手术后病人疼痛控制状况的调查研究

[目的]了解手术后病人疼痛控制状况。[方法]随机抽取北京地区5家综合性三级甲等医院,采用休斯顿疼痛情况量表及疼痛治疗指数评估表,对304例手术后第2天的住院病人进行调查。[结果]手术后病人期望术后疼痛为轻度,希望能够缓解疼痛;术后疼痛程度达到了中重度,对情绪和日常活动有轻、中度水平的影响;疼痛治疗指数显示有60.19%的病人存在疼痛治疗不足;病人对控制疼痛服务评价较高,而对疼痛控制教育的满意程度评分较低。[结论]手术后病人疼痛尚未得到有效控制,建议制定术后疼痛控制制度和实践指南,采取针对性措施,改善术后疼痛控制不良的状况。     

手术后病人疼痛控制状况的调查研究

[目的]了解手术后病人疼痛控制状况。[方法]随机抽取北京地区5家综合性三级甲等医院，采用休斯顿疼痛情况量表及疼痛治疗指数评估表，对304例手术后第2天的住院病人进行调查。[结果]手术后病人期望术后疼痛为轻度，希望能够缓解疼痛；术后疼痛程度达到了中重度，对情绪和日常活动有轻、中度水平的影响；疼痛治疗指数显示有60.19％的病人存在疼痛治疗不足：病人对控制疼痛服务评价较高，而对疼痛控制教育的满意程度评分较低。[结论]手术后病人疼痛尚未得到有效控制，建议制定术后疼痛控制制度和实践指南，采取针对性措施，改善术后疼痛控制不良的状况。     

术后病人疼痛程度控制目标的研究

[目的]探讨术后病人疼痛程度控制的目标。[方法]采用问卷调查方法,对227例术后病人术后疼痛程度和疼痛对病人活动、咳嗽、深呼吸、进食、睡眠、情绪及满意度等的影响进行调查分析,包括当前的疼痛评估和过去24 h疼痛情况的评估。[结果]术后病人疼痛程度与疼痛对病人日常活动、情绪及满意度的影响程度显著相关,且疼痛评分〉4分时各影响因素出现显著变化。[结论]建议将疼痛评分≤4分作为术后病人疼痛程度的控制目标,以指导医务人员和病人有效地控制术后疼痛。     

术后病人疼痛程度控制目标的研究

[目的]探讨术后病人疼痛程度控制的目标。[方法]采用问卷调查方法,对227例术后病人术后疼痛程度和疼痛对病人活动、咳嗽、深呼吸、进食、睡眠、情绪及满意度等的影响进行调查分析,包括当前的疼痛评估和过去24 h疼痛情况的评估。[结果]术后病人疼痛程度与疼痛对病人日常活动、情绪及满意度的影响程度显著相关,且疼痛评分>4分时各影响因素出现显著变化。[结论]建议将疼痛评分≤4分作为术后病人疼痛程度的控制目标,以指导医务人员和病人有效地控制术后疼痛。     

支持性心理干预对癌痛病人疼痛及生活质量的影响

[目的]探讨支持性心理干预在缓解癌症病人疼痛、改善生活质量中的作用。[方法]选择符合标准的癌痛病人共120例,按照对照匹配原则随机分为两组,对照组采用常规护理方法,观察组在常规护理的基础上采用支持性心理干预,观察两组病人疼痛、生活质量改善情况。[结果]经支持性心理干预后,癌症病人疼痛程度减轻(P0.05);生活质量提高,其中生理功能、躯体疼痛、精力、情感职能、精神健康差异均有统计学意义(P0.05)。[结论]在常规护理的基础上进行支持性心理干预可以缓解癌症病人的疼痛,提高其生活质量。     

认知功能障碍与认知正常老年人疼痛程度及疼痛行为的比较研究

[目的]比较认知障碍老年人与认知正常老年人的疼痛行为、程度有无差别。[方法]便利抽样选取认知功能障碍老年疼痛病人60例、认知功能正常的老年疼痛病人60例及认知功能障碍无疼痛的老年病人30例,由经过统一培训的评定员采用认知障碍疼痛评估量表（参考国外的疼痛评估工具自编）、重度痴呆病人疼痛评估表和非言语疼痛评估指标对3组病人进行疼痛程度评估,比较认知障碍老年人与认知正常老年人的疼痛行为、程度是否存在差剐。[结果一}认知障碍疼痛组与认知正常疼痛组老年人疼痛程度无统计学差异（P〉0．05）,而认知障碍无疼痛组量表得分显著低于其他两组（P〈0．001）。使用PACIE评估疼痛行为,认知正常疼痛组与认知障碍疼痛组的疼痛行为得分在语言／声音、活动、身体姿势上差异有显著性（P〈0．05）,其余各条目得分两组之间无统计学差异（P〉0．05）。[结论]认知障碍老年人与认知正常老年人的疼痛程度无差别,但在疼痛的行为表现上有一定区别。     

