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...     

慢性疼痛患者的生活质量及其与抑郁、疼痛的关系

目的 探讨慢性疼痛患者的生活质量及其与抑郁、疼痛的关系.方法 采用一般调查问卷、简明MiGill疼痛量表、BECK抑郁自评问卷、SF-12生活质量量表对115例健康人和139例慢性疼痛患者进行调查,对结果进行相关分析和多元线性回归分析.结果 慢性疼痛患者的生活质量总分及各维度得分均低于健康人组(p<0.001),其抑郁得分高于健康人组(p<0.001).慢性疼痛患者的生活质量总分及身体健康、心理健康维度的得分与抑郁得分、疼痛得分均呈正相关,抑郁、疼痛强度进入回归方程(F＝46.864,p<0.001),方程可以解释慢性疼痛患者生活质量变化的40.8%.结论 慢性疼痛患者的生活质量较健康人群低.抑郁与疼痛均对患者的生活质量有影响,提示临床护士应采用干预措施,减轻患者的抑郁和疼痛程度,从而提高其生活质量.     

济南市社区老年慢性疼痛患者生活质量影响因素的分析

目的:了解社区老年慢性疼痛患者生活质量的影响因素,为社区医护人员制定相应干预措施提供依据.方法:采用一般人口学资料调查表,SF-12生活质量量表,激惹、抑郁和焦虑自评量表,医学应对问卷,汉化版慢性疼痛自我效能感量表等对192例老年慢性疼痛患者进行调查.结果:老年慢性疼痛患者生活质量躯体健康得分39.47±9.94分,心理健康得分47.47±9.22分,均显著低于无慢性疼痛组(P＜0.01).自我效能感、抑郁、屈服的应对方式、受教育程度是老年慢性疼痛患者生活质量的影响因素(P＜0.01),可解释55.8％的变异量.结论:社区老年慢性疼痛患者的生活质量主要受自我效能感、屈服的应对方式、抑郁、受教育程度等因素的影响;社区医护人员应针对自我效能感得分较低、抑郁、常采用屈服型应对方式、低教育水平的人群进行重点干预,更好地改善其生活质量.     

慢性疼痛患者生活质量影响因素的分析

采取疼痛调查问卷、BECK焦虑及抑郁自评问卷、简明MG疼痛量表、阿森斯失眠量表、疼痛自我效能量表以及生活质量SF-12表对我院94例慢性疼痛患者与同期的94例健康者予以比较分析。结果慢性疼痛患者的抑郁、焦虑以及失眠得分远远高于健康组,P〈0.05,差异有统计学意义。疼痛自我效能与生活质量得分明显小于健康组,不同疼痛部位数目、不同疼痛程度的慢性疼痛患者之间生活质量得分具有显著差异,P〈0.05有统计学意义。影响慢性疼痛患者的生活质量的因素有多种,需采取多方位的干预措施。     

阻塞性睡眠呼吸暂停综合征患者生活质量现状及影响因素分析

目的探讨阻塞性睡眠呼吸暂停综合征患者生活质量的现状和影响因素。方法采用一般资料调查问卷、世界卫生组织生活质量量表,对130例OSAS患者进行问卷调查,分析OSAS患者的生活质量的现状和影响因素。结果 OSAS患者生活质量总分(12.80±2.69)分,生理领域得分(12.66±2.41)分,心理领域得分(13.08±2.01)分,独立性领域得分(15.68±2.11)分,社会关系领域得分(12.94±1.87)分,环境领域得分(11.81±1.75)分,宗教信仰领域得分(11.18±3.55)分;其中,生理领域、心理领域、社会关系领域、环境领域得分及生活质量总分低于常模(P0.05)。不同病情严重程度、体重指数、性别、年龄、婚姻状况、民族的OSAS患者生活质量得分差异有统计学意义(P0.05)。结论 OSAS患者的生活质量总体较差;体重指数越高的患者其生活质量总分、独立性领域、社会关系领域得分越低;女性患者的生活质量总体水平低于男性;青年和中年患者在宗教信仰领域得分高于老年患者,少数民族患者独立性领域得分高于汉族患者。     

