頭頸部癌症病人疼痛特質與其因應策略之探討

Characteristics of Cancer Related Pain and Coping in Head and Neck Cancer Patients

謝佩芸(Pei-Yun Hsieh)

指導教授 ： 賴裕和

國立臺灣大學/醫學院/護理學研究所/碩士(2010年)

https://doi.org/10.6342/NTU.2010.03401

摘要

頭頸癌病患接受頸部淋巴廓清術後，常有慢性疼痛、僵硬或筋肌膜疼痛產生等合併症，這些合併症和生活品質的下降有顯著相關；相關研究發現主訴頭頸部疼痛病患中，有一半診斷為筋肌膜疼痛；然而，少有研究針對筋肌膜疼痛對頭頸癌病患的影響，因此本研究會深入探討筋肌膜疼痛之現況及影響。本研究目的在探討不同頭頸部癌症病人疼痛特質（強度、時間、部位、性質、原因）、生活影響、疼痛因應與憂鬱之相關性。本研究為描述相關性研究，採橫斷式研究設計（cross-sectional design），立意取樣（purposive sampling），於台灣某醫學中心耳鼻喉科門診，針對接受同步化療及放射治療或手術結束後三個月以上至五年內的頭頸部癌症病患，進行結構式問卷進行資料收集，包括：「基本資料表」、「簡明疼痛量表」、「McGill簡短版疼痛量表」、「頸部淋巴廓清術後生活影響量表」、「疼痛因應策略量表」、「醫院焦慮憂鬱量表」，收案時間為98年12月至99年6月，收案人數共136名，研究結果顯示(1)鼻咽癌及口腔癌的疼痛強度無顯著差異，疼痛強度和生活干擾程度呈顯著正相關，疼痛性質最主要是痠痛。(2)筋肌膜疼痛和術後生活影響程度有顯著正相關，筋肌膜疼痛發生率最高在斜方肌，其次為提肩胛肌。(3)教育程度、身體功能狀態和憂鬱有負相關，筋肌膜疼痛強度和憂鬱有正相關，口腔癌病患憂鬱得分顯著高於鼻咽癌病患；接受兩種廓清術的憂鬱總分顯著高於沒有手術或僅接受選擇性淋巴廓清術。(4)過去治療方式(化學治療累積劑量、治療後至今時間、放射技術和淋巴廓清術式)和疼痛性質、強度無顯著相關。(5)以藥物處理疼痛策略為主。本研究有助臨床護理人員瞭解治療結束期後頭頸癌常見疼痛描述及疼痛對生活及情緒之影響層面，並對筋肌膜疼痛現況有進一步瞭解，以提供臨床照護人員依據以增加疼痛照護能力。

關鍵字

頭頸部癌症 ； 筋肌膜疼痛 ； 疼痛因應 ； 憂鬱

並列摘要

Head and neck cancer patients frequently complained of many discomforts, such as chronic pain, rigidness, myofasical pain and so on. These complications are known to influence patient’s quality of life. However, there is little research that has been done to discover the impacts of myofascial pain on head and neck cancer patients. The purposes of the study are to exam (1) the myofascial pain prevalence, locations and intensity among patient diagnosed with head and neck cancer, (2) the correlation between pain, coping and depression. This is a cross-sectional study conducted in a medical center in northern Taiwan. A total of 136 head and neck cancer patients were recruited. Instruments used to collect data from participants were Brief Pain Inventory (BPI), Mc Gill Pain Questionnaire (MPQ), Neck Dissection Impairment Index (NDII), Hospital Anxiety and Depression Scale (HADS), and Brief Pain Coping Inventory (BPCI). Data were analyzed using independent t-test, ANOVA, and Pearson’s correlation. The findings showed that (1) there is no significant differences in pain intensity between nasopharyngeal cancer and oral cavity cancer patients. (2) The major pain characteristic is aching. (3) Pain intensity has high correlation with life interference. (4) The highest incidence of myofascial pain area is trapezius muscle, followed by levator scapulae. (5) Myofascal pain intensity is significantly correlated to patients’ severity of depression and life interfernence. (6) Oral cavity cancer patients have higher depression scores than those diagnosed with nasopharyngeal cancer. (7) Patients who received two kinds of neck dissection reported higer depression scores than those without neck dissection surgey or only SND did. (8) Patients mainly adopted medicine to cope with their pain. These study results provide evidence about the status quo of pain among HNC patients during the survival period. We also reveal that myofascial pain impacts life function and mood of these patients. Overall we hope that these findings will rouse clinical staff paying much attention to ease patients’ myofascal pain, and further understand its physical and emotional impacts on those.

並列關鍵字

Head and neck cancer ； Myofascial pain ； Coping ； Depression

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