Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100 Tzyou 1st Road, Kaohsiung, 807, Taiwan.
Department of Surgery and ICU, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan.
Support Care Cancer. 2021 Apr;29(4):1903-1911. doi: 10.1007/s00520-020-05656-x. Epub 2020 Aug 15.
The undertreatment of cancer pain is a global issue although many international guidelines and various studies bloom to explore the approaches in pain management. However, there is no standard care for cancer pain in routine practices. To set up a standardized procedure for improving cancer pain management in Taiwan, the Good Pain Management (GPM) program is explored to provide treatments following the US National Cancer Care Network (NCCN) Adult Cancer Pain Guideline.
Patients diagnosed with moderate-to-severe cancer pain were eligible and randomized into the GPM or control arm and observed the first 48 h to evaluate the effects of pain management between 2 arms. Pain control, adequacy of treatments, patient satisfaction, and quality of life (QoL) of eligible patients were analyzed. Ad hoc analyses based on the pain medication category were also conducted.
Fifty-one patients were enrolled, with 26 and 25 assigned to the GPM and control arms, respectively. Significant differences among the GPM and control arms were found including a greater decrease in the mean numerical rating scale (NRS) score in the GPM arm (- 4.6 vs. - 2.8), a lower proportion of moderate-to-severe pain in the GPM arm (23.2% vs. 39.8%), and a higher pain management index (PMI) score in the GPM arm (0.64 points vs. 0.33 points) (all p < 0.05). Ad hoc analyses revealed that the patient subgroups using strong opioids showed better patient satisfaction in GPM arm when compared with the same subgroup in the control arm.
In summary, our study demonstrated that the implementation of a standardized pain assessment and management approach (GPM ward program) showed significant improvements on pain relief, decreased the portion of moderate-to-severe cancer pain, and increased patient satisfaction in the 1st 48 h after admission. The implementation of the GPM approach in the cancer ward may provide sooner and better improvement of cancer pain management for patients who suffered moderate-to-severe cancer pain.
ClinicalTrials.gov (Identifier: NCT03155516).
尽管有许多国际指南和各种研究探讨疼痛管理方法，但癌症疼痛治疗不足仍是一个全球性问题。然而，在常规实践中，并没有癌症疼痛的标准护理。为了在台湾建立改善癌症疼痛管理的标准化程序，探索了良好疼痛管理（GPM）计划，以提供遵循美国国家癌症护理网络（NCCN）成人癌症疼痛指南的治疗方法。
符合条件的中重度癌症疼痛患者被随机分配到 GPM 或对照组，并在观察的前 48 小时内评估 2 组之间的疼痛管理效果。分析合格患者的疼痛控制、治疗充分性、患者满意度和生活质量（QoL）。还根据疼痛药物类别进行了特定分析。
共纳入 51 例患者，其中 26 例和 25 例分别被分配到 GPM 和对照组。GPM 和对照组之间存在显著差异，包括 GPM 组平均数字评分量表（NRS）评分下降更大（-4.6 对-2.8），GPM 组中度至重度疼痛比例较低（23.2%对 39.8%），GPM 组疼痛管理指数（PMI）评分较高（0.64 分对 0.33 分）（均 p<0.05）。特定分析显示，与对照组相同亚组相比，使用强阿片类药物的患者亚组在 GPM 组的患者满意度更高。
总之，我们的研究表明，实施标准化疼痛评估和管理方法（GPM 病房计划）可显著缓解疼痛，降低中重度癌症疼痛的比例，并在入院后 48 小时内提高患者满意度。在癌症病房实施 GPM 方法可为中重度癌症疼痛患者提供更快、更好的癌症疼痛管理改善。
ClinicalTrials.gov（标识符：NCT03155516）。
