Von Roenn J H, Cleeland C S, Gonin R, Hatfield A K, Pandya K J
Northwestern University Medical School, Section of Medical Oncology, Chicago, IL 60611.
Ann Intern Med. 1993 Jul 15;119(2):121-6. doi: 10.7326/0003-4819-119-2-199307150-00005.
The Eastern Cooperative Oncology Group (ECOG) conducted a groupwide survey to determine the amount of knowledge about cancer pain and its treatment among physicians practicing in ECOG-affiliated institutions and to determine the methods of pain control being used by these physicians.
Survey.
A questionnaire was sent to all ECOG physicians with patient care responsibilities (medical oncologists, hematologists, surgeons, and radiation therapists), practicing in university institutions, Community Clinical Oncology Program (CCOP) institutions, and Cooperative Group Outreach Programs (CGOP) institutions.
A physician cancer pain questionnaire developed by the Pain Research Group at the University of Wisconsin was used. The questionnaire was designed to assess physicians' estimates of the magnitude of pain as a specific problem for cancer patients, their perceptions of the adequacy of cancer pain management, and their report of how they manage pain in their own practice setting.
The study analyzed responses to 897 of 1800 surveys. In regard to the use of analgesics for cancer pain in the United States, 86% felt that the majority of patients with pain were undermedicated. Only 51% believed pain control in their own practice setting was good or very good; 31% would wait until the patient's prognosis was 6 months or less before they would start maximal analgesia. Adjuvants and prophylactic side-effect management should have been used more frequently in the treatment plan. Concerns about side-effect management and tolerance were reported as limiting analgesic prescribing. Poor pain assessment was rated by 76% of physicians as the single most important barrier to adequate pain management. Other barriers included patient reluctance to report pain and patient reluctance to take analgesics (both by 62%) as well as physician reluctance to prescribe opioids (61%).
Professional education needs to focus on the proper assessment of pain, focus on the management of side effects, and focus on the use of adjuvant medications. A better understanding of the pharmacology of opioid analgesics is also needed. Physicians also need to educate patients to report pain and to effectively use the medications that are prescribed for pain management.
东部肿瘤协作组（ECOG）开展了一项全组范围的调查，以确定在ECOG附属机构执业的医生对癌症疼痛及其治疗的了解程度，并确定这些医生所采用的疼痛控制方法。
调查。
向所有负责患者护理工作的ECOG医生（医学肿瘤学家、血液学家、外科医生和放射治疗师）发放了问卷，这些医生在大学机构、社区临床肿瘤项目（CCOP）机构和协作组外展项目（CGOP）机构执业。
使用了威斯康星大学疼痛研究小组编制的医生癌症疼痛问卷。该问卷旨在评估医生对疼痛严重程度的估计，将其作为癌症患者的一个具体问题，评估他们对癌症疼痛管理充分性的看法，以及他们报告自己在实际临床中如何管理疼痛。
该研究分析了1800份调查问卷中897份的回复。关于美国癌症疼痛的镇痛药使用情况，86%的人认为大多数疼痛患者的用药不足。只有51%的人认为他们自己临床中的疼痛控制良好或非常好；31%的人会等到患者预后为6个月或更短时间才开始使用最大剂量的镇痛药。辅助药物和预防性副作用管理在治疗方案中应更频繁地使用。据报告，对副作用管理和耐受性的担忧限制了镇痛药的处方。76%的医生将疼痛评估不佳评为充分疼痛管理的最重要单一障碍。其他障碍包括患者不愿报告疼痛（62%）、患者不愿服用镇痛药（62%）以及医生不愿开具阿片类药物（61%）。
专业教育需要注重疼痛的正确评估、副作用的管理以及辅助药物的使用。还需要更好地了解阿片类镇痛药的药理学。医生还需要教育患者报告疼痛并有效使用为疼痛管理开具的药物。
