Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna (L1:00), Stockholm, SE-171 76, Sweden.
R & D Department, Stockholms Sjukhem Foundation, Mariebergsgatan 22, Stockholm, SE-112 19, Sweden.
BMC Palliat Care. 2024 Jul 15;23(1):171. doi: 10.1186/s12904-024-01497-1.
Despite pain control being a top priority in end-of-life care, pain continues to be a troublesome symptom and comprehensive data on pain prevalence and pain relief in patients with different diagnoses are scarce.
The Swedish Register of Palliative Care (SRPC) was used to retrieve data from 2011 to 2022 about pain during the last week of life. Data were collected regarding occurrence of pain, whether pain was relieved and occurrence of severe pain, to examine if pain differed between patients with cancer, heart failure, chronic obstructive pulmonary disease (COPD) and dementia. Binary logistic regression models adjusted for sex and age were used.
A total of 315 000 patients were included in the study. Pain during the last week of life was more commonly seen in cancer (81%) than in dementia (69%), heart failure (68%) or COPD (57%), also when controlled for age and sex, p < 0.001. Severe forms of pain were registered in 35% in patients with cancer, and in 17-21% in non-cancer patients. Complete pain relief (regardless of pain intensity) was achieved in 73-87% of those who experienced pain, depending on diagnosis. The proportion of patients with complete or partial pain relief was 99.8% for the whole group.
The occurrence of pain, including severe pain, was less common in patients with heart failure, COPD or dementia, compared to patients with cancer. Compared with cancer, pain was more often fully relieved for patients with dementia, but less often in heart failure and COPD. As severe pain was seen in about a third of the cancer patients, the study still underlines the need for better pain management in the imminently dying.
No trial registration was made as all patients were deceased and all data were retrieved from The Swedish Register of Palliative Care database.
尽管疼痛控制是临终关怀的首要任务，但疼痛仍然是一个麻烦的症状，并且关于不同诊断患者的疼痛发生率和疼痛缓解的综合数据仍然很少。
使用瑞典姑息治疗登记处（SRPC）检索了 2011 年至 2022 年关于生命最后一周疼痛的数据。收集了疼痛发生情况、疼痛是否缓解以及严重疼痛发生情况的数据，以检查癌症、心力衰竭、慢性阻塞性肺疾病（COPD）和痴呆患者之间的疼痛是否存在差异。使用调整了性别和年龄的二元逻辑回归模型。
共有 315000 名患者纳入研究。生命最后一周的疼痛在癌症患者中更为常见（81%），而在痴呆患者中（69%）、心力衰竭患者（68%）或 COPD 患者中（57%）更为常见，即使在调整了年龄和性别后也是如此，p<0.001。在癌症患者中，35%的患者出现严重疼痛，而非癌症患者中为 17-21%。根据诊断，经历疼痛的患者中有 73-87%完全缓解（无论疼痛强度如何）。在整个组中，完全或部分缓解疼痛的患者比例为 99.8%。
与癌症患者相比，心力衰竭、COPD 或痴呆患者疼痛的发生，包括严重疼痛，较少见。与癌症相比，痴呆患者的疼痛缓解更为常见，但心力衰竭和 COPD 患者的疼痛缓解较少。由于约三分之一的癌症患者出现严重疼痛，因此该研究仍强调在临终患者中需要更好的疼痛管理。
由于所有患者均已死亡，且所有数据均从瑞典姑息治疗登记处数据库中检索，因此未进行试验注册。
