慢性疼痛患者疼痛灾难化水平及影响因素分析

目的 探讨慢性疼痛患者疼痛灾难化现状及影响因素,为实施针对性干预提供参考。方法 采用便利抽样法选择武汉市某三甲医院门诊303例慢性疼痛患者为研究对象,运用一般资料调查表及疼痛灾难化量表进行调查。结果 慢性疼痛患者疼痛灾难化得分28.00(17.00,39.00)分,沉思维度得分最高,无助维度得分最低;93例(30.7%)患者有疼痛灾难化倾向。多元线性回归分析显示,平均疼痛程度、疼痛类型、疼痛部位个数、个人月收入、文化程度是疼痛灾难化的影响因素(均P<0.05),共解释34.0%的变异量。结论 慢性疼痛患者疼痛灾难化较高,需重点关注疼痛程度高、疼痛部位多、月收入和文化程度低的患者,进行针对性干预,以减轻疼痛,从而降低患者疼痛灾难化认知水平。     

老年慢性疼痛患者疼痛接受度对生活质量的影响

目的探讨老年患者慢性疼痛接受度对其生活质量的影响。方法采用McGill疼痛问卷、中文版简易慢性疼痛接受问卷及简明生活质量量表,对太原市3所三甲医院就诊的235例老年慢性疼痛患者进行调查。结果老年慢性疼痛患者McGill疼痛得分(61.89±22.55)分,慢性疼痛接受得分为(23.79±5.23)分,活动参与得分高于疼痛意愿;生活质量得分为(57.01±15.41)分;疼痛接受与生活质量呈正相关(P0.01),且是生活质量的预测因素。结论疼痛接受程度越高,老年慢性疼痛患者的生活质量越好。医护人员应根据疼痛接受中活动参与的益处,制定促进老年慢性疼痛患者参与活动的诊疗计划,以促进老年患者生活质量的提高。     

慢性疼痛患者疼痛接受度与影响因素研究

目的 了解慢性疼痛患者疼痛接受度及影响因素,为针对性干预提供参考。方法 采用中文版慢性疼痛接受问卷及一般资料问卷,对295例疼痛数字评分（NRS）≥3分的慢性疼痛患者进行调查。结果 慢性疼痛患者疼痛接受度得分（22.52±10.78）分,活动参与维度得分高于疼痛意愿维度;分层线性回归分析显示,居住地、离异/丧偶、疼痛部位数及疼痛程度是疼痛接受度的影响因素,共解释15.1%的变异量（P<0.05,P<0.01）。结论 慢性疼痛患者疼痛接受度较低,需重视农村、离异/丧偶、疼痛部位多及疼痛程度重的患者。     

国际疼痛研究学会(IASP)关于慢性疼痛综合征的分类

一、相对全身性的综合征1.外周神经痛2 .残肢痛3.幻肢痛4 .复杂性区域疼痛综合征Ⅰ(反射性交感神经营养不良 )5 .复杂性区域疼痛综合征Ⅱ (灼痛 )6 .中枢性疼痛 (包括丘脑性疼痛和假性丘脑性疼痛 )7.脊髓空洞症 (当影响至头部或肢体时 )8.风湿性多肌痛症9.纤维组织炎或弥漫性肌筋膜痛症候群10 .风湿性关节炎11.骨性关节炎12 .双磷酸钙盐沉积症13.痛风14 .血友病性关节炎15 .烧伤16 .精神源性 (心源性 )疼痛(1)肌紧张(2 )错觉或幻觉(3)癔病性或忧郁性17.伪病二、头面部的神经痛1.三叉神经痛 (痛性抽搐 )2 .中枢神经损伤继发性的神经痛 (三叉…     

慢性疼痛患者自我管理行为的调查分析

目的 了解慢性疼痛患者的自我管理行为,为分阶段对慢性疼痛患者实施针对性护理干预提供参考.方法 采取便利抽样方法抽取武汉市11所三甲医院慢性疼痛患者268例,采用疼痛阶段变化问卷(PSOCQ)进行调查.结果 患者对疼痛的自我管理行为呈现不同的阶段和型态,依次为思考前期(39.92%)、思考期(45.52%)、行动期(7....     

