比較癌症疼痛的非藥物處置－系統性文獻回顧暨網絡分析

背景：癌末病患常會經歷癌症疼痛症狀的困擾，臨床藥物治療成效雖佳，但病患仍會遭受輕度至中度的癌症疼痛症狀，需要非藥物疼痛處置輔助。因此，本研究期望透過系統性文獻回顧，以實證為基礎的比較各種非藥物癌痛處置。研究目的：比較癌症病人各種非藥物疼痛處置降低疼痛強度的成效？研究方法：本文搜尋The Cochrane Library、PubMed、CINAHL、EMbase等資料庫，以布林邏輯運用進階搜尋P+O的中英文關鍵字搜尋有關非癌症疼痛處置的隨機對照試驗文章，以Cochrane risk of bias tool（ROB）進行文獻評讀，更進一步以網路分析（Network meta-analysis）分析來驗證及比較其臨床實際減緩疼痛的成效，最後並以GRADEpro GDT進一步統整臨床建議等級。結果：經系統性文獻搜尋總共納入42篇RCT文章，共5757名病患，癌症疼痛非藥物介入措施共9項，統計之曲線效果最佳者為效果最佳者為「TENS」，疼痛分數下降之SMD為2.08（95% CI 0.54-8.06），而效果最差的為「耳針」，其SMD為0.18（95% CI 0.06-0.49），其餘分別為「疼痛衛教」1.45（95% CI 0.9-2.33）、「按摩」1.37（95% CI 0.68-2.77）、「正念減壓」1.22（95% CI 0.52-2.85）、「音樂治療」1.08（95% CI 0.39-3.01）、「草藥」1.0（95% CI 0.41-2.43）、「認知行為治療」0.59（95% CI 0.13-2.73）、「針灸」0.57（95% CI 0.26-1.26）。許多比較都沒有直接臨床試驗，只能通過間接比較來估計。多重比較需要進一步更多的非藥物癌痛研究。結論與應用：研究結果顯示TENS的止痛成效最佳，為一項優先選擇的非藥物癌痛處置措施。在適合病人的期望下，建議可透過分享決策過程（SDM），提供病人及家屬可選擇之疼痛處置相關資訊，搭配以非藥物處置來達到緩解病患疼痛，提高癌症疼痛病患生活品質的最終目標。

關鍵字

非藥物疼疼處置；癌症疼痛；網絡分析

並列摘要

Background: Patients with terminal cancer always experienced mild to moderate cancer-related pain symptoms, even the pharmacological treatment is effective for controlling pain, patients still need non-pharmacological pain management for complementary effect. Therefore, this systematic review was to find out the best effective non-pharmaceutical treatment based on a systematic review. Purposes: What is the effectiveness of various non-drug pain management for cancer patients on pain intensity? Research method: A systematic review was conducted by searching randomized controlled trial articles on databases such as the Cochrane Library, PubMed, CINAHL, EMbase, and uses Bollinger logic to search for P + O keywords in both Chinese and English. We appraisal by the Cochrane Risk of Bias tool (ROB) for reviewing the study quality. The network meta-analysis was conducted to verify and compare its clinical effectiveness in reducing pain intensity on the Visual Analogue Scale (VAS). Combined mean difference (MD) and 95% credible interval (CI) were calculated. Finally, GRADEpro GDT was used to integrate the clinical recommendations. Results: A total of 42 RCT articles were included through a systematic review, of 5757 patients, and 9 various non-pharmacological managements for cancer pain, and According to statistics, the curve with the best effect is "TENS", the SMD of the decrease in pain score is 2.08 (95% CI 0.54-8.06), and the worst effect is "Auricular Acupuncture" with SMD of 0.18 (95 % CI 0.06-0.49), the rest are "Pain Health Education" 1.45 (95% CI 0.9-2.33), "Massage" 1.37 (95% CI 0.68-2.77), "Mindfulness" 1.22 (95% CI 0.52-2.85), "Music Therapy" 1.08 (95% CI 0.39-3.01), "herbal medicine" 1.0 (95% CI 0.41-2.43), "Cognitive Behavioral Therapy" 0.59 (95% CI 0.13-2.73), "Acupuncture :0.57 (95% CI 0.26-1.26). Several comparisons lacked the direct trials, we can only estimate it by indirect comparison. Further non-pharmacological cancer pain studies were necessary for the multiple comparison. Conclusion and application: "TENS" demonstrated the best pain relief effect for cancer pain reduction, should be considered first as the non-pharmacological pain management for cancer patients. Under the expectation of patients, the other choices could be provided as optional choices while sharing the decision-making with patients and family members Complementary with the use of non-pharmacological managements could achieve the ultimate goal of alleviating pain and improving the quality of life of cancer pain patients.

並列關鍵字

non-pharmacological pain management ； cancer pain ； network meta-analysis

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