顽固性癌痛的治疗

随着麻醉医学的不断发展,麻醉不仅限于手术治疗,重症监护、危重病人的抢救、疼痛治疗等等已成为麻醉的工作范畴,针对顽固性癌痛,长期以来,学术界认为;采用常规药物治疗癌痛忍不易缓解,而且伴有神经系统损害癌痛即为顽固性癌痛,如肿瘤压迫神经、血管、骨转移等。1.顽固性癌痛的种类     

实施癌痛规范化治疗的临床实践意义

目的：分享云南省肿瘤医院在全国“癌痛规范化治疗示范病房”创建活动中,实施癌痛诊疗的经验,进一步促进云南省癌痛规范化治疗。方法：回顾我院创建“癌痛规范化治疗示范病房”的历程,以癌痛患者规范化治疗为手段,以控制癌痛症状,提高癌痛患者的生活质量为目的,以安全质量为要求,总结创建“癌痛规范和治疗示范病房”的具体实施、癌痛诊疗流程及经验。结果：在创建“癌痛规范化治疗示范病房”的活动中,规范了医护对于癌痛患者的诊疗,改善了癌痛患者的症状,有效地缓解患者癌症疼痛,效果较为突出。经过全院努力,于2012年通过了卫生部首批“癌痛规范化治疗示范病房”评审。结论：我院“癌痛规范化治疗示范病房”的创建,能够进一步规范医护对于癌痛患者的诊疗,促进医师合理用药;同时,通过对患者及家属的宣教,进一步促进了惠者的依从性,从根苯上减轻了癌痛患者的痛苦,改善了患者的生活质量。此项目是一项民生工程、惠民工程,是一项使癌痛患者真正受益的工程,需要继续推广。     

创建“癌痛规范化治疗示范病房”的经验体会

<正>癌痛是由肿瘤所致的疼痛,是长期困扰肿瘤患者的一个重要问题,已被作为"第五生命体征"来处理[1]。全世界每年新发癌症患者1 000余万,每年至少有500万癌症患者在遭受疼痛的折磨,70%的晚期癌症患者认为癌痛是主要症状,30%具有难以忍受的剧烈疼痛[2],为使癌痛患者能够接受规范化治疗,减轻癌痛的折磨,提高生存质量,同时提高医务人员对癌痛的认识,2011年卫生部开始在全国开展"创建癌痛规范化治疗示范病房"活动。     

药学监护促进癌痛药物合理性使用的作用研究

目的 回顾性分析癌痛药物使用的情况,探讨药学监护在癌痛规范化治疗中的作用。方法 制定癌痛规范化治疗标准,随机抽取2019—2020年癌痛患者病历60份进行合理性评价;临床药师以癌痛药物不合理使用作为切入口,对癌痛患者实施药学监护,通过制定并调整给药方案,给予患者用药教育,为临床提供癌痛药学服务。结果 癌痛患者多为60岁以上者（56.7%）,止痛药物使用最多的是盐酸羟考酮缓释片,其次为氨酚曲马多片。32例患者存在不合理使用情况,主要表现为使用阿片类药物未滴定。给予患者药学监护和用药教育可以促进合理使用。结论 临床药师提供癌痛药学监护可以促进癌痛药物的合理性使用,癌痛规范化治疗有利于临床合理用药。     

癌痛可用哪些止痛药

<正>所谓癌症疼痛(癌痛),是指癌症、癌症相关性病变及抗癌治疗所致的疼痛。癌症疼痛多为慢性疼痛。晚期癌症患者疼痛发生率约为50%~60%,其中三分之一的患者为重度疼痛。但癌痛并不是只发生在晚期癌症患者中,早中期癌症患者同样可能会有癌痛。癌痛是影响病人生活质量的重要因素,必须重视癌痛的治疗。很显然,治疗癌症疼痛最重     

从医学人文教师的视角审视医学人文教学--一种实证研究

[目的]考察医学人文教师对医学人文教学目标、课程设置、教学改革等问题的认知,为医学人文教学改革提供建议。[方法]用自行设计的医学人文教育问卷对医学人文教师进行调查,运用SPSS18.0进行统计分析。[结果]医学人文教育重要性已达成共识,但是对教育目标的认知与学历、工龄有一定联系,教学方法单一、学生不重视等是医学人文教学改革最主要问题。[结论]推进医学人文教学改革需要转变观念、明确目标,深化对医学人文能力的认识;要合理设置课程,明确核心模块,注重互补;教学模式应结合医学实践,以PBL等方法为主,多元化相结合;在考核方面,以实践考核为主,辅以开卷、论文写作。     

