Επίπτωση νευροπαθητικού πόνου, εργαλεία διάγνωσης, ψυχολογικές παράμετροι χρόνιου πόνου και στρατηγικές αντιμετώπισης σε ογκολογικούς ασθενείς
Φόρτωση...
Ημερομηνία
Συγγραφείς
Τζαμάκου, Ελευθερία
Τίτλος Εφημερίδας
Περιοδικό ISSN
Τίτλος τόμου
Εκδότης
Πανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικής
Περίληψη
Τύπος
Είδος δημοσίευσης σε συνέδριο
Είδος περιοδικού
Είδος εκπαιδευτικού υλικού
Όνομα συνεδρίου
Όνομα περιοδικού
Όνομα βιβλίου
Σειρά βιβλίου
Έκδοση βιβλίου
Συμπληρωματικός/δευτερεύων τίτλος
Περιγραφή
ΕΙΣΑΓΩΓΗ. Ο νευροπαθητικός πόνος εμφανίζεται σε περισσότερο από 20 % των ογκολογικών ασθενών και είναι συχνά δύσκολα ελεγχόμενος. Για την διάγνωσή του, τα ερωτηματολόγια DN4, Pain Detect και S- LANSS, έχουν σταθμιστεί στην Ελληνική γλώσσα, αλλά η διαγνωστική τους ακρίβεια δεν έχει μελετηθεί, αναλυθεί και συγκριθεί στους ογκολογικούς ασθενείς στην Ελλάδα.
ΣΚΟΠΟΣ. Να μελετηθεί η επίπτωση του νευροπαθητικού πόνου στους ογκολογικούς ασθενείς και η διαγνωστική ακρίβεια των ερωτηματολογίων DN4, Pain Detect και S- LANSS. Επίσης να μελετηθεί η σχέση μεταξύ της ψυχολογικής καταπόνησης, του πόνου και της Ποιότητας Ζωής.
ΥΛΙΚΟ ΚΑΙ ΜΕΘΟΔΟΣ. Προοπτική, συγχρονική (cross sectional), επιδημιολογική μελέτη παρατήρησης, μετά από έγκριση της Ε. Ε. του Νοσοκομείου και μετά από ενυπόγραφη συγκατάθεση των ασθενών.
Μελετήθηκαν 256 ασθενείς με χρόνιο καρκινικό πόνο, από τον Απρίλιο του 2012 έως και τον Ιούλιο του 2015. Η διάγνωση του νευροπαθητικού πόνου τέθηκε από τον ειδικό Αναισθησιολόγο, οι ασθενείς συμπλήρωσαν τα ερωτηματολόγια Pain Detect και S- LANSS, ενώ το DN4, συμπληρώθηκε από άλλον ειδικό γιατρό μετά από συνέντευξη. Εκτιμήθηκε η ψυχοπαθολογία των ασθενών και η ποιότητα ζωής, με τις κλίμακες WHOQOL-BREF και SCL-90.
Στατιστική: t – test, Chi square, Καμπύλες ROC. Δείκτες αξιοπιστίας για το DN4 και το Pain Detect: Küder Richardson και Cronbach’s a, αντίστοιχα.
ΑΠΟΤΕΛΕΣΜΑΤΑ. Εξαιρέθηκαν 71 ασθενείς. Επίπτωση νευροπαθητικού πόνου: 41,1% (76 ασθενείς), 16 (21,1%) ασθενείς με αμιγώς νευροπαθητικό και 60 (78,9%) με μικτό πόνο. Οι καμπύλες ROC για DN4 και Pain Detect, με AUC: 0.857 και 0.870 αντίστοιχα, έδειξαν αξιοπιστία και στα δύο ερωτηματολόγια.
Ευαισθησία και Ειδικότητα: DN4: 51,3% και 94,3%, Pain Detect: 21,1% και 100% και S-LANSS: 44,4% και 95,5% αντίστοιχα. Δεν προέκυψαν συσχετίσεις μεταξύ των ασθενών: αναφορικά με τον τύπο (νευροπαθητικός- αλγαισθητικός) και την ένταση του πόνου, την ηλικία, το φύλο και το μορφωτικό επίπεδο. Η εκτίμηση της αναλγητικής αγωγής ανέδειξε ότι οι ασθενείς υποθεραπεύονται. Αναφορικά με την ποιότητα ζωής οι ασθενείς παρουσίασαν χαμηλές τιμές στη σωματική (34.06 ± 21.08) και ψυχική υγεία (47.43 ± 20.85). Για τις κοινωνικές σχέσεις και το περιβάλλον: 64.90 ± 16.64 και 66.57 ± 14.01, αντίστοιχα. Οι παραπάνω παράμετροι συσχετίστηκαν σημαντικά με τις διαταραχές ύπνου και στατιστικά σημαντικές συσχετίσεις με: ενοχή, ιδεοψυχαναγκασμό, παρανοϊκό ιδεασμό και διαπροσωπική ευαισθησία. Αναφορικά με την ψυχοπαθολογία υψηλές τιμές αφορούσαν: σωματοποίηση, κατάθλιψη, διαταραχές ύπνου και σκέψεις θανάτου.
