慢性疼痛對情緒狀態及睡眠品質之影響：慢性癌痛與慢性每日頭痛之比較

A Comparison of the Effect of Chronic Pain on Mood States and Quality of Sleep Between Patients With Cancer Pain and Patients With Daily Headache

王潤清(Ruenn-Ching Wang)

指導教授 ： 林佳靜教授

臺北醫學大學/護理學院/護理學研究所/碩士(2004年)

摘要

情緒困擾與睡眠障礙是慢性癌痛病患與慢性每日頭痛病患常見之症狀困擾，也常與疼痛交互作用，導致疼痛之複雜性。比較兩組慢性疼痛影響之差異性，有助於對慢性疼痛特質之認識。本研究目的為：（1）比較慢性癌痛（惡性疼痛）病患與慢性每日頭痛（非惡性疼痛）病患在疼痛、情緒狀態及睡眠品質之差異性。（2）探討慢性癌痛病患與慢性每日頭痛病患在疼痛、情緒狀態、睡眠品質彼此相關之差異性。研究對象係慢性每日頭痛病患以北部某醫學中心之神經內科門診及住院病人為主，慢性癌痛病患以中部某醫學中心及某區域醫院之腫瘤科門診及住院病人為主，採方便取樣來選取符合收案條件並同意進行研究者，以結構式問卷收集資料，共收得慢性癌痛病患94人、慢性每日頭痛病患102人。本研究所使用之研究工具包括基本屬性問卷、簡明疼痛量表（BPI-C）、情緒狀態簡明量表（POMS-SF）、匹茲堡睡眠品質指標（PQSI）來測試病患之疼痛、情緒狀態、及睡眠品質情形。研究資料採用independent sample t-test、Mann-Whitney U、chi-square、Pearson’s correlation進行統計。 本研究結果發現：（1）慢性每日頭痛病患之平均疼痛高於慢性癌痛病患，但兩組在最劇烈疼痛、最輕疼痛及現在疼痛與慢性癌痛並無顯著差異。（2）慢性癌痛病患之疼痛干擾顯著高於慢性每日頭痛病患，但在疼痛干擾情緒、睡眠兩項，兩組並無顯著差異。（3）慢性癌痛病患與慢性每日頭痛病患在緊張、生氣、混亂、憂鬱之情緒並無顯著差異，但慢性癌痛病患較慢性每日頭痛病患容易疲憊及活力差。（4）慢性癌痛病患與慢性每日頭痛病患之睡眠品質均差，兩組之疼痛強度與疼痛干擾皆與睡眠品質呈顯著正相關。（5）慢性每日頭痛病患之疼痛強度、疼痛干擾、情緒狀態、睡眠品質皆彼此呈顯著正相關。（6）在慢性癌痛之疼痛強度、疼痛干擾、情緒狀態、睡眠品質彼此相關方面，除在疼痛強度與情緒狀態未達顯著相關外，其餘皆彼此呈現顯著相關。（7）慢性癌痛與慢性每日頭痛之情緒狀態與睡眠品質皆達統計上顯著正相關。 本研究提供醫療人員對慢性癌痛（惡性疼痛）與慢性每日頭痛（非惡性疼痛）在疼痛、情緒狀態及睡眠品質影響之認識。慢性疼痛病患，不論其疾病是惡性與否，疼痛與睡眠品質、情緒狀態皆有某程度之交互影響，因而導致病患不適，我們在照護上應不分疾病之惡性與否，去思考慢性疼痛對病患帶來之影響。

關鍵字

慢性癌痛 ； 慢性每日頭痛 ； 慢性疼痛 ； 情緒狀態 ； 睡眠品質

並列摘要

The purposes of this study were：（1）to compare the effect of pain on mood states and quality of sleep between patients with chronic cancer pain and patients with chronic daily headache and（2）to explore the relationship among pain, mood states and quality of sleep between patients with chronic cancer pain and patients with chronic daily headache. A convience sample of chronic cancer pain was recruited from a regional teaching hospital and a medical center in Taichung. A convience sample of chronic daily headache was recruited from a medical center in Taipei. There were 94 chronic cancer pain patients and 102 chronic daily headache patients participated in the study. The questionnaire consisted of four major sections：the Chinese version of the Profile of Mood States（POMS）short form, the Chinese version of the Pittsburgh Sleep Quality Index（PSQI）, the Brief Pain Inventory-Chinese version（BPI-C）, and a demographic questionnaire. Data were analyzed using independent sample t-test, Mann-Whitney U, chi-square, and Pearson’s correlation. The results were as follows.（1）The chronic daily headache patients reported significantly higher levels of average pain than did the patients with chronic cancer pain. There were no difference on the worst pain, the least pain, and pain now between these two groups.（2）The chronic cancer patients reported significantly higher levels of pain interference than did the patients with chronic daily headache. There were no difference on the interference of mood and of sleep between two groups.（3）There were no difference on tense, angry, confusion, and depression between two groups. The chronic cancer patients reported significantly higher levels of fatigue and lower levels of vigor than did the patients with chronic daily headache.（4）Both two groups suffered from poor sleep. Pain intensity and pain interference were significantly correlated with quality of sleep measured by the PSQI on these two groups.（5）Pain intensity, pain interference, moods states were significantly correlated with each other in patients with chronic daily headache.（6）Pain intensity was not significantly correlated with the total mood disturbance in patients with chronic cancer pain. However pain interference was significantly correlated with the total mood disturbance in patients with chronic cancer pain.（7）The total mood disturbance was significantly correlated with quality of sleep measured by the PSQI for these two groups. The results of this study have provided importment implications for management of chronic cancer pain as well as chronic daily headache.

並列關鍵字

Chronic cancer pain ； Chronic daily headache ； Chronic pain ； Mood states ； Quality of sleep

參考文獻

姚建安(1998)?癌末病患的睡眠障礙?安寧療護雜誌，9，30-33。

陳獻宗(1999)?疼痛症候群?當代醫學，26(12)，974-979。

黃采薇、賴裕和、鄭安理、史麗珠、張正雄、向肇英(2001)?背部按摩對化學治療期間疲憊及焦慮之成效?台灣醫學，5(4)，369-378。

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)，373-382。

陳美妃、王秀紅(1995)?老年婦女睡眠品質及其相關因素?護理研究，3(4)，323-334。