三阶段叙事疗法对结直肠癌根治术患者术后疼痛程度、心理弹性及应对方式的影响

目的:研究三阶段叙事疗法对结直肠癌根治术患者术后疼痛程度、心理弹性及应对方式的影响。方法:选取我院2020-2022年收治的78例接受结直肠癌根治术的患者作为研究参与者,将其随机分为观察组和常规组,每组39例。常规组患者术后给予常规护理,观察组在对照组基础上给予三阶段叙事疗法护理,比较2组患者手术前后疼痛评分、心理弹性(CD-RISC)以及应对方式(MCMQ)评分。结果:治疗后观察组患者疼痛评分显著低于常规组(P<0.05);观察组患者CD-RISC评分显著高于常规组(P<0.05);观察组患者面对评分显著高于常规组(P<0.05),回避和屈服评分显著低于常规组(P<0.05)。结论:三阶段叙事疗法可改善结直肠癌根治术患者术后疼痛程度、心理弹性及应对方式,值得临床推广应用。     

术前疼痛灾难化和全膝关节置换术后慢性疼痛的相关性

目的 探讨膝骨关节炎(KOA)患者术前疼痛灾难化与全膝关节置换术(TKA)术后慢性疼痛(CPSP)的相关性。方法 选择2020年8月至2021年1月行首次单侧TKA患者240例,男105例,女135例,年龄45～64岁,BMI 18～30 kg/m²,ASAⅠ—Ⅲ级。根据是否发生术前疼痛灾难化将患者分为两组：灾难化组(n=78)和非灾难化组(n=162)。所有患者麻醉方法和手术方式一致。记录性别、年龄、BMI、ASA分级、K-L分级、KOA病程、术前合并心血管疾病、术前镇痛药物使用例数和术前1 d C-反应蛋白(CRP)浓度。术前1 d记录医院焦虑抑郁量表(HAD)、中枢敏化问卷(CSQ)和疼痛灾难化量表(PCS),若PCS评分≥30分认为发生疼痛灾难化。记录术中丙泊酚、瑞芬太尼、舒芬太尼用量、出血量、止血带使用时间、手术时间、补救镇痛例数、术后住院时间和术后6个月内使用非甾体抗炎药(NSAIDs)例数。记录术后6个月静息和活动时VAS疼痛评分,若术后6个月静息或(和)活动时VAS疼痛评分>3分记为发生CPSP。采用Poisson回归分析评估发生术前疼痛灾难...     

老年慢性疼痛患者疼痛与依恋心理的相关性研究

目的探讨老年慢性疼痛患者疼痛情况及与依恋心理的关系,为提高老年疼痛患者临床护理质量提供参考。方法对254例老年慢性疼痛患者采用亲密关系经历量表中文版、简明疼痛评估量表进行调查。结果老年慢性疼痛患者疼痛程度得分23~45(32.01±10.34)分,对日常生活影响得分为18~62(45.84±10.27)分;依恋焦虑得分为(3.50±0.71)分,依恋回避为(2.94±0.69)分,其中安全型依恋达36.22%,冷漠型和恐惧型分别为24.01%和20.87%,专注型占18.90%。依恋焦虑和依恋回避与疼痛程度和疼痛影响呈正相关(均P0.01)。结论老年慢性疼痛患者疼痛程度多中度偏重,影响患者日常生活,非安全型依恋占较高的比例,应加强对老年疼痛患者非安全型依恋的筛查和护理干预,以降低患者疼痛程度。     

慢性疼痛对社区老年人日常生活的影响及其应对方式研究进展

综述慢性疼痛对社区老年人日常生活的影响及其应对方式,分析影响老年人选择不同疼痛应对方式的原因.提出慢性疼痛影响老年人日常生活的多个方面,造成老年人日常生活能力下降.需提高对老年人疼痛问题的重视,积极促进老年人疼痛问题的解决,提高老年人生活质量.     

