慢性疼痛患者人格特质对疼痛程度的影响

目的探讨慢性疼痛患者人格特质对疼痛程度的影响。方法选取该院2017年6月至2019年6月收治的腰椎间盘突出症患者200例,随机分为对照组和干预组,各100例。对照组进行疼痛科常规护理干预,干预组在疼痛常规护理干预基础上进行情绪调节疗法。干预前运用艾森克人格问卷(EPQ-RSC)对患者进行调查,对比干预前后患者正负情绪量表(PANAS)、情绪调节量表(ERQ)、数字疼痛评估法(NRS)和症状自评量表(SCL-90)评分差异。结果干预前,两组患者EPQ-RSC各维度评分、PANAS评分、ERQ评分、NRS评分和SCL-90评分组间差异均不显著;干预后,干预组PA评分、认知重评评分明显高于对照组,NA评分、表达抑制评分、NRS评分以及SCL-90量表中躯体化、焦虑、抑郁、偏执4个因子的评分均明显低于对照组,差异均有统计学意义(均P<0.05)。结论通过艾森克人格特质问卷预测慢性疼痛患者的积极情绪,以此为依据对患者进行情绪管理,可有效调节患者情绪,引导患者恢复正性情绪,降低疼痛程度,改善临床症状,从而尽快恢复。     

混合痔术后患者早期疼痛灾难化现状及其影响因素

目的探讨混合痔术后患者早期疼痛灾难化发生情况及其影响因素。方法便利抽样选取某院242例混合痔术后患者为研究对象,采用一般情况调查表、疼痛灾难化量表、肛门视觉模拟评分及正性负性情绪量表对其进行调查。结果本组混合痔术后患者早期疼痛灾难化总分为(36.78±8.08)分,其中102例(42.15%)患者疼痛灾难化总分≥38分,达到疼痛灾难化水平;多元回归分析结果显示,年龄、文化程度、肛门视觉模拟评分、负性情绪得分是影响其疼痛灾难化的主要因素(均P0.01)。结论混合痔术后患者早期疼痛灾难化水平较高,高龄、小学/初中、肛门疼痛强度、负性情绪得分高的患者更易发生疼痛灾难化;护理人员应根据影响因素实施针对性的干预措施,以降低疼痛灾难化的发生。     

TKA患者手术前后疼痛灾难化认知与疼痛、情绪状态的相关性分析

目的探讨人工全膝关节置换(TKA)患者手术前后疼痛灾难化与疼痛及情绪状态的相关性。方法采用一般资料调查表和视觉模拟评分表(VAS)、疼痛灾难化量表(PCS)和正性负性情绪量表扩展版(PANAS-X),对76例TKA患者进行调查。采用Pearson相关性分析探讨疼痛、情绪状态与疼痛灾难化的关系。结果本组76例TKA患者疼痛灾难化术前总分为(26.36±10.35)分,术后总分为(13.80±7.17)分,术后疼痛灾难化总分比术前下降47.6%,差异有统计学意义(P0.05);居住地得分在术前与术后差异均有统计学意义(P0.05);退休前职业得分只在术前差异有统计学意义(P0.05);居住方式只在术后差异有统计学意义(P0.05)。经Pearson相关性分析,术前PCS总分与术前的VAS得分、基本负性情绪总分及各维度、其他情绪状态总分呈一定正相关(P0.01),与基本正性情绪总分呈一定负相关(P0.01);术后PCS得分与术后的VAS总分、基本负性情绪总分、"疲劳"呈一定正相关(P0.01),与基本正性情绪总分呈一定负相关(P0.01)。结论 TKA患者疼痛灾难化水平与疼痛、负性情绪、疲劳呈正相关,与正性情绪呈负相关。不但术前的疼痛灾难化认知水平影响术后的疼痛和负性情绪,而且术前的疼痛和负性情绪也会影响术后的疼痛灾难化认知水平。护理人员应实时关注围术期TKA患者疼痛症状的变化及情绪状态,根据患者的情绪状况给予针对性的心理护理。     

冠状动脉硬化性心脏病患者的疼痛灾难化现状及其影响因素

目的调查冠状动脉硬化性心脏病(简称冠心病)患者疼痛灾难化现状及其影响因素,为临床干预研究提供科学依据。方法2020年12月至2021年4月,采用便利抽样法选取某三级甲等医院心内科收治的冠心病患者258例为调查对象,采用一般资料调查表、视觉模拟评分量表(visual analogue scale,VAS)、疼痛灾难化量表(pain catastrophzing scale,PCS)对其进行调查。结果冠心病患者疼痛灾难化平均总分为20.00(25.00)分,疼痛灾难化发生率为16.7%。线性回归分析结果显示,冠心病患者疼痛灾难化的主要影响因素是心功能Ⅲ级、疼痛程度和性别,可解释总变异量的55.1%。结论冠心病患者疼痛灾难化被证实有一定的发生率,应重点关注心功能Ⅲ级、疼痛程度较大和女性患者。     

