侵襲性肺癌病患之疼痛經驗探討

Abstract

疼痛為侵襲性肺癌病患最具威脅的一種症狀，但國內肺癌相關疼痛研究極為缺乏，故本研究目的為探討侵襲性肺癌病患疼痛生理特質與對生活之干擾情形、疼痛信念與疼痛因應策略及疼痛處理困難情形、疾病治療特質與周邊神經病變性疼痛情形。本研究採用橫斷式研究設計，以立意取樣收錄診斷為第III~IV分期之肺癌病患，排除一個月內執行手術之病患，以區分手術後急性疼痛與癌症慢性疼痛之差別，收案地點於台北某醫學中心之腫瘤科及胸腔內科門診，使用結構式問卷進行資料收集，包括：「基本資料表」、「簡易疼痛量表」、「麥基爾簡短版疼痛量表」、「疼痛及麻醉性止痛藥信念量表－癌症版」、「簡易疼痛因應策略量表」、「疼痛處理困難量表」及「神經性疼痛量表」。本研究共收案80人，結果顯示侵襲性肺癌病患最痛之疼痛強度為5.9分（SD＝2.0），平均疼痛強度為3.8分（SD＝1.7），疼痛干擾則以情緒影響最大，其次為日常生活及行走能力。發現病患皆普遍存有負向的忍耐疼痛與麻醉性止痛藥信念，疼痛因應策略以非藥物行為來因應疼痛為主，多數病患選擇忍耐疼痛。此外，化學治療引發周邊神經病變性疼痛之發生率為30.6%，以表面疼痛、尖銳刺痛及敏感痛最為常見。本研究結果顯示目前國內肺癌病患之疼痛控制及疼痛信念仍有待加強，因此，未來發展改善疼痛之介入措施是必要的，將有助於提昇肺癌病患的生活品質。

Pain is one of the most significant issues faced by advanced lung cancer patients. However, few studies have explored the pain experiences in lung cancer patients. Therefore, the purposes of this study were to (1) explore the pain severity and pain interference in advanced lung cancer patients; (2) explore the pain beliefs and coping strategies of advanced lung cancer patients; (3) identify the prevalence of chemotherapy-induced peripheral neuropathic pain (CIPN) and the degree of CIPN in advanced lung cancer patients. A cross-sectional survey study was conducted at a medical center in Taipei. Eligible subjects were patients diagnosed with lung cancer, clinical stage III-IV. For study purposes, patients who had undergone one or more operations within the previous one-month period were excluded from questions designed to identifying the different characteristics of acute surgical pain and chronic cancer pain. Patients were assessed by using (1) background information form, (2) Brief Pain Inventory (BPI), (3) Short-Form McGill Pain Questionnaire (SF-MPQ), (4) Pain and Opioid Analgesics Beliefs Scale-Cancer Version (POABS-CA), (5) Brief Pain Coping Inventory (BPCI), (6) Pain barriers Questionnaire, (7) Neuropathic Pain Scale (NPS). A total of 80 lung cancer patients were recruited in this study. The major results showed that the average pain intensity was 3.8 (SD=1.7) and the worst pain intensity was 5.9 (SD=2.0). The most severe pain interference was on mood, general activity and walking ability. The results also found that most patients had pain endurance beliefs and negative effect beliefs about using opioid analgesics. Besides, the prevalence of chemotherapy-induced peripheral neuropathic pain (CIPN) was 30.6%, and “surface pain,” “sharp pain,” and “sensitive pain” were most described by patients. The results suggest that poor cancer pain management is still a major problem to influence advanced lung cancer patients' daily life. We, therefore, strongly recommend that further interventions be developed to decrease pain problems.