癌痛护理个案分析

目的：癌痛治疗是癌症治疗的重要组成部分,治疗疼痛的目的是最大程度的止痛、最小的副作用和提高生活质量,规范的疼痛治疗对于躯体感觉功能并没影响,有研究表明,全面进行疼痛治疗将有助于延长患者的生存。疼痛不是单靠药物和医疗技术就能完全控制,因为癌痛及其患者的影响是全面、复杂的。姑息医学的理念告诉我们：要用‘四全照顾’即,全人、全家、全程、全队’的疼痛照顾模式,才能更好地为患者及其家属提供全面的疼痛控制。意义：为提高癌症病人的生活质量,WHO于1982年在意大利成立了癌痛治疗专家委员会,经讨论一致认为应用现有的和为数有限的镇痛药物就可以解除大多数癌症病人的疼痛,并提出t到2000年达到在全世界范围内使癌症病人不痛’的目标。研究表明,癌痛得不到充分的治疗和护理属于普遍现象,控制癌痛是不容忽视的全球性公共健康问题。因此,掌握正确的疼痛评估方法,实施有效的止痛措施和完善的护理,对三阶梯止痛的实施、提高癌痛患者的生活质量有着重要的意义。     

癌痛 要勇敢说出来

<正>癌痛指患有恶性肿瘤后出现的疼痛,也就是癌性疼痛。临床上将癌痛分成三类,第一类指由肿瘤本身引起的疼痛,约75%~80%的癌痛由此引起,属最主要的癌痛类型;第二类指由治疗引起的疼痛,如化疗、放疗以及一些微创治疗,10%~15%的癌痛由此引起;第三类指癌症患者平时所伴随的慢性疼痛,比如伴有三叉神经痛、腰腿痛或者带状疱疹神经痛。     

癌痛治疗避免八大误区

<正>疼痛是癌症主要症状,由于认识上的误区,在我国,仅三成癌痛患者的疼痛得到有效缓解。长期疼痛会严重影响患者及其家人的生活质量,导致免疫力下降,阻碍抗癌治疗的顺利进行。因此,正确认识癌痛,避免癌痛治疗中的误区十分重要。?误区1:癌痛能忍就忍,忍不住再吃药疼痛会影响患者的睡眠、身体代谢和机体免疫力,不     

癌症患者需了解的癌痛知识

<正>目前全球每年新增癌症患者1 270万,每年癌症死亡人数760万,56%晚期患者经历至少一个月以上的中、重度癌痛折磨。面对难以忍受的疼痛,患者和家属存在不少困惑和认识误区。所以,对待这些疼痛患者,就需要疼痛科专业医师的指导及帮助。下面对临床上常见的一些问题进行解答。1.癌痛患者强忍疼痛好吗?癌痛是癌症患者最常见的症状,也是影响癌症患者生活质量的主要原因。然而大部分癌痛患者对癌痛     

癌痛患者的健康教育临床路径

目的为癌痛患者提供健康教育临床路径,使其进行癌痛规范化管理及治疗。方法将140例癌痛患者随机分成观察组和对照组各70例,观察组由疼痛专员、责任医生、责任护士组成的疼痛小组采用临床路径进行健康教育,负责对患者进行癌痛程度、知识层次、自理能力的评估,制订相应健康教育临床路径内容。对照组由责任医生、责任护士采用常规健康教育,即治疗护理过程中进行宣教。结果观察组疼痛控制效果、疼痛知识掌握情况、患者生活质量改善以及医护满意度均显著优于对照组,差异有统计学意义(p<0.05)。结论对癌痛患者应用临床路径实施健康教育可明显提高疼痛控制效果,值得推广。     

普外科病人疼痛认知状况调查

目的了解普外科病人对术后疼痛的认知程度,为临床医护人员进行优质的疼痛管理和控制提供参考。方法便利抽取徐州医学院附属医院普外科151名择期手术病人进行问卷调查,用SPSS13．0软件包对调查结果进行统计学分析。结果病人表示对疼痛知识一点儿也不了解、了解极少、稍微了解的占82．8％;不同性别、文化程度及是否有手术疼痛史的病人回答疼痛常识问题的结果,其差异无统计学意义。但≥56岁组的病人较18～35和36～55岁2个年龄组病人的答对题数高（P=0．031）;病人渴望获取疼痛知识,但又缺乏主动参与性。结论病人对疼痛知识了解甚少,应加强对病人的术前宣教,提高医护人员对疼痛处理的重视程度,促使医护人员和病人共同参与疼痛控制。     