慢性疼痛住院患者自我效能感与心理弹性、疼痛灾难化的相关性分析

目的 探讨慢性疼痛患者心理弹性与疼痛灾难化对其自我效能感的影响。方法 采用一般资料调查表、心理弹性量表、疼痛灾难化量表、慢性疼痛自我效能感量表对西安市某三级甲等医院疼痛科住院治疗的慢性疼痛274例患者进行相关调查。结果 慢性疼痛患者的心理弹性总分59.61±17.05分,疼痛灾难化总分22.00±11.40分,慢性疼痛自我效能感总分66.01±20.13分。单因素分析显示,慢性疼痛患者自我效能感得分在不同年龄、婚姻状况、文化程度、职业、每周疼痛次数、疼痛程度、有无其他慢性病方面比较差异有统计学意义（P<0.05）。相关性分析显示,慢性疼痛患者心理弹性总分与自我效能感总分呈正相关（r=0.466,P<0.01）;疼痛灾难化总分与自我效能感总分呈负相关（r=-0.446,P<0.01）。多元线性回归分析显示,年龄、婚姻状况、文化程度、职业、心理弹性总分和疼痛灾难化总分是慢性疼痛患者自我效能感的影响因素。结论 医护人员应及时采取措施,形成个体化干预方案,关注老年患者的心理状态及疼痛灾难化心理,提高慢性疼痛患者的心理弹性,降低其疼痛灾难化,进而提高其自我效能感,为患者树立自我...     

规范化疼痛干预对骨科术后疼痛的临床效果研究

目的探讨规范化疼痛干预对骨科术后患者疼痛的影响。方法将144例患者随机分为对照组和干预组,对照组实施常规骨科术后的护理,干预组采用规范化疼痛干预措施,即术前对患者进行疼痛健康教育,将疼痛强度记录在"疼痛护理记录单"中,针对不同的疼痛强度采取相应的措施。观察两组患者术后3d的数字疼痛强度量表(NRS)疼痛评分、睡眠满意度、疼痛缓解程度和休斯顿疼痛情况调查表。结果术后3d两组的平均疼痛强度和睡眠满意度差异均有显著意义(P<0.01);干预组患者经过规范化管理后,有效疼痛缓解率达91%,疼痛控制总体满意度和相关条目的满意度均值最低在8分。结论规范化疼痛干预能有效缓解骨科患者术后疼痛,提高睡眠满意度和疼痛护理的满意度,促进患者康复。     

补充与替代医学心身疗法对癌性疼痛患者的影响

目的 研究补充与替代医学(CAM)心身疗法对癌性疼痛患者负性情绪、睡眠质量和应对方式的影响。方法 选择本院2018年8月—2019年10月诊治的75例癌性疼痛患者为研究对象，采用随机数字表法将患者分为对照组(36例)和试验组(39例),对照组采用常规护理，试验组在常规护理的基础上采用CAM心身疗法，两组均干预1周，比较两组患者的疼痛程度[采用视觉模拟评分法(VAS)评估]、正负性情绪[采用正性负性情绪量表(PANAS)评估]、睡眠质量[采用匹兹堡睡眠质量指数(PSQI)评估]和应对方式[采用医学应对问卷(MCMQ)评估]。结果 重复测量方差分析显示，两组患者VAS评分的组间效应、时间效应及交互效应均有统计学意义(P<0.05);干预后，试验组患者PANAS正性情绪维度评分高于对照组，负性情绪维度评分低于对照组(P<0.05);干预后，试验组患者的PSQI各维度评分和总分低于对照组(P<0.05);干预后，试验组患者的MCMQ面对维度评分高于对照组，回避、屈服维度评分和总分低于对照组(P<0.05)。结论 将CAM心身疗法应用于癌性疼痛患者，可有效控制患者的疼痛，...     