慢性腰背痛病人疼痛、自我效能、功能障碍与生活质量的关系研究

[目的]调查慢性腰背痛病人疼痛、自我效能、功能障碍和生活质量的相互关系。[方法]采用疼痛数字评价量表(NRS)、中文版疼痛自我效能量表(PSEQ)、Oswestry功能障碍指数问卷(ODI)和简明健康状况量表(SF-36)对94例慢性腰背痛病人进行调查。[结果]慢性腰背痛病人疼痛得分为(4.13±1.54)分,疼痛自我效能得分为(39.09±9.31)分,ODI为(17.26±6.55)分,生活质量各维度均低于常模。Oswe-stry功能障碍指数与疼痛强度呈正相关,与疼痛自我效能呈负相关,疼痛自我效能与生活质量呈正相关。[结论]慢性腰背痛病人总体生活质量较差,疼痛、疼痛自我效能、腰痛功能障碍和生活质量之间的相互影响程度不一,应指导护理人员有针对性地实施干预措施,从而改善病人生活质量。     

疼痛对长期血液透析患者生活质量的影响

目的了解长期血液透析患者疼痛状况及其对生活质量的影响。方法选择北京协和医院维持性血液透析5年以上患者33例,平均年龄(60.7±9.6)岁,平均透析龄为(9.5±3.9)年(5～17年)。收集患者一般临床资料,用简明疼痛问卷(brief pain inventory,BPI)调查,了解疼痛原因、性质、程度和部位,及其对生活的影响;用SF-36健康调查量表调查患者生活质量。结果本组患者疼痛的发生率为75.8%,主要疼痛部位:肩(51.5%)、膝(36.4%)、腕(18.2%)、髋(15.2%)。自我疼痛程度评分为(3.7±1.9)分(0～10分),24.2%的患者需要长期服用止痛药来缓解疼痛。疼痛的程度和部位与患者的年龄、性别、原发病、透析时间、K t/V、血钙、血磷、甲状旁腺激素和血红蛋白没有关系。疼痛患者SF-36健康调查量表多方面得分均低于非疼痛患者。结论长期透析患者慢性疼痛发生率高,严重影响其生活质量,值得关注。     

上海市社区老年人的慢性疼痛认知与应对方式的研究

目的 了解上海市社区老年人对于老年慢性疼痛的认知和应对方式。方法 选取上海市13个社区99名老年人进行问卷调查,内容主要包括一般情况、慢性疼痛应对策略问卷和面部疼痛表情(FPS-R)量表。结果 据调查老年人最近一段时间疼痛程度为(4.78±2.32)分,疼痛程度与应对策略问卷中寻求支持(r=0.51)、忽视疼痛(r=0.26)、行动解决(r=0.28)、限定活动(r=0.53)、消极心态(r=0.61)这五个维度相关性较大。结论 上海社区老年人的疼痛程度处于中重度,其疼痛程度与应对策略相关,医护人员应重视社区老年慢性疼痛的患者,重视疼痛教育与管理,采取相应措施提高患者的应对策略,减轻慢性疼痛对生活带来的影响。     

