REHPA - The Danish Knowledge Centre for Rehabilitation and Palliative Care, Institute of Clinical Research, University of Southern Odense, Odense, Denmark.
Department of Rehabilitation, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
Scand J Pain. 2020 Oct 27;21(1):127-134. doi: 10.1515/sjpain-2020-0087. Print 2021 Jan 27.
The prevalence and impact of pain among patients with multiple myeloma (MM) in their everyday life require renewed attention. MM patients' survival has increased considerably over the last decades and active disease episodes are interrupted by longer periods with disease inactivity. The aim with this study is to explore pain intensity and pain interference with daily activities during periods of stable or inactive MM disease.
In a cross-sectional study from September 2017 to May 2019, self-reliant MM patients in stable disease filled a comprehensive selection of validated questionnaires regarding pain, other symptoms and quality of life, which they experienced in their daily living. Patient reported pain intensity and interference with daily activities were analyzed for associations with several clinical and demographic factors and discussed from a total pain perspective. The two outcomes, pain intensity and pain interfering with daily activities, were analyzed in two age groups (<65 years or ≥65 years).
Among 92 participants, 80% experienced pain to interfere with their daily activities (equal in both age groups), and 63% reported moderate to severe pain intensity; (75% ≥65 years, and 49% <65 years). Pain intensity was significantly associated with signs of depression (OR 4.0 [95% CI: 1.2-13.9]) and age ≥65 years (OR 3.3 [95% CI: 1.2-9.2]). Pain interfering with daily activities was nearly significantly associated with bone involvement (OR 3.4 [95% CI: 1.0-11.6]) and signs of depression (OR 5.9 [95% CI: 1.0-36.3]). The patients were bothered with many problems in addition to pain; fatigue (91%), bone involvement (74%), signs of depression (41%), signs of anxiety (32%), comorbidity (29%) and uncertainty in relation to employment or pension (25%). Neuropathic pain was more prevalent in the feet (33% [95% CI: 23%, 43%]) compared with pain in the hands (13% [95% CI: 7%, 22%]).
In periods of stable disease, many MM patients continue to live with intense pain interfering with their daily activities. Additional or associated problems are the presence of bone involvement, neuropathic pain, older age, uncertainty in relation to employment or pension, comorbidity, signs of depression, anxiety and fatigue. This highlights the importance of health professionals being receptive to the patients' experience of pain throughout their trajectories, to assess pain systematically and to interpret this experience from a total pain perspective. While pain problems in relation to diagnosing and treating MM is well known, this study brings the message that even during periods of stable or inactive MM disease, the patients experience pain with a moderate to severe intensity, that interferes with their everyday living. The improved survival and the consequential long trajectories make coherence in the pain treatment even more important for the patients, who may see different professionals in different health care settings for different reasons. The patient group requires a coordinated, holistic patient-centered pain treatment throughout the disease trajectory.
多发性骨髓瘤（MM）患者日常生活中的疼痛发生率和影响需要重新引起关注。在过去几十年中，MM 患者的生存率有了显著提高，且疾病活动期之间的间歇期延长。本研究旨在探讨稳定期或非活动期 MM 疾病期间患者的疼痛强度和对日常活动的干扰情况。
在 2017 年 9 月至 2019 年 5 月的一项横断面研究中，稳定期 MM 患者自主填写了一套全面的、经验证的问卷，内容涉及他们在日常生活中经历的疼痛、其他症状和生活质量。分析患者报告的疼痛强度和对日常活动的干扰与若干临床和人口统计学因素之间的关系，并从全面疼痛的角度进行讨论。这两个结果（疼痛强度和对日常活动的干扰）在两个年龄组（<65 岁或≥65 岁）中进行分析。
在 92 名参与者中，80%的人报告疼痛对其日常生活造成干扰（两个年龄组中比例相同），63%的人报告疼痛强度为中度至重度；（75%≥65 岁，49%<65 岁）。疼痛强度与抑郁迹象（比值比 4.0 [95%置信区间：1.2-13.9]）和年龄≥65 岁（比值比 3.3 [95%置信区间：1.2-9.2]）显著相关。疼痛对日常活动的干扰与骨骼受累（比值比 3.4 [95%置信区间：1.0-11.6]）和抑郁迹象（比值比 5.9 [95%置信区间：1.0-36.3]）几乎显著相关。除了疼痛外，患者还存在许多其他问题；疲劳（91%）、骨骼受累（74%）、抑郁迹象（41%）、焦虑迹象（32%）、合并症（29%）和就业或养老金的不确定性（25%）。与手部疼痛（13%[95%置信区间：7%-22%]）相比，足部疼痛（33%[95%置信区间：23%-43%]）更常见于神经病理性疼痛。
在稳定期疾病期间，许多 MM 患者仍然存在强烈的疼痛，且疼痛对其日常生活活动造成干扰。其他或相关问题包括骨骼受累、神经病理性疼痛、年龄较大、与就业或养老金相关的不确定性、合并症、抑郁、焦虑和疲劳。这突出了健康专业人员在患者的整个治疗过程中对其疼痛体验保持敏感性、系统地评估疼痛以及从全面疼痛的角度来解释这种体验的重要性。虽然与诊断和治疗 MM 相关的疼痛问题已经广为人知，但本研究表明，即使在稳定或非活动期 MM 疾病期间，患者也会经历中度至重度的疼痛，且疼痛会干扰他们的日常生活。生存状况的改善和随之而来的漫长病程使得对患者的疼痛治疗保持连贯性更加重要，因为他们可能会因为不同的原因，在不同的医疗保健环境中由不同的专业人员进行治疗。患者群体需要在整个疾病过程中接受协调的、整体的、以患者为中心的疼痛治疗。