正性音乐刺激对手外科患者术后疼痛及负性情绪的影响

目的 探讨正性音乐刺激对手外伤患者术后疼痛及负性情绪的影响。 方法 选取2017年1-6月我院手外科治疗的68例手外伤患者为研究对象,随机将其分为对照组和实验组各34例。对照组给予常规护理干预,实验组在对照组基础上加用正性音乐刺激。干预6周后,比较2组患者痛觉视觉模拟评分(visual analogue scale/score,VAS)、焦虑和抑郁情绪变化。 结果 入组时,2组患者负性情绪和痛觉视觉模拟评分比较,差异均无统计学意义(P>0.05)。干预6周后,实验组焦虑、抑郁评分及痛觉视觉模拟评分均低于对照组(t=14.645 ,P<0.001;t=12.728 ,P<0.001;t= 9.156,P<0.001)。 结论 正性音乐刺激能够显著减轻患者术后疼痛,改善手外伤患者负性情绪,值得在临床应用和推广。     

疼痛敏感度用于预测经皮脊柱内镜髓核摘除术治疗腰椎间盘突出症的早期效果

目的:观察疼痛敏感度对经皮脊柱内镜髓核摘除术(percutaneous transforaminal endoscopic discectomy,PTED)治疗腰椎间盘突出症早期效果的影响。方法:101例诊断为腰椎间盘突出症病人行脊柱内镜髓核摘除术。术前完成以下量表:疼痛敏感度量表(pain sensitivity questionnaire,PSQ)、医院焦虑抑郁量表(hospital anxiety and depression scale,HADS)、疼痛灾难化量表(pain catastrophizing scale,PCS)和Oswestry功能障碍指数问卷表(oswestry disability index,ODI)。术后6月进行随访,内容包括腰腿痛评分(numerical rating scales,NRS)、ODI和Mac Nab评估。结果:98例病人完成随访。PTED术后症状显著缓解,根据Mac Nab评估结果将病人分为两组:优良组(83.7%)和中差组(16.3%)。优良组的PSQ评分显著低于中差组;PSQ评分与手术前后的ODI差值之间显著相关,但与手术前后NRS差值之间无明显相关。HADS和PCS评分在两组间无明显差异,且与手术前后的ODI、NRS差值之间无明显相关。结论:PSQ或许可用于预测PTED术后早期的整体功能恢复,但无法预测手术后的疼痛缓解程度。     

Dimensions of "unidimensional" ratings of pain and emotions in patients with chronic musculoskeletal pain

The use of unidimensional scales to measure pain intensity has been criticised because of the multidimensional nature of pain. We conducted multiple linear regression analyses to determine which dimensions of pain – sensory versus affective – predicted scores on unidimensional scales measuring pain intensity and emotions in 109 Italian women suffering from chronic, non-malignant musculoskeletal pain. We then compared the results with earlier findings in two groups of cancer patients suffering from acute post-operative pain and chronic cancer-related pain, respectively. Age, physical capacity and scores on the multidimensional affect and pain survey (MAPS) were used to predict patients’ ratings on one visual analogue scale (VAS) and three numerical rating scales (NRS) measuring pain intensity, anxiety and depressed mood. Unidimensional pain intensity ratings were predicted better from sensory than from affective pain predictors, and the affective predictors made no unique contribution (NRS), or only a very small one (VAS). Both sensory and emotional pain aspects were unique predictors of NRS anxiety and depression. Therefore, in contrast to earlier findings in two different types of cancer patients, in subjects affected by chronic non-malignant musculoskeletal pain, the scores on unidimensional pain intensity scales mainly reflect sensory pain dimensions, supporting the discriminant validity of the NRS and VAS used. However, the patients had some difficulty in distinguishing between sensory and emotional information. For this reason, several unidimensional scales to rate pain intensity and emotions separately should be used to obtain a complete picture of the status and needs of any given patient.     

疼痛护理强化模式在宫颈癌患者围术期中的应用

目的 观察疼痛护理强化模式在宫颈癌患者围术期中的应用效果。方法 选取2017年2月-2018年12月于我院接受手术治疗的宫颈癌患者80例为研究对象,采用随机数字表法将其分为对照组和观察组,每组各40例,对照组接受常规疼痛护理,观察组采用疼痛强化护理干预,采用疼痛数字评分法 (numerical rating scale,NRS)、匹兹堡睡眠质量指数量表(Pittsburgh sleep quality index,PSQI)比较2组疼痛情况及睡眠质量。结果 观察组干预后NRS及PSQI评分均低于对照组(t=-9.127,P<0.001;t=-7.460,P<0.001)。结论 采用疼痛护理强化模式对宫颈癌手术病例加以干预,可促其获得良好的疼痛控制效果与睡眠质量改善效应。     

Intravenous dexketoprofen versus paracetamol in non-traumatic musculoskeletal pain in the emergency department: A randomized clinical trial

