成人癌症疼痛臨床照護指引

Clinical Practice Guideline on Pain Control in Adult Cancer Patients

10.6880/TJON.201112/SP_11.06

胡文郁(Wen-Yu Hu)；陳宛榆(Wan-Yu Chen)；羅淑芬(Shu-Fen Lo)；陳書毓(Sha-Ya Chen)；黃翰心(Hahn-Shin Huang)；陳幼貴(Yu-Kuei Chen)

癌症 ； 疼痛 ； 正念減壓療法 ； 治療性按摩 ； 疼痛教育訓練 ； 指引 ； cancer ； pain ； mindfulness based stress reduction ； therapeutic massage ； pain education program ； guideline

腫瘤護理雜誌

11卷增訂刊（2011 / 12 / 01）

87 - 127

繁體中文

癌症病人的「臨床疼痛（clinical pain）」乃受身體、心理情緒、靈性以及社會文化等因素刺激而形成的複雜主觀自覺症狀，使得臨床疼痛不易控制。本實證指引透乃過實證的「6S」原則，針對近十年國內外已發展的「照護指引」與「文獻」進行系統性資料搜尋，以及嚴謹的評核與評讀，最後，評核強度為「建議／強烈建議」之「成人癌症疼痛指引」共11篇，以及證據等級為「II- ～ I++」之「治療性按摩（8篇）、正念減壓療法（11篇）、經皮電神經刺激術（2篇）以及疼痛教育訓練（8篇）」等非藥物治療與持續照護之實證文獻，共29篇。據此實證結果，本指引從「臨床護理人員」全人照護與整體性疼痛的實務觀點，透過「醫療團隊合作」以及熟悉地「護理過程」的角度，綜合整理出疼痛護理評估與照護處置的概念構圖，並以「四階段與十步驟」之圖示方式，呈現疼痛類型評估的推理過程與處置照護流程。指引撰寫內容，包括（1）評估期：詢問病人的疼痛分數、記錄第五生命徵象以及整體性疼痛之初始評估；（2）確認問題期：確認疼痛類型；（3）處置與照護期：針對不同類型疼痛，選擇適切地藥物治療、非藥物治療及持續疼痛評估；（4）持續照護期：疼痛教育訓練、轉換照護機構或返家時疼痛處置注意事項以及鴉片類藥物副作用的照護。期望本指引撰寫的內容與建議具有臨床實用性，有利於護理人員閱讀查詢，進而培養其對病人疼痛的敏銳覺察與推理能力，與醫療團隊合作以確認癌症病人的疼痛類型和可能成因，以提供安全、有效且適當地藥物與個別性且適切的非藥物治療，成功地控制或緩解疼痛，以提升腫瘤護理人員疼痛照護的品質。

Clinical pain in adult cancer patient is a subjective symptom caused by a complex mix of Physical, psychological, spiritual, and other societal or cultural factors. This guidelines utilizes the 6S principle and systematic review to search the recent 10 years of research development in adult cancer pain, therapeutic massage, mindfulness based stress reduction (MBSR), transcutaneous electrical nerve stimulation (TENS), pain education program (PEE), and other non-pharmacological treatment. Through a strict and careful apprasial, 11 articles were found to be either recommended or strongly recommended guidelines. With the clinical nursing staff and its' familiar nursing process, Team collaboration, holistic care and total pain management in mind, the results from the apprasial are organized into a concept map. This concept map is categorized into 4 stages and 10 steps: (1) assessment stage: obtaining patient's pain score, recording the fifth vital sign, and a total pain initial assessment; (2) confirmation stage: confirmation of the type of pain; (3) treatment and care stage: both appropriate pharmacological and non-pharmacological treatments, continuous pain assessment; (4) continued care stage: pain education program for patient and family, transfer to nursing facilities, care for side effect of opioid drugs. Our expection is that the contents of this guideline will be practical and easy to read nurse. We also intented on raising the nursing staff's competenc of clinical reasoning and sensitivity to patients' pain, which will allow for better diagnoses of the type and causes of pain. In turn, nurses will be better equipped for providing pharmacological or non-pharmacological treatment that is safe, effective and appropriate to control or relieve the pain. We believe this will raise the quality of care provided by the oncology nursing staff.

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