ERCP胆总管取石术病人参与术后疼痛管理的效果研究

[目的]探讨经内镜逆行胰胆管造影(ERCP)胆总管取石术病人主动参与到术后疼痛管理中的效果研究。[方法]采用方便抽样法选取2017年1月—2017年10月肝胆外科收治的胆总管结石并且行经ERCP取石术的病人42例设为对照组,选取2017年12月—2018年8月肝胆外科住院的胆总管结石且行经ERCP取石术的病人42例设为观察组。采用自制的病人基本资料调查问卷、数字疼痛评估量表、简明疼痛量表、疼痛护理满意度量表对两组病人进行调查,并对结果进行比较分析。[结果]观察组术前疼痛评分低于对照组术前疼痛评分,差异有统计学意义(P0.05);观察组术后疼痛最剧烈评分(2.99±1.29)分、目前疼痛强度评分(0.73±0.28)分低于对照组术后疼痛最剧烈评分(3.97±1.63)分、目前疼痛强度评分(1.33±0.95)分,差异有统计学意义(P0.05)。观察组疼痛护理满意度得分(75.84±10.08)分、信任关系得分(35.45±7.56)分、专业技术能力得分(18.90±3.28)分、教育关系得分(17.65±3.32)分高于对照组疼痛护理满意度得分(70.23±10.22)分、信任关系得分(32.82±5.34)分、专业技术能力得分(16.34±3.43)分、教育关系得分(15.30±3.25)分,差异均有统计学意义(P0.05)。[结论]病人主动参与到术后疼痛管理中可有效降低病人术后疼痛程度并提高疼痛护理满意度,促进无痛病房的发展。     

慢性疼痛病人疼痛困扰现状及其影响因素研究

[目的]了解慢性疼痛病人的疼痛困扰现状,并分析其影响因素,为采取针对性护理干预提供参考。[方法]采用一般资料调查表及简明疼痛程度量表对288例门诊慢性疼痛病人进行调查。[结果]慢性疼痛病人在过去1周遭受的疼痛程度为(4.82±1.79)分,慢性疼痛给病人带来的困扰依次为日常生活、工作、睡眠、情绪,其平均分均在5.00分以上。性别、职业、文化程度、个人月收入、年龄、疼痛部位数及病程不同,病人疼痛困扰的不同方面差异有统计学意义(P0.05或P0.01);回归分析显示,个人月收入、疼痛部位数及年龄是病人疼痛困扰的重要影响因素(P0.05或P0.01)。[结论]慢性疼痛病人承受着较为严重的疼痛折磨,疼痛给病人工作、日常生活、睡眠、情绪造成的困扰较大,低收入、疼痛部位多、老年、女性、农民、低学历、病程长的慢性疼痛病人,其感受到的疼痛困扰程度更高,应成为重点干预人群。     

Educational achievement and chronic pain disability: mediating role of pain-related cognitions

OBJECTIVE: This study examined the relation between level of educational achievement (LOE) and the clinical morbidity associated with chronic pain. SETTING: a multidisciplinary pain rehabilitation program located within a university hospital. PATIENTS: Two hundred ninety-nine consecutive patients with chronic spinal pain, average age 39.6 years (SD = 10.7) and with an average duration of pain of 41.9 months (SD = 51.6). OUTCOME MEASURES: Age, duration of pain, sex, and compensation and litigation status were controlled for in the statistical analysis because each was found to be significantly associated with LOE. Pain intensity was assessed by the McGill Pain Questionnaire. Affective distress was assessed by the Global Severity Index from the Brief Symptom Inventory. Severity of depressive symptoms was derived from scores from the Center for Epidemiological Studies-Depression Scale. Pain beliefs and pain coping strategies were assessed by the Survey of Pain Attitudes and the Coping Strategies Questionnaire, respectively. Finally, self-report of pain-related disability was assessed by the Pain Disability Index. RESULTS AND CONCLUSIONS: After controlling for relevant covariates, LOE was unrelated to pain intensity, severity of depressive symptoms, or affective distress, but was inversely related to self-reported disability. Persons with lower LOEs possessed a greater belief that pain is a "signal of harm," unrelated to emotional experience, disabling and uncontrollable. They also endorsed more passive and maladaptive coping strategies, including a tendency to catastrophize about their pain. Path analysis indicated that, after controlling for the influence of both the belief that pain is a "signal of harm" and catastrophizing on the association between LOE and disability, this relation loses statistical significance. These results suggest that pain-related cognitions mediate the relation between LOE and pain disability and that persons with lower LOEs are more likely to develop maladaptive pain beliefs and coping strategies.     