IntroductionAlthough acute musculoskeletal pain has a wide range of causes from tendinitis, muscle spasm, to bone and joint injuries, it is a frequent occurrence in emergency services. Paracetamol and non-steroidal anti-inflammatory analgesics (NSAID) are common used in the treatment of musculoskeletal pain. This study sets out to compare the effectiveness of intravenous dexketoprofen and paracetamol in musculoskeletal pain relief.MethodsThis prospective, randomized, double blind, controlled study was carried out in a university emergency room. The participating patients were randomized into two groups to receive either 50 mg of dexketoprofen or 1000 mg of paracetamol intravenously by rapid infusion in 150 ml of normal saline. Visual analogue scale (VAS), Numeric Rating Scala (NRS) was employed for pain measurement at baseline, after 15, after 30 and after 60 mins.Results200 patients were included in the study, excluding 7342 of them. The mean age of the patients was calculated as 32,6. Paracetamol and dexketoprofen intervention decreases NRS pain scores over time. When compared to all pain locations, the NRS pain score of the patients was found to be statistically more effective in dexketoprofen than in paracetamol (p = 0.001). Paracetamol and dexketoprofen intervention reduces pain VAS scores over time. When the VAS pain score of the patients was compared to all pain locations, dexketoprofen was found to be statistically more effective than paracetamol (p = 0.001).ConclusionIntravenous dexketoprofen seemed to achieve superior analgesia to intravenous paracetamol when compared with all pain locations in patients with non-traumatic musculoskeletal pain.     

腰椎间盘突出症患者出院准备度与疼痛程度的相关性分析

目的探讨腰椎间盘突出症患者出院准备度现状、疼痛程度及其相关性。方法对2019年3月—9月河南省某三甲医院收治的196例腰椎间盘突出症患者采用出院准备度量表(RHDS)和疼痛数字分级法(NRS)进行问卷调查,并用Pearson相关分析法进行分析。结果腰椎间盘突出症患者RHDS总分为(94.17±8.56)分,处于偏高水平,3个维度中得分最高的是个人状态,其次是预期性支持,最后是适应能力。腰椎间盘突出症患者入院时NRS评分为(6.10±0.30)分,为中度疼痛;出院前4 h NRS评分为(1.70±0.50)分,为轻度疼痛;出院前4 h患者疼痛评分明显降低,差异有统计学意义(t=1.892,P<0.05)。腰椎间盘突出症患者的RHDS总分及3个维度得分均与患者出院前4 h的NRS评分呈负相关(P<0.05)。结论腰椎间盘突出症患者出院准备度处于较高水平,出院前疼痛程度明显减轻处于较低水平,两者呈负相关。医护人员应积极关注腰椎间盘突出症患者的出院准备度,帮助其减轻疼痛,促进患者康复。     

疼痛护理干预对全腹壁整形术围手术期焦虑及术后疼痛态度的影响

目的 探讨术前疼痛护理干预对全腹壁整形围手术期焦虑水平、疼痛态度及疼痛干扰的影响.方法 于2018年1月～2020年3月年进行随机对照研究,共有54例患者纳入研究,随机分为对照组(n=26)和试验组(n=28);对照组接受常规护理,试验组除常规护理外还实施了术前疼痛护理干预.使用视觉模拟量表(VAS-A)评估焦虑程度、...     

Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale.

OBJECTIVES: To determine the minimal clinically important difference (MCID) of changes in chronic musculoskeletal pain intensity that is most closely associated with improvement on the commonly used and validated measure of the patient's global impression of change (PGIC), and to estimate the dependency of the MCID on the baseline pain scores. METHODS: This was a prospective cohort study assessing patient's pain intensity by the numerical rating scale (NRS) at baseline and at the 3 month follow-up, and by a PGIC questionnaire. A one unit difference at the lowest end of the PGIC ("slightly better") was used to define MCID as it reflects the minimum and lowest degree of improvement that could be detected. In addition we also calculated the NRS changes best associated with "much better" (two units). In order to characterize the association between specific NRS change scores (raw or percent) and clinically important improvement, the sensitivity and specificity were calculated by the receiver operating characteristic (ROC) method. PGIC was used as an external criterion to distinguish between improved or non-improved patients. RESULTS: 825 patients with chronic musculoskeletal pain (233 with osteoarthritis of the knee, 86 with osteoarthritis of the hip, 133 with osteoarthritis of the hand, 290 with rheumatoid arthritis and 83 with ankylosing spondylitis) were followed up. A consistent relationship between the change in NRS and the PGIC was observed. On average, a reduction of one point or a reduction of 15.0% in the NRS represented a MCID for the patient. A NRS change score of -2.0 and a percent change score of -33.0% were best associated with the concept of "much better" improvement. For this reason these values can be considered as appropriate cut-off points for this measure. The clinically significant changes in pain are non-uniform along the entire NRS. Patients with a high baseline level of pain on the NRS (score of >7 cm), who experienced either a slight improvement or a higher level of response, had absolute raw and percent changes greater that did patients in the lower cohort (score of less than 4 cm). CONCLUSIONS: These results are consistent with the recently published findings generated by different methods and support the use of a "much better" improvement on the pain relief as a clinically important outcome. A further confirmation in other patient populations and different chronic pain syndromes will be needed.     

