疼痛衛教及放鬆訓練對改善癌症疼痛之效果探討

The Effects of Pain Education and Relaxation Training in Patients with Cancer Pain

郭淑柳(Shu-liu Guo)

指導教授 ： 賴裕和

臺北醫學大學/護理學院/護理學研究所/碩士(2002年)

摘要

疼痛是癌症病人最常面臨的問題，是多層面的複雜經驗，疼痛處理需要多方位的處置方式，故本研究目的在比較疼痛衛教、疼痛衛教加放鬆訓練與接受現有病房照護對癌症疼痛經驗改善之效果探討。 本研究設計採類實驗法，於北部某教學醫學中心腫瘤相關病房選取符案病患，針對符案的癌症疼痛病患，以隨機分派將符案病患分為實驗組（Ⅰ）接受疼痛衛教方案（14人）、實驗組（Ⅱ）接受疼痛衛教加放鬆訓練方案（12人）及接受一般病房常規照護的對照組（14人），進行連續五天之上述的介入性方案措施，研究資料以描述性統計及成對t檢定、單因子變異數分析、重複測試變異數分析評價介入方案的效果。 研究結果發現：(1)疼痛衛教組之平均疼痛強度、睡眠及日常生活的疼痛干擾在研究後具有顯著改善。(2)疼痛衛教加放鬆訓練組之平均疼痛強度、最嚴重的疼痛強度、睡眠及行走能力的疼痛干擾在研究後具有顯著改善。(3)疼痛衛教組與疼痛衛教加放鬆訓練組在疼痛及麻醉性止痛藥的信念方面有顯著改善，但對照組個案則完全無改變。(4)疼痛衛教組與疼痛衛教加放鬆訓練組在研究後焦慮、憂鬱程度有顯著改善，而對照組只在焦慮程度有改善，但疼痛衛教加放鬆訓練組的焦慮、憂鬱改善程度均高於疼痛衛教組、對照組。 本研究結果顯示，疼痛衛教及放鬆訓練可降低癌痛病患的疼痛強度、疼痛干擾，改善病患負向疼痛信念及焦慮、憂鬱情緒困擾，使得癌痛病患的疼痛獲得更好控制及改善。

關鍵字

癌症疼痛 ； 疼痛信念 ； 疼痛干擾 ； 負向情緒困擾 ； 疼痛衛教 ； 放鬆訓練

並列摘要

Pain is one of the complicated problems and faced by cancer patients. A multi-modalities approach to cancer pain has been suggested. In this study, we aimed to assess the effects of pain education and relaxation training for patients with cancer pain. A quasi-experimental design with pre- and post-test was used for this study. Eligible cancer patients with pain(N=40), were randomly assigned to three groups, including(1) pain education group, 15 minutes education for 5 consecutive days (Experimental groupⅠ, n=14),(2) pain education plus relaxation training group, 15 minutes education and 15 minutes relaxation training for 5 consecutive days (Experimental groupⅡ,n=12), and (3) control group which receive 15 minutes care as usual ward routine (n=14). The Brief Pain Inventory Short Form (BPI-S), Pain and Opioid Analgesic Beliefs Scale — Cancer (POABS-CA), and Profile of Mood State Short Form for anxiety and depression (POMS-anxiety ,and depression) were used to evaluate the effects of these interventions on pain intensity, pain interferences, beliefs about opioids, and mood status. Data were analyzed using paired t—test, ANOVA, and repeated measures ANOVA. The results showed that (1) the average pain intensity, pain interfere with sleep and general activity, negative effect of pain belief, anxiety and depression level were significantly reduced in patients receiving the pain education (Exp.Ⅰ group) comparing to control group; (2) the average pain intensity, pain interfere with sleep and walking ability, negative effect of pain belief, anxiety and depression level were reduced significantly in patients receiving pain education with relaxation training (Exp.Ⅱgroup); (3)there was no significantly statistical difference between the two experimental groups in each variable though it did show a significant immediate effects on reducing anxiety and depression in patients receiving each relaxation training; (4) control group, interestingly, only the anxiety level was reduced eminent. In conclusion, the results strongly suggest that pain education and relaxation training are all effectively in improving cancer patients’ pain problem. These interventions should be further applied to daily cancer pain management.

並列關鍵字

cancer pain ； pain beliefs ； anxiety ； depression ； pain education ； relaxation training

參考文獻

梁淑媛(1999)?疼痛對門診癌症病人及其家屬之情緒衝擊?未發表的碩士論文，臺北:臺北醫學大學。 梁淑媛、林佳靜、陳品玲、劉淑娟(2000)?癌症病人及其家屬對癌痛及其影響感受之比較?新臺北護理期刊，2(2)，17-30。

陳佩英、史麗珠、王正旭、賴裕和、張獻崑、陳美伶(1999)?疼痛對癌症病患焦慮與憂鬱之影響?台灣醫學，3(4)，373-381。

賴裕和(2000)?病人對癌痛及麻醉性止痛藥之信念探討-量表發展與現況?護理研究，8(5)，557-565。

謝麗鳳、林佳靜、賴裕和、鄒宗山(1998)?家屬對止痛藥物的擔心與癌症病人疼痛控制的相關性?護理研究，6(4)，327-336。

范金環(1999)?肌肉鬆弛處置對於改善剖腹產後急性疼痛的成效之探討?未發表的碩士論文，花蓮:慈濟醫學暨人文社會學院。