术后急性疼痛与慢性疼痛关系的研究进展

背景 术后急性疼痛管理仍然不尽人意,如何防治急性疼痛转化为慢性疼痛仍然是临床亟待解决的问题. 目的 阐述术后急性疼痛转化为慢性疼痛的研究进展,为术后疼痛管理以减少慢性疼痛的发生提供参考. 内容 就急性疼痛转化为慢性疼痛的可能性等方面作一综述. 趋向 进一步研究术后急性疼痛转化为慢性疼痛的机制,以明确有效的预防急性疼痛慢性化的方法.     

Breakthrough pain in opioid-treated chronic non-malignant pain patients referred to a multidisciplinary pain centre: a preliminary study

BACKGROUND: Breakthrough pain (BTP) has not formerly been discussed as such in chronic non-malignant pain patients referred to pain centres and clinics. The purpose of the study was to investigate the prevalence, characteristics and mechanisms of BTP in opioid-treated chronic non-malignant pain patients referred to a pain centre and to assess the short-term effects of pain treatment. METHODS: Patients were assessed at referral (T(0)) and after a treatment period of 3 months (T(3)) using the visual analogue scale (VAS) of the brief pain inventory (BPI) within somatic nociceptive, neuropathic and/or visceral pain conditions, the mini mental state examination (MMSE) and the hospital anxiety and depression scale (HADS). The main treatment intervention from T(0) to T(3) was to convert short-acting oral opioids to long-acting oral opioids and to discontinue on demand and parenteral use of opioids. RESULTS: Thirty-three patients were assessed at T(0) and 27 at T(3). The prevalence of BTP declined significantly from T(0) (90%) to T(3) (70.4%). Worst, least, average and current pain intensities as well as duration of BTP were significantly reduced from T(0) to T(3.) The majority of BTPs were exacerbation of background pain assumed to be of the same pain mechanisms. High average pain intensity (BPI) was significantly associated with high scores for both anxiety and depression (HADS). CONCLUSION: BTP in chronic non-malignant pain patients seems to be surprisingly frequent and severe. Stabilizing the opioid regimen seems to reduce pain intensity in general as well as the intensity and duration of BTP. Average pain intensity was associated with anxiety and depression.     

Chronic pain in children in the UK: a survey of pain clinicians and general practitioners

Background: There is a lack of information about the prevalence, manifestations, and management of chronic pain in children in the UK. We surveyed consultants with an interest in chronic pain management and general practitioners (GPs) in the UK in order to understand their perspective on chronic pain in children. Methods: We conducted a postal survey of clinicians with an interest in chronic pain management and GPs in the UK. The survey contained questions relating to the following aspects of managing children with chronic pain: (i) clinicians’ training and experience; (ii) available resources; (iii) perceived prevalence, presentation, and referral patterns; (iv) interventions; and (v) outcomes. Results: 472 pain clinicians and 131 GPs were contacted. The response rates were 55% and 61% respectively. Of the respondents, 77% of pain clinicians and 95% of GPs acknowledged a lack of adequate training for managing children with chronic pain. 57% of the pain clinicians and 63% of the GPs reported that the prevalence of chronic pain in children was <5%. In the comments section, 22% of those respondents who frequently manage children with chronic pain reported an increase in the incidence of this problem over the last 5 years. The common chronic pain syndromes in children were reported to be: musculoskeletal and limb pain, recurrent abdominal and pelvic pain, and headache. 15% of the respondents advised that children with chronic pain would be best managed in specialist pediatric centers and 75% opined that majority of children with chronic pain have a fair to good prognosis. Conclusions: More information is required about prevalence, manifestations and long‐term effects of chronic pain in children in the UK. There is a need for increasing training and resources amongst GPs and pain clinicians for managing chronic pain in the pediatric age group.     