颅内肿瘤患者围手术期疼痛管理方案的构建及应用研究

目的构建颅内肿瘤患者围手术期疼痛管理方案,并探讨应用效果。方法采用便利抽样法,选取南京市某三级甲等医院神经外科符合纳入、排除标准的颅内肿瘤患者为研究对象,其中2019年8月—10月收治的51例患者为试验组,在常规护理的基础上实施疼痛管理方案,2019年5月—7月收治的51例患者为对照组,予以常规的疼痛护理。比较两组术后24 h和72 h的疼痛数字评价量表评分、术后24 h和1周的一般自我效能感量表评分、满意度评分和术后并发症的发生率。结果静息状态下,试验组术后72 h的疼痛数字评价量表得分为(2.49±0.86)分,低于对照组的(3.43±0.92)分,差异有统计学意义(t=5.339,P<0.001);术后1周,试验组一般自我效能感量表得分为(21.22±1.71)分,高于对照组的(19.51±1.87)分,差异有统计学意义(t=-4.805,P<0.001);试验组满意度评分为(93.67±2.20)分,高于对照组的(90.86±2.03)分,差异有统计学意义(t=-6.694,P<0.001)。结论实施围手术期疼痛管理方案,有利于缓解颅内肿瘤患者术后静息性疼痛,...     

Prevalence and treatment of pain in adults admitted to Italian hospitals.

BACKGROUND: Very few studies have been conducted on the presence and control of pain in Italian hospitals. AIMS: The present study estimates pain prevalence and therapy in Italian hospitalised patients. METHODS: In the autumn of 2000, a survey was taken on 4523 inpatients throughout Italy. All eligible patients were given a questionnaire with two Numerical Rating Scales (NRS) concerning their pain intensity at interview and over the previous 24 h. Nurses were given a second questionnaire asking for information on analgesic treatment and another NRS about the pain they supposed the patient felt. RESULTS: At interview, 91.2% (95%CI: 90.3-92.1%) of the patients reported pain; 46.6% reported severe pain. The prevalence of severe pain was significantly lower in women and was double in general medicine wards compared to surgical wards. The degree of agreement between the pain reported by the patient and the pain scores given by the nurse was poor (Cohen K=0.318). Only 28.5% of the inpatients had taken analgesics in the past 24 h and the probability of receiving analgesic treatment was higher for women (adjusted OR=1.33, 95%CI: 1.14-1.54) and lower for general medicine compared to surgical wards (adjusted OR=0.55, 95%CI: 0.45-0.64), while it was unrelated both to the patient's self-reported pain and to level of pain assessed by the nurse. CONCLUSIONS: Pain affects an impressively high percentage of inpatients and is largely untreated and unrecognised in Italian wards. Educational intervention is required to improve the knowledge and attitudes of health professionals towards the approach and handling of patients in pain.     

Three new datasets supporting use of the Numerical Rating Scale (NRS-11) for children’s self-reports of pain intensity

Despite wide usage of the Numerical Rating Scale (NRS) for self-report of pain intensity in clinical practice with children and adolescents, validation data are lacking. We present here three datasets from studies in which the NRS was used together with another self-report scale. Study A compared post-operative pain ratings on the NRS with scores on the Faces Pain Scale-Revised (FPS-R) in 69 children age 7–17 years who had undergone a variety of surgical procedures. Study B compared post-operative pain ratings on the NRS with scores on the Visual Analogue Scale (VAS) in 29 children age 9–17 years who had undergone pectus excavatum repair. Study C compared ratings of remembered immunization pain in 236 children who comprised an NRS group and a sex- and age-matched VAS group. Correlations of the NRS with the FPS-R and VAS were r = 0.87 and 0.89 in Studies A and B, respectively. In Study C, the distributions of scores on the NRS and VAS were very similar except that scores closest to the no pain anchor were more likely to be selected on the VAS than the NRS. The NRS can be considered functionally equivalent to the VAS and FPS-R except for very mild pain (<1/10). We conclude that use of the NRS is tentatively supported for clinical practice with children of 8 years and older, and we recommend further research on the lower age limit and on standardized age-appropriate anchors and instructions for this scale.