Headache and other types of chronic pain

OBJECTIVE: To compare pain severity, disability, psychological distress, and quality of life between patients with headache and nonheadache treatment-seeking chronic pain patients. METHODS: Six hundred forty-three patients seeking treatment at a university pain clinic were divided into 3 categories based on primary pain complaint and the presence of focal or diffuse pain complaints: headache, nonheadache focal (pain involving <50% of the body), and nonheadache diffuse (pain involving >/=50% of the body). Patients completed questionnaires to identify pain severity, disability, depression, anxiety, and quality of life. RESULTS: Patients with headache differed from nonheadache patients for all evaluated parameters. Average pain severity on a 0 to 10 point severity scale was 5.55 for headache, 6.93 for nonheadache focal, and 8.05 for nonheadache diffuse. Pain occurred an additional 1.51 to 1.71 days per week for patients without headache. Compared to patients with headache, patients without headache reported greater frequency of reduced daily activities and complete disability related to pain. In addition, patients without headache and with diffuse pain reported more depression (78.2% vs. 45.8%) and anxiety (70.0% vs. 39.1%) than patients with headache. Quality of life measures were significantly reduced in patients with either nonheadache focal or diffuse conditions compared to patients with headache. CONCLUSIONS: Even when considering patients with focal rather than diffuse chronic pain complaints, patients with headache are dissimilar from other patients with chronic pain. Pain severity, frequency, disability, psychological distress, and quality of life are significantly more prominent or impaired in patients with chronic pain without headache compared to patients with headache.     

Obesity and the impact of chronic pain

OBJECTIVE: To evaluate obesity as a marker for increased pain severity, disability, and psychologic distress in treatment-seeking, mixed chronic pain patients. METHODS: Three hundred seventy-two consecutive chronic pain patients seeking evaluation at a university pain clinic were divided into 3 weight categories, based on body mass index (BMI): normal (BMI < 25 kg/m2), overweight (BMI between 25 kg/m and 30 kg/m2), and obese (BMI > or = 30 kg/m2). Patients completed questionnaires to identify pain severity, disability, depression, anxiety, and quality of life. RESULTS: Pain severity and days per week with pain were similar among the weight groups. Disability was related to increasing weight status, with increased BMI associated with more days per week with both reduced activity and complete disability. Depressive symptoms were also related to weight category, with an average Beck Depression Inventory score of 11.81 +/- 7.55 in normal, 12.88 +/- 11.64 in overweight, and 15.78 +/- 9.88 in obese patients. Anxiety scores were similar among the weight categories. Physical function domain of quality of life was also reduced in relation to weight. CONCLUSIONS: Weight is associated with co-morbid disability, depression, and reduced quality of life for physical function in chronic pain patients. Calculation of the BMI should become a routine part of the screening evaluation for chronic pain patients, with additional screening for disability and psychologic distress in patients with elevated BMIs.     

Are patient ratings of chronic pain services related to treatment outcome?

Consumer ratings of satisfaction with treatment are rarely used as measures of treatment outcome. This study examined the relationships between service ratings and psychometric outcomes of patients receiving pain-management services in a tertiary teaching hospital. A group of 122 patients who completed a multidisciplinary pain-management program rated their satisfaction with and effectiveness of services received and changes in their pain condition and quality of life (QOL). They also completed pre- and posttreatment measures of pain severity, pain interference, depression, and disability. Pain severity, pain interference, and depression significantly decreased following treatment. The patients' ratings of services were significantly associated with outcome measures. Pre- to posttreatment changes in pain severity and pain interference were associated with treatment satisfaction and effectiveness, improvement in pain condition, and QOL. Pre- to posttreatment change in disability was significantly related to ratings of treatment effectiveness, improvement in pain condition, and quality of life. The findings suggest that pain intensity, pain interference, and disability are important outcome dimensions of pain-management programs.     

Grading the severity of chronic pain.

