Ballarín Castany Àngels, Casanovas Font Jordi, Serrà Rigol Thaïs, Formiguera Macià Anna, Oller Piqué Ramon, Gómez-Batiste Xavier
Equip d'Atenció Primària Vic, Vic, Barcelona, España.
Equip d'Atenció Primària Vic, Vic, Barcelona, España.
Aten Primaria. 2025 May;57(5):103135. doi: 10.1016/j.aprim.2024.103135. Epub 2024 Nov 16.
To describe the analgesic treatment of patients with advanced chronic disease (ACD), to determine pain management, and to detect opportunities for improvement.
Observational, descriptive, cross-sectional, multicentre study.
Three primary care teams, one intermediate care hospital and five nursing homes in Catalonia.
Patients with ACD and pain according to the Brief Pain Inventory (Short Form) scale (or Pain Assessment in Advanced Dementia scale, in case of advanced dementia).
Place of care (home, nursing home, hospital), end of life (EOL) trajectory (organ failure, cancer, dementia, multimorbidity), type of analgesic treatment and pain management according to the Pain Management Index scale.
The study included 183 patients. The most frequent EOL trajectory was dementia, followed by organ failure, multimorbidity and cancer. The most commonly used analgesic was paracetamol, while weak opioids were testimonial. Analgesic use differed according to EOL trajectory and place of care, with the use of strong opioids prevailing in cancer and hospital, respectively. Almost half of patients had negative PMI, and none non-pharmacological intervention for pain control was recorded.
In patients with ACD and palliative needs, the use of strong opioids continues to prevail in the hospital setting and oncological disease, although pain is highly prevalent in all EOL trajectories and places of care. The high percentage of negative PMI reveals the opportunity for an individualised analgesic ladder stepping for better pain control. Also, incorporating non-pharmacological approaches could help improve pain in these patients.
描述晚期慢性病（ACD）患者的镇痛治疗，确定疼痛管理情况，并发现改进机会。
观察性、描述性、横断面、多中心研究。
加泰罗尼亚的三个初级保健团队、一家中级护理医院和五家养老院。
根据简明疼痛量表（简表）（或晚期痴呆症患者的疼痛评估量表，适用于晚期痴呆症患者）患有ACD且疼痛的患者。
护理地点（家庭、养老院、医院）、临终（EOL）轨迹（器官衰竭、癌症、痴呆症、多种疾病并存）、镇痛治疗类型以及根据疼痛管理指数量表进行的疼痛管理。
该研究纳入了183名患者。最常见的EOL轨迹是痴呆症，其次是器官衰竭、多种疾病并存和癌症。最常用的镇痛药是对乙酰氨基酚，而弱阿片类药物使用较少。镇痛药的使用因EOL轨迹和护理地点而异，强阿片类药物的使用分别在癌症患者和医院中占主导。几乎一半的患者疼痛管理指数为阴性，且未记录任何用于疼痛控制的非药物干预措施。
在有姑息治疗需求的ACD患者中，尽管在所有EOL轨迹和护理地点疼痛都非常普遍，但强阿片类药物在医院环境和肿瘤疾病中的使用仍然占主导。疼痛管理指数阴性的高比例表明有机会采用个体化的镇痛阶梯疗法以更好地控制疼痛。此外，纳入非药物方法可能有助于改善这些患者的疼痛状况。
