Department of Internal Medicine I, University Hospital Halle, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
Department of General, Visceral and Transplantation Surgery, Ludwig-Maximilians-University, Munich, Germany.
Pancreatology. 2020 Oct;20(7):1511-1518. doi: 10.1016/j.pan.2020.08.017. Epub 2020 Aug 28.
BACKGROUND/OBJECTIVES: Pancreatic ductal adenocarcinoma (PDAC) is frequently associated with severe pain. Given the almost inevitably fatal nature of the disease, pain control is crucial. However, data on quality of pain management in PDAC is scarce.
This is a multi-center, prospective study to evaluate the quality of pain management in PDAC. Insufficient pain treatment (undertreatment) was prevalent if there was an incongruence between the patients level of pain and the potency of analgesic drug therapy. Determinants of pain and undertreatment were identified using multivariable logistic regression.
139 patients with histologically confirmed PDAC were analyzed. The prevalence of pain was 63%, with approximately one third of the patients grading their pain as moderate to severe. Palliative stage (OR: 3.37, 95%CI: 1.23-9.21, p = 0.018) and localization of the primary tumor in the body or tail (OR: 2.57, 95%CI: 1.05-6.31, p = 0.039) were independent determinants of pain. Of those reporting pain, 60% were undertreated and in 89% pain interfered with activities and emotions. Age ≥ 70 years (OR: 3.20, 95%CI: 1.09-9.41, p = 0.035) was an independent predictor of undertreatment. Patients with longer-known PDAC ( ≥ 30 days) showed improved pain management compared to new cases (OR: 0.19, 95%CI: 0.05-0.81, p = 0.025). Treatment by gastroenterologists (OR: 0.22, 95%CI: 0.05-0.89, p = 0.034) was associated with less undertreatment.
The results show a high proportion of PDAC patients with pain, pain interference and undertreatment, whose characteristics could help to identify patients at risk in the future. Several changes in the management of cancer-related pain are necessary to overcome barriers to optimal treatment.
背景/目的：胰腺导管腺癌（PDAC）常伴有严重疼痛。鉴于该疾病几乎必然致命，因此控制疼痛至关重要。然而，PDAC 患者疼痛管理质量的数据却很少。
这是一项多中心前瞻性研究，旨在评估 PDAC 患者疼痛管理质量。如果患者的疼痛程度与镇痛药物治疗的强度不一致，则认为存在治疗不足（治疗不足）。使用多变量逻辑回归确定疼痛和治疗不足的决定因素。
对 139 例组织学证实的 PDAC 患者进行了分析。疼痛的患病率为 63%，约有三分之一的患者将其疼痛程度评为中度至重度。姑息治疗阶段（OR：3.37，95%CI：1.23-9.21，p=0.018）和原发肿瘤位于体部或尾部（OR：2.57，95%CI：1.05-6.31，p=0.039）是疼痛的独立决定因素。报告疼痛的患者中有 60%存在治疗不足，89%的患者疼痛影响了活动和情绪。年龄≥70 岁（OR：3.20，95%CI：1.09-9.41，p=0.035）是治疗不足的独立预测因素。与新发病例相比，PDAC 病程较长（≥30 天）的患者疼痛管理得到改善（OR：0.19，95%CI：0.05-0.81，p=0.025）。由胃肠病学家治疗（OR：0.22，95%CI：0.05-0.89，p=0.034）与治疗不足的发生率较低相关。
结果显示，有相当比例的 PDAC 患者存在疼痛、疼痛干扰和治疗不足的情况，这些特征有助于识别未来有风险的患者。需要对癌症相关疼痛的管理进行一些改变，以克服优化治疗的障碍。