食管癌患者经济毒性体验及应对措施的质性研究

目的 了解食管癌患者经济毒性心理体验与应对措施,为深入理解食管癌患者经济毒性的内涵、采取适合的应对提供参考。方法 采用现象学研究法,目的选取25例食管癌患者进行半结构式深度访谈。采用Giorgi现象学分析法分析资料并提炼主题。结果 提炼了食管癌患者经济毒性体验3个主题：承担直接及间接多方面经济负担;心理压力、担忧未来与不确定感;经济问题对日常生活影响严重。应对措施4个主题：缩减非必要的治疗成本;降低生活支出;寻求有限的经济援助;选择与决策工作岗位。结论 食管癌患者面临不同程度的经济毒性问题,对身心健康造成多种影响,其自身也采取一些措施应对经济毒性。建议国家政策及管理者高度关注患者经济毒性问题,采取多渠道多途径的综合干预策略及措施,帮助患者减少及降低经济毒性问题。     

Police officers' coping strategies: An Australian police survey

Police officers, in the performance of their duties, face a range of potentially stressful situations and events. These have the capacity to cause significant personal distress, leading to short — and long-term changes in mood, psychological functioning and social activity. In response to the stresses of the job, officers must utilize any number of coping strategies to deal with their occupational stress. The aim of the present study was to examine the stress-coping strategies used by a large sample of Australian police personnel. Responses to the Revised Ways of Coping Checklist showed that most officers utilize problem-focused, direct action coping strategies, with more limited use of social supports, self-blame and wishful thinking. While their coping behaviours may help them moderate problem-focused stress concerns, the data suggest that many officers may not deal effectively with their emotion-focused concerns. These data are examined in the light of the research literature detailing the so-called police personality.     

Neuromuscular exercises on pain intensity,functional disability,proprioception, and balance of military personnel with chronic low back pain

BackgroundDue to their occupational status, military personnel are a high-risk group for low back pain (LBP).PurposeThe aim of this study was to investigate the effect of neuromuscular exercises on the severity of pain, functional disability, proprioception, and balance in military personnel with LBP.MethodsMilitary personnel with LBP were randomly assigned into two groups: intervention (n=15) and control (n=15). The intervention group performed 60 minutes of neuromuscular exercises three times per week for eight weeks while the control group continued their routine physical activities.ResultsThe mean post-intervention pain intensity, disability, and proprioception error significantly decreased in the intervention group. Whereas their mean post-interventions static and dynamic balance scores significantly increased.ConclusionsThe results indicate eight weeks of neuromuscular exercise decreased pain intensity and improved functional ability, static and dynamic balance, and proprioception among military staff suffering chronic low back pain.     

Use of the UPOINT phenotype system in treating Chinese patients with chronic prostatitis/chronic pelvic pain syndrome: a prospective study

The urinary, psychosocial, organ-specific, infection, neurological/systemic and tenderness (UPOINT) phenotype system has been validated to be an effective phenotype system in classifying patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in western populations. To validate the utility of the UPOINT system and evaluate the effect of multimodal therapy based on the UPOINT system in Chinese patients with CP/CPPS, we performed this study. Chinese patients with CP/CPPS were prospectively offered multimodal therapy using the UPOINT system and re-examined after 6 months. A minimum 6-point drop in National Institutes of Health-Chronic Prostatitis Symptoms Index (NIH-CPSI) was set to be the primary endpoint. Finally, 140 patients were enrolled in the study. The percentage of patients with each domain was 59.3%, 45.0%, 49.3%, 22.1%, 37.9%, and 56.4% for the UPOINT, respectively. The number of positive domains significantly correlated with symptom severity, which is measured by total NIH-CPSI scores (r = 0.796, P < 0.001). Symptom duration was associated with a greater number of positive domains (r = 0.589, P < 0.001). With 6 months follow-up at least, 75.0% (105/140) had at least a 6-point improvement in NIH-CPSI after taking the therapy. All NIH-CPSI scores were significantly improved from original ones: pain 10.14 ± 4.26 to 6.60 ± 3.39, urinary 6.29 ± 2.42 to 3.63 ± 1.52, quality of life 6.56 ± 2.44 to 4.06 ± 1.98, and total 22.99 ± 7.28 to 14.29 ± 5.70 (all P < 0.0001). Our study indicates that the UPOINT system is clinically feasible in classifying Chinese patients with CP/CPPS and directing therapy.     