ΣΥΜΠΕΡΑΣΜΑΤΑ. Οι ασθενείς παραπέμπονται στο Ιατρείο Πόνου σε πολύ προχωρημένο στάδιο, υποδιαγιγνώσκονται και υποθεραπεύονται αναφορικά με την αναλγητική αγωγή και την ψυχολογική υποστήριξη. Η διάγνωση παραμένει κυρίως κλινική. Τα διαθέσιμα διαγνωστικά εργαλεία ενδέχεται, μετά από κάποιες τροποποιήσεις, να ενισχύσουν την κλινική διάγνωση, όχι όμως και να την αντικαταστήσουν. Η παρουσία χρόνιου πόνου στους Ογκολογικούς ασθενείς συνοδεύεται από κατάθλιψη, αίσθημα ανεπάρκειας και κατωτερότητας, δυσφορία του ασθενούς, ανησυχία, διαταραχές ύπνου και πτωχή Ποιότητα Ζωής.
Background. Oncology patients often experience neuropathic pain in approximately 20% and it is the most difficult type of pain to be controlled. DN4, Pain Detect and S-LANSS questionnaires have been validated in Greek language. Their diagnostic accuracy have never been studied, analyzed and compared in Greek cancer patients. Objectives. This study aimed to evaluate the prevalence of neuropathic pain in cancer patients and the diagnostic accuracy of DN4, Pain Detect and S-LANSS. Furthermore, the relationship between psychosocial distress, pain and quality of life was of interest. Materials and Methods. This study is an observational, cross-sectional, prospective, epidemiological research. It was approved by the Hospital Ethics Committee and all participants provided an informed consent. A total of 256 consecutive oncology patients were studied and analyzed during the period between April 2012 and July 2015. The clinical diagnosis for neuropathic pain was established by a Pain Specialist and patients completed DN4 and Pain Detect, while DN4 was completed by another Pain Specialist, through an interview. Their Quality of Life and Psychopathology (WHOQO L-BREF and SCL-90) were also evaluated. Statistics: t-test, Chi square, Receiver Operating Characteristic (ROC) curves. Reliability indexes for DN4 and Pain Detect: Küder Richardson and Cronbach’s a respectively Results. 71 patients were excluded. The prevalence of neuropathic pain due to Pain Specialist was 41% (76 patients): 16 patients out of 76 (21%), experienced pure neuropathic pain and 60 (79%) patients, mixed pain. ROC curves and AUC’s of DN4 and Pain Detect were equal to 0.857 and 0.870 respectively, showing reliability to both of them. Sensitivity and Specificity: 51,3% and 94,3% for DN4, 21,1% and 100% for Pain Detect and 44,4% and 95,5% for S-LANSS, respectively. There weren’t any statistically significant differences between type (neuropathic-nociceptive) and intensity of pain, age, sex and educational level. The treatment evaluation, revealed that patients were under treated. In relation to quality of life, patients appeared lower values in physical (34.06 ± 21.08) and mental health (47.43 ± 20.85) and for social relationships and environment: 64.90 ± 16.64 and 66.57 ± 14.01, respectively. Sleep disturbances were statistically significant and statistically significant correlations were found to: Guilt, Obsessive Compulsive, Paranoid Ideation and Interpersonal Sensitivity. From the analysis of SCL-90, patients had high values to somatization, depression, sleep disturbances and thoughts of death. Background. Oncology patients often experience neuropathic pain in approximately 20% and it is the most difficult type of pain to be controlled. DN4, Pain Detect and S-LANSS questionnaires have been validated in Greek language. Their diagnostic accuracy have never been studied, analyzed and compared in Greek cancer patients. Objectives. This study aimed to evaluate the prevalence of neuropathic pain in cancer patients and the diagnostic accuracy of DN4, Pain Detect and S-LANSS. Furthermore, the relationship between psychosocial distress, pain and quality of life was of interest. Materials and Methods. This study is an observational, cross-sectional, prospective, epidemiological research. It was approved by the Hospital Ethics Committee and all participants provided an informed consent. A total of 256 consecutive oncology patients were studied and analyzed during the period between April 2012 and July 2015. The clinical diagnosis for neuropathic pain was established by a Pain Specialist and patients completed DN4 and Pain Detect, while DN4 was completed by another Pain Specialist, through an interview. Their Quality of Life and Psychopathology (WHOQO L-BREF and SCL-90) were also evaluated. Statistics: t-test, Chi square, Receiver Operating Characteristic (ROC) curves. Reliability indexes for DN4 and Pain Detect: Küder Richardson and Cronbach’s a respectively Results. 