Impact of community-based education on health care evaluation in patients with acute chest pain syndromes: the Wabasha Heart Attack Team (WHAT) project

BACKGROUND: Community education programmes focused on raising public awareness of the symptomatology of acute coronary syndromes have had mixed results. OBJECTIVES: The Wabasha Heart Attack Team project, a unique multidisciplinary public education effort in Minnesota, sought to educate area citizens about signs and symptoms of acute myocardial infarction (MI). METHODS: After an intensive 1-month education period, we compared presentations for emergency evaluation of chest pain during the study period with baseline data from the same seasonal period of the preceding year. RESULTS: Visits to the Emergency Room for symptomatic heart disease increased significantly during the study period (56 patients versus 46 patients during the baseline period), as did the percentage of patients presenting with acute MI (18% versus 12%, P < 0.05). Use of emergency medical services for pre-hospital evaluation was significantly increased (41% versus 27%, P < 0.05). CONCLUSION: A community education campaign can significantly increase use of pre-hospital emergency medical service resources and may increase the number of patients presenting with acute chest pain symptoms, including MI.     

Intractable pain: a neglected area of medical education in the UK.

Unease over the previous management of 67 patients referred for treatment to 3 pain relief clinics led us to investigate the current state of education in pain and pain control in the UK. Twenty-seven medical schools provided data which revealed; (i) in 4 schools no teaching whatsoever is given in these subjects; (ii) in the remainder it is accorded an average of 3.5 hours during the 5 year course, with little evidence of multidisciplinary teaching; (iii) only 10 schools (37%) regularly set questions on pain control in formal examinations. A survey of 219 general practitioners revealed a wide-ranging lack of knowledge about the facilities and approach to treatment at their local pain relief clinic. These findings have wide reaching implications for medical education. At the undergraduate level they demonstrate a need for more multidisciplinary teaching and practical experience in specialist units. Thereafter specialists in pain control must enable practising doctors to keep abreast of new developments. This may require them to devote more time writing for a non-specialist audience and devising short, postgraduate courses.     

西安市医护人员疼痛管理知识、态度和行为调查

目的 对西安市医护人员疼痛管理知识、态度和行为进行调查,并分析其影响因素,为医护人员疼痛管理的持续改进提供科学依据。方法 采用自制的医护人员疼痛管理知识、态度和行为调查问卷对西安市4家三甲医院医护人员进行调查,采用描述流行病学分析方法对医护人员疼痛管理知识、态度和行为情况进行分析,并采用单、多因素分析方法对疼痛管理知识、态度和行为的影响因素进行分析。结果 1 018名医护人员对疼痛管理知识、态度和行为的答题得分率分别为45.80%、40.73%和46.09%。多重回归分析结果显示,工作年限（β'=0.116）、职称（β'=0.089）、疼痛科/肿瘤科相关科室工作经历（β'=0.249）、接受疼痛知识教育或培训（β'=0.357）是医护人员疼痛管理知识得分的影响因素;工作年限（β'=0.227）、疼痛科/肿瘤科相关科室工作经历（β'=0.416）、接受疼痛知识教育或培训（β'=0.269）、知识得分（β'=0.263）是医护人员疼痛管理态度得分的影响因素;工作年限（β'=0.176）、疼痛科/肿瘤科相关科室工作经历（β'=0.263）、接受疼痛知识教育或培训（β'=0.242）、知识得分（β'=0.203）、态度得分（β'=0.237）是医护人员疼痛管理行为得分的影响因素。结论 医护人员疼痛管理知识、态度和行为水平均处于较低水平,亟待进一步提高,对医护人员的疼痛管理继续教育应予以重视。     

Improving pain management practice. A medical center moves beyond education to document and manage patient care

In 1993 nurses at Providence/ Portland Medical Center, Portland, OR, initiated a quality improvement project to assess pain levels in the facility's inpatients. A convenience sample in April 1993 showed an average pain intensity of 6.30 on a 0-10 scale (where O equals no pain and 10 is the worst pain imaginable). With the nursing administrator's support, pain management nurses presented a four-hour course in the basics of pain assessment and intervention to more than 850 nurses and 100 other professionals. In August 1993 nurses found that the intensity of patient pain had dropped to 5.70 on the 0-10 scale. Still dissatisfied with this situation, the nurses proceeded with a three-pronged approach to improve the medical center's quality of pain management: making the problem visible by better documentation and communication about pain; making an institutional commitment to pain management, including establishing pain management quality improvement as the medical center's first patient outcome institutional objective; eliciting the endorsement of influential committees. In August 1994 a random sample revealed patient pain had decreased to 3.21. The next step focused on empowering patients and families through education (e.g., revising the booklet on patient rights and responsibilities, posting signs in rooms encouraging patients to report pain) and clearing up myths and misconceptions through inservices and posters. A sampling in November 1995 showed that the average pain intensity of inpatients had been reduced to 2.32. Plans for continuous quality improvement interventions will further enhance patient comfort and recovery.     