Assessment of pain in chronic wounds: A survey of Australian health care practitioners

Pain associated with chronic wounds can delay wound healing, affects quality of life, and has a major impact on physical, emotional, and cognitive function. However, wound‐related pain is often under‐assessed and may therefore be suboptimally managed. The aim of this study was to describe the assessment practices used to assess chronic wound pain by health practitioners in Australia. A structured self‐administered questionnaire was posted to members of an Australian national wound care organisation, whose membership represents various health practitioners involved in wound management. A total of 1190 (53%) members completed the survey. Overall, wound pain assessment was most commonly conducted at every consultation or wound dressing change (n = 718/1173, 61%). Nurses were more likely to assess wound‐related pain before, during, and after the wound dressing procedures compared with other health care practitioners. In contrast, podiatrists assessed wound pain only when the patient complained about the pain. The most common assessment method was simply talking to the patient (n = 1005/1180, 85%). Two‐thirds of practitioners used a validated pain assessment tool. The most commonly used tool was the numerical analogue scale (n = 524/1175, 46%). In summary, these findings suggest that there is no consistent method for the assessment of wound‐related pain, and there are substantial variations in how and when wound‐related pain is assessed between different professions.     

Virtual reality for acute and chronic pain management in adult patients: a narrative review

Virtual reality is a computer-generated environment that immerses the user in an interactive artificial world. This ability to distract from reality has been utilised for the purposes of providing pain relief from noxious stimuli. As technology rapidly matures, there is potential for anaesthetists and pain physicians to incorporate virtual reality devices as non-pharmacological therapy in a multimodal pain management strategy. This systematic narrative review evaluates clinical studies that used virtual reality in adult patients for management of acute and chronic pain. A literature search found 690 citations, out of which 18 studies satisfied the inclusion criteria. Studies were assessed for quality using the Jadad and Nottingham-Ottawa Scales. Agreement on scores between independent assessors was 0.87 (95%CI 0.73–0.94). Studies investigated virtual reality use: intra-operatively; for labour analgesia; for wound dressing changes; and in multiple chronic pain conditions. Twelve studies showed reduced pain scores in acute or chronic pain with virtual reality therapy, five studies showed no superiority to control treatment arms and in one study, the virtual reality exposure group had a worsening of acute pain scores. Studies were heterogeneous in: methods; patient population; and type of virtual reality used. These limitations suggest the evidence-base in adult patients is currently immature and more rigorous studies are required to validate the use of virtual reality as a non-pharmacological adjunct in multimodal pain management.     

Pain knowledge and fear-avoidance beliefs of French osteopathy students and educators towards chronic low back pain: An osteopathic educational institution-based cross-sectional survey

BackgroundPractitioners’ fear-avoidance beliefs can influence positively or negatively therapeutic outcomes in their patients. This study reports pain knowledge and fear-avoidance beliefs of French osteopathy students and educators towards the management of chronic low back pain (cLBP).MethodsAn online cross-sectional survey was proposed to educators and students. It included sociodemographic characteristics and two questionnaires: the FABQ-HC to assess beliefs on the effects of physical and work activities for people with cLBP, and the NPQ to assess participants' knowledge of pain.ResultsParticipants (N = 172) had mean FABQ-HC subscale scores of 11.02 ± 4.44 (Physical activity) and 24.37 ± 11.78 (Work). The mean NPQ total score was 11.90 ± 2.05. There were no significant score differences between students and educators (p > 0.05). Results showed that Year 4 students (N = 65) had a significantly better score (p < 0.05) at the FABQ-HC Physical Activity than Year 5 students (N = 71). Educators (N = 36) having less than 10 years of practice in osteopathy had better scores than other educators (p < 0.01) at the FABQ-HC Work. Educators and students in the study show similar scores to other French HCPs and international osteopaths on the FABQ-HC Physical activity. In contrast, they scored lower on the FABQ-HC Work.ConclusionsThe main finding was that educators and students belonging to the same OEI have no significantly different beliefs about cLBP and no significantly differing knowledge of pain. There is potential to improve pain education especially concerning the beliefs around cLBP concerning work activity.