71 patients were excluded. The prevalence of neuropathic pain due to Pain Specialist was 41% (76 patients): 16 patients out of 76 (21%), experienced pure neuropathic pain and 60 (79%) patients, mixed pain. ROC curves and AUC’s of DN4 and Pain Detect were equal to 0.857 and 0.870 respectively, showing reliability to both of them. Sensitivity and Specificity: 51,3% and 94,3% for DN4, 21,1% and 100% for Pain Detect and 44,4% and 95,5% for S-LANSS, respectively. There weren’t any statistically significant differences between type (neuropathic-nociceptive) and intensity of pain, age, sex and educational level. The treatment evaluation, revealed that patients were under treated. In relation to quality of life, patients appeared lower values in physical (34.06 ± 21.08) and mental health (47.43 ± 20.85) and for social relationships and environment: 64.90 ± 16.64 and 66.57 ± 14.01, respectively. Sleep disturbances were statistically significant and statistically significant correlations were found to: Guilt, Obsessive Compulsive, Paranoid Ideation and Interpersonal Sensitivity. From the analysis of SCL-90, patients had high values to somatization, depression, sleep disturbances and thoughts of death. Conclusions. Patients referred in Outpatient Pain Clinic in an advanced stage of disease. Their neuropathic cancer pain has underrecognised and undertreated, in relation to analgesic drugs and psychosocial support. The diagnosis remains in a clinical setting. The available diagnostic tools have low sensitivity and some manifestations are required to clinical diagnosis without replacing it. The presence of chronic pain is accompanied by depression, lack of efficiency, inferiority, distress, anxiety, sleep disturbances and poor quality of life.
Background. Oncology patients often experience neuropathic pain in approximately 20% and it is the most difficult type of pain to be controlled. DN4, Pain Detect and S-LANSS questionnaires have been validated in Greek language. Their diagnostic accuracy have never been studied, analyzed and compared in Greek cancer patients. Objectives. This study aimed to evaluate the prevalence of neuropathic pain in cancer patients and the diagnostic accuracy of DN4, Pain Detect and S-LANSS. Furthermore, the relationship between psychosocial distress, pain and quality of life was of interest. Materials and Methods. This study is an observational, cross-sectional, prospective, epidemiological research. It was approved by the Hospital Ethics Committee and all participants provided an informed consent. A total of 256 consecutive oncology patients were studied and analyzed during the period between April 2012 and July 2015. The clinical diagnosis for neuropathic pain was established by a Pain Specialist and patients completed DN4 and Pain Detect, while DN4 was completed by another Pain Specialist, through an interview. Their Quality of Life and Psychopathology (WHOQO L-BREF and SCL-90) were also evaluated. Statistics: t-test, Chi square, Receiver Operating Characteristic (ROC) curves. Reliability indexes for DN4 and Pain Detect: Küder Richardson and Cronbach’s a respectively Results. 71 patients were excluded. The prevalence of neuropathic pain due to Pain Specialist was 41% (76 patients): 16 patients out of 76 (21%), experienced pure neuropathic pain and 60 (79%) patients, mixed pain. ROC curves and AUC’s of DN4 and Pain Detect were equal to 0.857 and 0.870 respectively, showing reliability to both of them. Sensitivity and Specificity: 51,3% and 94,3% for DN4, 21,1% and 100% for Pain Detect and 44,4% and 95,5% for S-LANSS, respectively. There weren’t any statistically significant differences between type (neuropathic-nociceptive) and intensity of pain, age, sex and educational level. The treatment evaluation, revealed that patients were under treated. In relation to quality of life, patients appeared lower values in physical (34.06 ± 21.08) and mental health (47.43 ± 20.85) and for social relationships and environment: 64.90 ± 16.64 and 66.57 ± 14.01, respectively. Sleep disturbances were statistically significant and statistically significant correlations were found to: Guilt, Obsessive