15%) required "justified" interventions.
These findings imply that analgesic treatment within the WHO framework was not reasonably utilized by non-pain specialists before referring patients to pain clinics.
世界卫生组织（WHO）的癌症疼痛管理指南特意制定得很简单，以便所有治疗癌症患者的医生都能广泛实施。如果疼痛在短时间内没有改善，建议转诊至疼痛专科医生处。本研究调查了非疼痛专科医生在将癌症相关疼痛患者转诊至疼痛诊所之前，是否合理使用了WHO指南。
转诊至疼痛专科医生处的癌症患者完成了几份问卷，包括人口统计学、病史和癌症相关疼痛；简式麦吉尔疼痛问卷（SF-MPQ）；以及简短健康调查问卷SF-12。获取了转诊信和病历中的数据。记录疼痛专科医生推荐的治疗方法，如果这些治疗方法在世卫组织阶梯框架内，则归类为“不合理”，如果包括额外的治疗方法，则归类为“合理”。
73名患者（44名女性，29名男性）参与了研究，年龄为55岁（范围25-85岁）。他们的疼痛平均持续6（1-192）个月。在0-10数字评分量表上，静息时的平均疼痛强度评分为7（2-10），活动时为8（3-10）。大多数患者遵循了转诊医生的建议并使用了阿片类药物。不良事件频繁发生。在所使用的WHO镇痛药步骤与报告的平均疼痛水平之间未发现显著相关性。有63例患者转诊（85%）被归类为“不合理”，而只有11例患者（15%）需要“合理”干预。
这些发现表明，非疼痛专科医生在将患者转诊至疼痛诊所之前，未合理利用WHO框架内的镇痛治疗。
