Gorospe Franklin F, Istanboulian Laura, Puts Martine, Wong David, Lee Elizabeth, Dale Craig M
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
Perioperative Services, Toronto General Hospital-University Health Network, Toronto, Ontario, Canada.
Can J Pain. 2020 Sep 15;4(1):210-224. doi: 10.1080/24740527.2020.1785855.
: Pain is a significant problem in adults living with advanced liver disease, having limited guidance available for its clinical management. While pain is considered a multidimensional experience, there have been limited reviews of the pain literature in advanced liver disease conducted with a multidimensional framework. The goal of this scoping review was to identify and map the multidimensional domains of pain in adults with advanced liver disease using the biopsychosocial model. We used Arksey and O'Malley's scoping framework. A search was conducted in MEDLINE, Embase, AMED, and CINAHL databases and the gray literature using specific eligibility criteria (1990-2019). Citation selection and data extraction were performed by two independent reviewers and in duplicate. Of the 43 studies that met inclusion criteria, 51% were from North America and 93% utilized quantitative methods. The combined studies reported on 168,110 participants with ages ranging between 23 to 87 years. Only 9% reported an objective scoring system for liver disease severity. Few studies reported pain classification (9%) and intensity (16%). Pain prevalence ranged between 18% and 100%, with pain locations including joint, abdomen, back, head/neck, and upper/lower extremities. We identified and mapped 115 pain factors to the biopsychosocial model: physical (81%), psychological (65%), and sociocultural (5%). Only 9% measured pain using validated multidimensional tools. Pharmacological intervention (92%) prevailed among pain treatments. Pain is not well understood in patients with advanced liver disease, having limited multidimensional pain assessment and treatment approaches. There is a need to systematically examine the multidimensional nature of pain in this population.
疼痛是晚期肝病成年患者面临的一个重大问题，其临床管理的指导有限。虽然疼痛被认为是一种多维度体验，但在晚期肝病中，以多维度框架对疼痛文献进行的综述有限。本范围综述的目的是使用生物心理社会模型识别并描绘晚期肝病成年患者疼痛的多维度领域。我们采用了阿克西和奥马利的范围综述框架。通过特定的纳入标准（1990 - 2019年）在MEDLINE、Embase、AMED和CINAHL数据库以及灰色文献中进行检索。由两名独立评审员进行重复的文献筛选和数据提取。在符合纳入标准的43项研究中，51%来自北美，93%采用定量方法。这些综合研究报告了168,110名参与者，年龄在23至87岁之间。只有9%报告了肝病严重程度的客观评分系统。很少有研究报告疼痛分类（9%）和强度（16%）。疼痛患病率在18%至100%之间，疼痛部位包括关节、腹部、背部、头/颈部以及上肢/下肢。我们识别并将115个疼痛因素描绘到生物心理社会模型中：生理因素（81%）、心理因素（65%）和社会文化因素（5%）。只有9%使用经过验证的多维度工具测量疼痛。在疼痛治疗中，药物干预占主导（92%）。晚期肝病患者的疼痛未得到充分理解，多维度疼痛评估和治疗方法有限。有必要系统地研究该人群疼痛的多维度性质。