Pain management. Theological and ethical principles governing the use of pain relief for dying patients. Task Force on Pain Management, Catholic Health Association

Pain management is a societal problem because of concerns about the use of drugs, the belief that patients are not good judges of the severity of their pain, and an alarming level of ignorance about pain and its treatment among physicians, nurses, and other healthcare providers. The result is that patients suffer pain unnecessarily, even up to the point of their death. Pain management is also a clinical-practice problem. Courses in pain and symptom management are not readily available to medical and nursing students. And in clinical practice, good pain assessment is not easy to accomplish because pain is so subjective. Fortunately, with education, doctors and nurses can vastly improve their ability to assess and manage patients' pain. Additional problems in pain management relate to the manner in which healthcare is provided today: an acute disease-oriented model of hospital care, frequent transfers, fragmented care, inadequate reimbursement, market forces that drive up costs, and maldistribution of clinical services. In improving their ability to manage pain, professionals must understand the difference between pain and suffering, acute and chronic pain, and the sensory and emotional aspects of pain. Guiding principles include Church teaching and ethical principles, such as patient self-determination, holistic care, the principle of beneficence, distributive justice, and the common good. Pain management strategies that will be instrumental in formulating effective responses to these problems include expanding professional and community education, affording pain funding priority, establishing institutional policies and protocols, forming clinical teams, encouraging hospice and home care, and requiring accreditation in pain and symptom management.     

Perceptions of disability and occupational stress as discriminators of work disability in patients with chronic pain

Pain-related work disability can be influenced by a number of medical, physical, and psychosocial factors. The present study investigated the role of perceived disability, occupational stress, pain, and distress in patients with chronic pain disorders who work despite pain and patients who are work disabled. A total of 165 patients referred to a multidisciplinary pain treatment center for chronic pain (> 6 months) were studied. The two groups were compared on age, gender, education, marital status, duration of pain problem, pain severity, psychological distress, perceived disability, and perception of the work environment. A discriminant function analysis was computed entering pain severity, distress, perceived disability (physical and psychosocial) and work environment variables. The two groups were equivalent on age, gender, education, marital status, and duration of pain problem. The groups differed on diagnosis and insurance coverage with the work-disabled group diagnosed with low back pain and receiving Workers Compensation coverage more frequently than working controls. Univariate analyses indicated that the work-disabled group reported higher pain severity, perceived physical and psychosocial disability, and job stress than their working cohorts. The discriminant function analysis indicated that the perception of physical disability, supervisor support, distress, and work pressure were capable of correctly classifying patients with chronic pain who continued to work from those who were work disabled. These findings indicate the importance of evaluating perceived disability and job stress, and if present, directing intervention effort at these factors in order to facilitate work re-entry.     

Patient pain in primary care: factors that influence physician diagnosis

BACKGROUND: The accurate recognition of patient pain is a crucial, but sometimes difficult, task in medical care. This study explored factors related to the physician's diagnosis of pain in primary care patients. METHODS: New adult patients were prospectively randomized to care by primary care providers at a university medical center clinic. Study participants were interviewed prior to the initial visit, and their level of self-reported pain was measured with the Visual Analog Pain Scale and the Medical Outcomes Study Short Form-36. The medical encounter was videotaped in its entirety and later analyzed using the Davis Observation Code to characterize physician practice style. Patient satisfaction was measured immediately after the visit. A review of the medical record was used to assess physician recognition of patient pain. RESULTS: For all patients (N = 509), as the amount of pain increased, the percentage of patients having pain diagnosed by the physician also increased. Female patients reported a greater amount of pain than male patients. When women were in severe pain, they were more likely than men to have their pain accurately recognized by their physician. The correct diagnosis of pain was not significantly related to patient satisfaction. Physician practice styles emphasizing technically oriented activities and health behavior discussions were strongly predictive of the physician diagnosing patient pain. CONCLUSIONS: The diagnosis of pain is influenced by the severity of patient pain, patient gender, and physician practice style. If the routine use of pain assessment tools is found to be effective in improving physician recognition and treatment of patients' pain, then application of these tools in patient care settings should be encouraged.