University of South-East Norway, Faculty of Health and Social Sciences, Department of Nursing and Health Sciences, Postboks 235, Kongsberg, Drammen, Norway.
University of Oslo, Faculty of Medicine, Department of Interdisiplinary Health Sciences, Oslo, Norway.
Scand J Pain. 2020 Jul 28;20(3):491-498. doi: 10.1515/sjpain-2019-0158.
Background and aims Psoriasis is a common chronic skin condition, causing skin lesions with thickened and scaling skin, as well as erythema and inflammation that may involve painful sores, cracks, and pustules. Previously psoriasis was regarded as a painless skin condition. However, over the past decade studies show that skin pain is a frequently reported and bothersome symptom in patients with psoriasis. There is however a lack of rich narratives describing the experience of skin pain in these patients. The aims of this qualitative study were therefore to explore in depth how patients experience psoriasis-related skin pain, and how they deal with it. Methods Thirteen patients with psoriasis were recruited from a dermatology ward and outpatient clinic. One of the investigators (TML) performed individual, semi-structured interviews at an undisturbed room in the hospital. Interviews were thematically analyzed using the method of Systematic Text Condensation as described by Malterud (2012). Results Three main themes were identified from the interviews. First, the skin pain experience was complex. Patients used a variety of adjectives and metaphors to describe their pain, and their skin was sensitive to stimuli of every-day activities. Itch was a common cosymptom, and could both mask pain but also cause severe pain due to excessive scratching and damage to the skin. Second, skin pain had a negative impact on patients' life. Skin pain reduced their physical activity level, impaired their sleep, and made them irritable, depressed, unconcentrated on tasks, as well as withdrawn from other people and social activities. Third, patients dealt with their skin pain in various ways. Although some took action to relieve the pain and distract themselves from pain, most of the patients applied maladaptive and passive coping strategies such as put up with it, avoid painful activities, become fearful or trivialize their pain. Conclusions The experience of psoriasis related skin pain is complex. The pain has a major negative impact on patients' life in terms of physical, emotional, cognitive, and social functions. Patients use a variety of adaptive but most frequently maladaptive coping strategies in order to deal with their skin pain. Implications This study provides new and in-depth knowledge on psoriasis related skin pain. This information is valuable for further work on pain assessment tools and pain management recommendations customized for skin pain experienced by patients with psoriasis.
背景与目的 银屑病是一种常见的慢性皮肤病，会导致皮肤出现增厚和鳞屑，同时还伴有红斑和炎症，可能会导致疼痛性溃疡、裂缝和脓疱。以前，银屑病被认为是一种无痛的皮肤病。然而，在过去的十年中，研究表明皮肤疼痛是银屑病患者经常报告的一种令人困扰的症状。然而，目前缺乏对这些患者皮肤疼痛体验的丰富描述。因此，本定性研究的目的是深入探讨患者如何体验银屑病相关的皮肤疼痛，以及他们如何应对这种疼痛。 方法 从皮肤科病房和门诊招募了 13 名银屑病患者。一名调查员（TML）在医院的一个安静房间进行了个体半结构化访谈。访谈采用 Malterud（2012 年）描述的系统文本浓缩方法进行主题分析。 结果 访谈中确定了三个主要主题。首先，皮肤疼痛体验是复杂的。患者使用各种形容词和隐喻来描述他们的疼痛，他们的皮肤对日常活动的刺激很敏感。瘙痒是一种常见的伴随症状，既可以掩盖疼痛，也可以因过度搔抓和皮肤损伤而导致剧烈疼痛。其次，皮肤疼痛对患者的生活有负面影响。皮肤疼痛降低了他们的身体活动水平，影响了他们的睡眠，使他们易怒、抑郁、注意力不集中、对任务不感兴趣，以及回避他人和社交活动。第三，患者以各种方式应对皮肤疼痛。尽管有些患者采取行动缓解疼痛并分散对疼痛的注意力，但大多数患者采用了适应性差的被动应对策略，如忍受、避免疼痛活动、变得恐惧或轻视自己的疼痛。 结论 银屑病相关皮肤疼痛的体验是复杂的。这种疼痛对患者的身体、情感、认知和社会功能方面的生活有重大负面影响。患者使用各种适应性但最常采用的适应性差的应对策略来处理皮肤疼痛。 意义 本研究提供了银屑病相关皮肤疼痛的新的深入知识。这些信息对于进一步开发针对银屑病患者皮肤疼痛的疼痛评估工具和疼痛管理建议非常有价值。