老年腰椎压缩性骨折病人术后应用改良疼痛评估图实施疼痛管理的效果

[目的]探讨改良疼痛评估图在老年腰椎压缩性骨折病人术后疼痛管理中的应用效果。[方法]将84例老年腰椎压缩性骨折病人按随机数字表法分为观察组和对照组,每组42例,观察组给予改良疼痛评估图进行评估,对照组采用传统疼痛评估工具。比较两组病人护理效果。[结果]观察组术后疼痛程度低于对照组(P0.05);观察组疼痛出现时间晚于对照组,疼痛评分低于对照组(均P0.05);观察组对护理满意度高于对照组(P0.05)。[结论]改良疼痛评估图的使用有利于准确评估老年腰椎压缩性骨折病人术后疼痛程度,有利于评估病人出现疼痛的时间和掌握疼痛评分,及时给予相应的疼痛控制,提高病人及家属的满意度。     

癌症病人疼痛管理教育效果评价

[目的]确定疼痛管理教育对减轻癌症病人疼痛的有效性。[方法]采用“癌症病人疼痛调查表”对90例肿瘤晚期疼痛病人进行调查,将病人分为实验组和对照组,每组45例,对照组进行常规护理,实验组根据回答情况对45例病人所存在的错误认识进行教育,干预后第3周再次对两组病人进行调查。[结果]通过疼痛管理教育,实验组病人对疼痛知识了解显著提高,疼痛程度较干预前明显下降（P〈0．01）。[结论]疼痛管理教育可以帮助病人获得管理疼痛的知识和技能,从而减轻疼痛,提高病人生活质量。     

晚期癌痛病人家居止痛满意度调查

据WHO统计,全球每天至少有500万癌症病人在遭受着疼痛的折磨。70%的晚期癌症病人认为疼痛是主要症状,30%具有难以忍受的剧烈疼痛[1]。疼痛不仅给病人带来躯体上的痛苦,而且也使病人在精神上产生巨大的压力,严重地影响着病人的生存质量。近年来,随着三阶梯止痛原则的普及,疼痛得到了明显的控制,但是未缓解的疼痛仍然普遍存在。而病人满意度作为评价医院治疗结果和医疗服务质量的指标之一,也是对医院开展"以病人为中心",针对病人需求,改善服务质量的客观依据[2,3]。病人满意度评价在国外得到了广泛的应用,部分发达国家已将疼痛控制满意度作为评价医疗护理质量的重要标准之     

病人自控镇痛泵在烧伤创面疼痛中的应用效果

[目的]对烧伤病人应用病人自控镇痛（PCA）泵效果进行评价，探讨适合烧伤病人疼痛治疗的方法。[方法]①将入选对象随机分为两组：观察组应用吗啡通过PCA泵进行持续静脉输注；对照组给予哌替啶肌肉注射。②分别记录两组病人换药前及换药后30min心率、呼吸、血压及血氧饱和度情况，测定换药后30min血糖、血清电解质及阴离子间隙（E4A）、血气分析及空腹血糖值。③记录换药后两组病人疼痛评分、镇静评分及不良反应（主要是恶心、呕吐）。[结果]观察组疼痛评分、应激性血糖升高反应明显低于对照组（P〈0．01），机体耗氧量降低及无氧代谢减少（P〈0．05）；使用PCA的病人无呼吸循环抑制表现。[结论]P（、A能有效地控制和缓解烧伤病人的疼痛，降低烧伤所致的高代谢。     

Predicting pain and pain responses to opioids

The mechanisms behind the wide individual variability in pain experience and relief are an area of intense research activity. Predicting individual clinical pain and the responsiveness to analgesics should increase the efficacy and tolerability of analgesic treatments, and improve the overall treatment outcome. Several factors have shown validity in the prediction of pain, with most studies having been performed in postoperative pain. These factors include younger age, female gender, multiple psychosocial contributors (e.g. negative affect, somatisation, depressive mood, expectations, anxiety), pre-existing physical comorbidities and pain, information provided by carers, and the nature of the pain insult. Recent studies have shown quantitiative sensory testing at high stimulus intensity (e.g. pain thresholds), as well as specific genetic factors and the functional testing of the endogenous pain modulatory pathways as emerging useful tools in the study of individual pain variability.Many of the above factors are also relevant in the prediction of analgesic responsiveness. The predominant pain characteristics, pain chronicity and neuroplastic changes, opioid-related genetic factors and psychological factors (including placebo response components) are major determinants of analgesic efficacy. Prediction of analgesia using quantitative sensory tests has been studied with some success.Better prediction of individual pain and analgesic responsiveness promises to improve pain control and general treatment outcome, and reduce adverse events as well as costs. Further prospective studies with interdisciplinary input validating the usefulness of predictive variables within algorithms are encouraged in large patient cohorts.     

Preamputation pain and acute pain predict chronic pain after lower extremity amputation.