This research develops and evaluates a simple method of grading the severity of chronic pain for use in general population surveys and studies of primary care pain patients. Measures of pain intensity, disability, persistence and recency of onset were tested for their ability to grade chronic pain severity in a longitudinal study of primary care back pain (n = 1213), headache (n = 779) and temporomandibular disorder pain (n = 397) patients. A Guttman scale analysis showed that pain intensity and disability measures formed a reliable hierarchical scale. Pain intensity measures appeared to scale the lower range of global severity while disability measures appeared to scale the upper range of global severity. Recency of onset and days in pain in the prior 6 months did not scale with pain intensity or disability. Using simple scoring rules, pain severity was graded into 4 hierarchical classes: Grade I, low disability--low intensity; Grade II, low disability--high intensity; Grade III, high disability--moderately limiting; and Grade IV, high disability--severely limiting. For each pain site, Chronic Pain Grade measured at baseline showed a highly statistically significant and monotonically increasing relationship with unemployment rate, pain-related functional limitations, depression, fair to poor self-rated health, frequent use of opioid analgesics, and frequent pain-related doctor visits both at baseline and at 1-year follow-up. Days in Pain was related to these variables, but not as strongly as Chronic Pain Grade. Recent onset cases (first onset within the prior 3 months) did not show differences in psychological and behavioral dysfunction when compared to persons with less recent onset. Using longitudinal data from a population-based study (n = 803), Chronic Pain Grade at baseline predicted the presence of pain in the prior 2 weeks. Chronic Pain Grade and pain-related functional limitations at 3-year follow-up. Grading chronic pain as a function of pain intensity and pain-related disability may be useful when a brief ordinal measure of global pain severity is required. Pain persistence, measured by days in pain in a fixed time period, provides useful additional information.     

高级职称护理人员职业高原现状及其对工作满意度、工作绩效的影响研究

目的探讨高级职称护理人员职业高原现状,并分析职业高原对工作满意度及工作绩效的影响。方法采用职业高原问卷、明尼苏达满意度问卷、工作绩效量表对136名高级职称护理人员进行问卷调查。结果高级职称护理人员职业高原得分(3.21±0.26)分,处于中等水平。年龄和职务是高级职称护理人员职业高原的影响因素(P0.01);职业高原中层级高原、内容高原是工作满意度的影响因素(P0.05),层级高原和内容高原是工作绩效的影响因素(P0.01或P0.05),工作满意度中外源性满意度是工作绩效的影响因素(P0.01)。结论高级职称护理人员职业高原不容忽视,医院及管理者应采取措施,降低职业高原的消极影响,提高高级职称护理人员的工作满意度和工作绩效。     

The relationship of demographic and psychosocial variables to pain-related outcomes in a rural chronic pain population

Rural residency and low socioeconomic status (SES) are associated with increased likelihood of chronic pain. Other demographics are also differentially associated with the experience of pain. This study examines the relations between demographic and pain-related variables in a virtually unstudied population of rural Alabama chronic pain patients. One hundred and fifteen patients completed validated measures of pain catastrophizing, depression, pain intensity, pain interference, perceived disability, and life satisfaction. Average age of study participants was 52-years, 79% were female, 74% were African-American, 72% reported annual income between 00,000-12,999, and 61% were unemployed. Although average years of reported education was 12.26, reading level percentile (primary literacy indicant) was 17.33. Cross-sectional multivariate and univariate analyses were conducted to examine associations among demographic and psychosocial variables in relation to various pre-treatment pain-related variables. The mediating role of pain catastrophizing and depression was investigated. Results indicate that race was significantly associated with pain intensity and pain interference, such that African-Americans reported higher scores than White-Americans. Pain catastrophizing was uniquely associated with pain intensity, pain interference, and perceived disability; depression was uniquely associated with pain interference and life satisfaction. Pain catastrophizing mediated the relation between primary literacy and pain intensity; age effects were differentially mediated by either pain catastrophizing or depression. These analyses provide an insight into the specific demographic and psychosocial factors associated with chronic pain in a low-literacy, low-SES rural population.     