Compulsive, Paranoid Ideation and Interpersonal Sensitivity. From the analysis of SCL-90, patients had high values to somatization, depression, sleep disturbances and thoughts of death. Background. Oncology patients often experience neuropathic pain in approximately 20% and it is the most difficult type of pain to be controlled. DN4, Pain Detect and S-LANSS questionnaires have been validated in Greek language. Their diagnostic accuracy have never been studied, analyzed and compared in Greek cancer patients. Objectives. This study aimed to evaluate the prevalence of neuropathic pain in cancer patients and the diagnostic accuracy of DN4, Pain Detect and S-LANSS. Furthermore, the relationship between psychosocial distress, pain and quality of life was of interest. Materials and Methods. This study is an observational, cross-sectional, prospective, epidemiological research. It was approved by the Hospital Ethics Committee and all participants provided an informed consent. A total of 256 consecutive oncology patients were studied and analyzed during the period between April 2012 and July 2015. The clinical diagnosis for neuropathic pain was established by a Pain Specialist and patients completed DN4 and Pain Detect, while DN4 was completed by another Pain Specialist, through an interview. Their Quality of Life and Psychopathology (WHOQO L-BREF and SCL-90) were also evaluated. Statistics: t-test, Chi square, Receiver Operating Characteristic (ROC) curves. Reliability indexes for DN4 and Pain Detect: Küder Richardson and Cronbach’s a respectively Results. 71 patients were excluded. The prevalence of neuropathic pain due to Pain Specialist was 41% (76 patients): 16 patients out of 76 (21%), experienced pure neuropathic pain and 60 (79%) patients, mixed pain. ROC curves and AUC’s of DN4 and Pain Detect were equal to 0.857 and 0.870 respectively, showing reliability to both of them. Sensitivity and Specificity: 51,3% and 94,3% for DN4, 21,1% and 100% for Pain Detect and 44,4% and 95,5% for S-LANSS, respectively. There weren’t any statistically significant differences between type (neuropathic-nociceptive) and intensity of pain, age, sex and educational level. The treatment evaluation, revealed that patients were under treated. In relation to quality of life, patients appeared lower values in physical (34.06 ± 21.08) and mental health (47.43 ± 20.85) and for social relationships and environment: 64.90 ± 16.64 and 66.57 ± 14.01, respectively. Sleep disturbances were statistically significant and statistically significant correlations were found to: Guilt, Obsessive Compulsive, Paranoid Ideation and Interpersonal Sensitivity. From the analysis of SCL-90, patients had high values to somatization, depression, sleep disturbances and thoughts of death. Conclusions. Patients referred in Outpatient Pain Clinic in an advanced stage of disease. Their neuropathic cancer pain has underrecognised and undertreated, in relation to analgesic drugs and psychosocial support. The diagnosis remains in a clinical setting. The available diagnostic tools have low sensitivity and some manifestations are required to clinical diagnosis without replacing it. The presence of chronic pain is accompanied by depression, lack of efficiency, inferiority, distress, anxiety, sleep disturbances and poor quality of life.
Περιγραφή
Λέξεις-κλειδιά
Επίπτωση νευροπαθητικού πόνου, Διαγνωστικά εργαλεία, Ογκολογικοί ασθενείς, Ψυχολογικές παράμετροι χρόνιου πόνου, Ποιότητα ζωής και ψυχοπαθολογία, Prevalence of neuropathic pain, Diagnostic tools, Cancer patients, Psychological parameters of chronic pain, Quality of life and psychopathology
Θεματική κατηγορία
Καρκινικός πόνος
Παραπομπή
Σύνδεσμος
Γλώσσα
el
Εκδίδον τμήμα/τομέας
Πανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικής
Όνομα επιβλέποντος
Αρναούτογλου, Ελένη
Εξεταστική επιτροπή
Παυλίδης, Νικόλαος
Αρναούτογλου, Ελένη
Παπαδόπουλος, Γεώργιος
Πενθερουδάκης, Γεώργιος
Πέτρου, Αναστάσιος
Σιαφάκα, Βασιλική
Τζίμας, Πέτρος
Αρναούτογλου, Ελένη
Παπαδόπουλος, Γεώργιος
Πενθερουδάκης, Γεώργιος
Πέτρου, Αναστάσιος
Σιαφάκα, Βασιλική
Τζίμας, Πέτρος
Γενική Περιγραφή / Σχόλια
Ίδρυμα και Σχολή/Τμήμα του υποβάλλοντος
Πανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικής
Πίνακας περιεχομένων
Χορηγός
Βιβλιογραφική αναφορά
Βιβλιογραφία : σ. 85-97
Ονόματα συντελεστών
Αριθμός σελίδων
97 σ.