Although previous research suggests that preamputation pain is a risk factor for pain after amputation, little is known about the association between acute postsurgical pain and chronic amputation-related pain. The current prospective study examined the associations of preamputation pain and acute postamputation pain with chronic amputation-related pain. The sample consisted of patients with lower limb amputation (N = 57) who provided both preamputation and postamputation data during a 2-year study period. Preamputation pain intensity and duration were assessed before amputation; acute phantom limb pain (PLP) and residual limb pain (RLP) intensity were assessed on postsurgical days 4 and 5. Acute PLP intensity was the only significant independent predictor of chronic PLP intensity at 6 and 12 months after amputation, whereas preamputation pain intensity was the only significant predictor of chronic PLP intensity at 24 months. Similarly, acute RLP was found to be the best overall predictor of chronic RLP. Other variables (age, gender, level and etiology of amputation, amount of postsurgical pain medication, and duration of preamputation pain) were not associated with chronic pain. These results suggest that higher levels of pain either before or soon after amputation might help to identify individuals at greatest risk for chronic pain problems and most in need of early, intensive pain interventions. PERSPECTIVE: This study suggests that both preamputation pain and acute pain soon after amputation might be associated with bothersome chronic pain. The results support further research on acute pain mechanisms and the effectiveness of early interventions aimed at preventing or managing amputation-related pain.     

Electronic momentary assessment in chronic pain II: pain and psychological pain responses as predictors of pain disability

OBJECTIVES AND METHODS: More than 7,100 electronic diaries from 80 patients with chronic pain (mean: 89.3, range 30-115) entered multilevel analyses to establish the statistical prediction of disability by pain intensity and by psychological functioning (fear avoidance, cognitive, and spousal pain responses). We also tested the differences between pre-chronic, recently chronic, and persistently chronic pain in the prediction of disability (impaired physical and mental capacity, pain interference with activities, immobility due to pain). RESULTS: Pain intensity explained 8% to 19% of the disability variance. Beyond this psychological functioning explained 7% to 16%: particularly fear-avoidance and cognitive pain responses predicted chronic pain disorder disability; spousal responses predicted immobility better than other aspects of disability. Immobility due to actual pain occurred infrequently. When it did, however, it was better predicted by avoidance behavior in the patient and by spousal discouragement of movement than by actual pain intensity. The prediction of immobility due to pain by, respectively, avoidance behavior and catastrophizing was better in chronic pain (>6 months) and that of physical impairment by catastrophizing better in persistently chronic pain (>12 months) than in pain of shorter duration. DISCUSSION: The psychological prediction of chronic pain disorder disability was determined beyond that accounted for by pain intensity. Nonetheless, psychological functioning explained substantial variance in chronic pain disorder disability. The psychological prediction of immobility and physical impairment was stronger with longer pain duration. Patient characteristics and momentary states of disability-and in particular of immobility-should be carefully distinguished and accounted for in chronic pain disorder.     

Labour pain: correlations with menstrual pain and acute low-back pain before and during pregnancy

Low-back pain is a major component of labour pain in a substantial number of women. The purpose of this study was to determine whether episodes of acute low-back pain prior to pregnancy is a predictor of low-back pain during labour. 114 women received the Short-Form McGill Pain Questionnaire (SF-MPQ) during labour and were asked to describe the pain separately for front and back contraction pain or continuous pain. The day after the birth of the child the women were interviewed to determine whether they had (a) a history of episodes of acute low-back pain before pregnancy, (b) low-back pain during pregnancy, and (c) low-back pain during menstruation. The results show that episodic low-back pain before pregnancy is not correlated with any aspect of labour pain. However, it is significantly correlated with episodes of low-back pain during pregnancy. In contrast, low-back pain during menstruation is significantly correlated with labour pain scores recorded for back and front contraction pain as well as for continuous back pain. The significant correlation of labour pain with back pain during menstruation suggests that both share a common underlying mechanism. Similarly, the correlation of low-back pain during pregnancy with episodes of acute low-back pain before pregnancy suggests that the strain on back muscles during pregnancy may activate the mechanisms that underlie the usual forms of low-back pain.     

The dimensionality of pain: palliative care and chronic pain patients differ in their reports of pain intensity and pain interference

The accurate, precise, and consistent assessment of pain is of particular importance in palliative care. The European Palliative Care Research Collaborative is developing a computer-based pain assessment instrument and has been evaluating the content and dimensionality of existing pain questionnaires. The most important dimensions of pain are intensity and interference. However, since pain interference is a consequence of and largely reflects pain intensity, we postulated that it might either provide information to enhance the evaluation of intensity, or that an overall summary measure of pain severity could be constructed by combining the 2 dimensions. Cancer patients in palliative care (n=395) and chronic pain patients (n=168) completed questionnaires that included 23 pain items culled from existing questionnaires. Psychometric analyses confirmed the existence of 2 main dimensions, intensity and interference, and also guided identification of items that contributed most strongly to these dimensions. However, there was strong evidence that the relationship between the intensity and the interference items differs markedly in palliative care patients compared to chronic pain patients. As hypothesized, there was strong correlation between intensity and interference, lending support to the possibility that, for some purposes, these dimensions may be combined to provide a higher-level summary measure of patients' pain experience. We conclude that these dimensions should be kept distinct when assessing patients in general, although for a single type of patient (such as palliative care patients), it may be possible to regard intensity and interference as contributing to an overall measure of pain severity.