盐酸曲马多缓释片对肌肉骨骼系统慢性疼痛患者的治疗优势

背景肌肉骨骼系统慢性疼痛可导致患者功能残疾和生活质量下降.探讨肌肉骨骼系统疾病的治疗方法,选择恰当的治疗药物对患者具有重要意义.目的评价盐酸曲马多缓释片毒曼丁对中度以上肌肉骨骼系统慢性持续性疼痛患者的镇痛效果及其耐受性.设计前后对照研究.单位北京大学人民医院关节病研究所.对象选择2000-03/06在北京大学人民医院骨科门诊求诊的患者,具有中度以上慢性非癌症性疼痛,应用非类固醇抗炎药物(nonsteroi dal anti-inflammatrry drugs,NSAIDs)疼痛缓解不满意的成人病例共40例.方法停用其他止痛药物和NSAID类药物,然后服用盐酸曲马多缓释片(奇曼丁),首剂50 mg,每12 h 1次,根据疼痛控制程度调整剂量,每次50 mg递增,最高剂量400 mg/d.观察时间为4周,受试者记录疼痛治疗手册,每周门诊随访1次,医师检查后填写临床观察表.主要观察指标患者服用药物前后的疼痛程度、疼痛缓解度和所有副作用及其严重程度.结果全部病例均完成试验,无失访,无因不能耐受而中途退出者.服药前疼痛评分平均为(6.80±1.84)分,服药后平均为(1.00±1.46)分,差异有显著性意义(P＜0.001).平均疼痛缓解度为(85.50±5.35)%,其中完全缓解和明显缓解占78%.出现的副作用有9例,总发生率为22%,其中以眩晕最常见,共有6例,其他包括恶心3例,嗜睡2例,呕吐1例,食欲缺乏1例,便秘和排尿困难1例,视力模糊1例等.结论盐酸曲马多缓释片是一种长效中枢性镇痛剂,使用方便.在治疗肌肉骨骼系统慢性疼痛方面具有优良的镇痛效果,不良反应轻,有良好的耐受性,为骨科慢性疼痛的药物治疗提供了一种新的选择.     

临床护士幸福进取感在工作满意度与职业认同中的中介效应

目的 探讨临床护士积极心理健康在职业认同与工作满意度中的中介效应.方法 采用幸福进取者调查问卷、工作满意度调查表及护士职业认同调查问卷对300名临床护士护士进行调查.结果 临床护士工作满意度程度为57.30％,工作满意度不同程度的临床护士的幸福进取感及职业认同感存在显著性差异（P＜0.01）,幸福进取感不满意得分为（2.31±0.26）,低满意得分为（3.68±0.42）,高满意得分为（4.59±0.38）,各维度得分比较差异有统计学意义（F=7.68,P＜0.01）;护士职业认同问卷不满意得分为（55.24 ±6.37）,低满意得分为（63.35 ±5.46）,高满意得分为（82.49 ±7.62）,各维度得分差异有统计学意义（F=9.34,P＜0.01）,幸福进取感各维度与工作满意度及职业认同感存在正相关性（r =0.226 ～0.337,P＜0.01）.结论 临床护士工作满意度不高,工作满意度及职业认同受积极心理健康的影响.     

子宫颈癌患者性功能与配偶态度的相关性分析

目的了解子宫颈癌患者的性功能和配偶态度的现状,并探讨二者之间的关系。方法采用女性性功能量表和配偶态度问卷对132例子宫颈癌患者及其配偶进行调查。结果本组子宫颈癌患者性功能得分为(16.53±8.53)分,性功能障碍发生比例达95.5%;配偶态度得分为(6.56±3.19)分;配偶态度与性功能总分及性唤起、阴道润滑度、性高潮、性满意度和性交痛维度均呈正相关(P0.05)。结论女性性功能得分处于性功能障碍的水平,配偶的态度与女性性功能密切相关,医护工作者应重视女性性功能状况及配偶态度,及时给予干预,以提高患者的性生活质量,从而提高生活质量。