疼痛教育及放鬆訓練對改善癌痛之立即與中程效果比較

Comparison of the Immediate and Mediate Effects of Pain Education and Relaxation Training on Cancer Pain Experiences

杜佳玲(Chia-Ling Tu)

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(2004年)

摘要

疼痛是與癌症相關的常見症狀，疼痛所造成的身體不舒服，可能間接降低生活品質及生存的意義，而疼痛是一個多層面的經驗，且焦慮、憂鬱等情緒困擾也會強化疼痛的感受，因此疼痛可藉由不同的方式來處理及控制，故本研究目的在於比較接受病房常規照護、給與疼痛教育及給與疼痛教育加上放鬆訓練對癌痛經驗改善之探討。 　　本研究採類實驗法，於北部五所教學醫院之腫瘤相關病房選取符合條件之癌痛病患，以隨機方式將病患分為對照組 (15人) 、實驗組I-疼痛教育組 (13人) 及實驗組II-疼痛教育加放鬆訓練組 (12人)，進行連續五天之介入性措施，共進行14天之觀察，研究資料以描述性統計、成對t檢定、單因子變異數分析及重複測量變異數分析來評值措施之成效。 　　研究結果發現：(1) 疼痛教育組之最重疼痛強度及平均疼痛強度有顯著改善 (2) 疼痛教育組之疼痛干擾整體量表具有顯著改善 (3) 疼痛教育放鬆訓練組之疼痛干擾整體量表具有顯著改善 (4) 疼痛教育組之疼痛及麻醉性止痛藥信念有顯著改善 (5) 疼痛教育加放鬆訓練組之疼痛及麻醉性止痛藥信念有顯著改善 (6) 疼痛教育加放鬆訓練組之憂鬱情緒困擾有顯著改善 (7) 疼痛教育放鬆訓練組之放鬆訓練對於改善疼痛、焦慮及憂鬱之情緒狀態有立即性效果。研究顯示給與正確之疼痛教育可以改善癌症病患疼痛強度、疼痛干擾、憂鬱情緒及疼痛與麻醉性止痛藥信念，而增加放鬆訓練能減緩憂鬱情緒困擾且對於疼痛、焦慮及憂鬱之情緒狀態有立即性效果。

關鍵字

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

並列摘要

Pain is a common manifestation related to cancer and pain induced discomfort over the body, possibly and indirectly reduced life quality and the meaning of survival. Pain is also a multi-modalities experienced, anxiety and depression of emotional disturbance also emphasize the feeling of pain. Therefore, pain can be treated and controlled by different methods. So the purpose of this study is to discuss an experience in comparison with accepting regular care of ordinary ward, giving pain education and pain education with relaxation training to improve cancer pain. The study is a quasi-experimental design, choosing appropriate cancer pain patients from the related oncology wards among five northern teaching hospitals, performing interventional procedures for continues 5days and total 14 days observation. Eligible cancer patients with pain (N=40), were randomly assigned to three groups, including (1) control group which receive 15 minutes care as usual ward routine (n=15), (2) pain education group which receive 15 minutes education (Experimental group I, n=13), and (3) pain education plus relaxation training group which receive 15 minutes education and 12 minutes relaxation training (Experimental group II, n=12). To evaluate the effect of these interventions on pain intensity, pain interferences, beliefs about pain and narcotic analgesics, and mood status were used with the Brief Pain Inventory Short Form (BPI-S), Pain and Opioid Analgesic Beliefs Scale-Cancer (POABS-CA), and Profile of Mood State Short From for anxiety and depression (POMS-anxiety and depression). Studying the above information by descriptive statistics, paired t-test, one-way ANOVA and repeated measures ANOVA. The results showed that (1) the most and average painful intensity had significant improvement in Experimental group I, (2) the total measured scales of painful disturbance had significant improvement in Experimental group I, (3) the total measured scales of painful disturbance had significant improvement in Experimental group II, (4) the negative effect of pain belief had significant improvement in two Experimental group, (5) the depressively emotional disturbance had significant improvement in Experimental group II, (6) relaxation training had immediate effects on improving pain, anxiety and depression. The study expressed giving correct pain education could improve the pain intensity, pain disturbance, depression emotion and negative effect of pain belief of cancer patients, and addition relaxation training could ameliorate depressively emotional disturbance and could have improving immediate effects on pain, anxiety and depression.

並列關鍵字

cancer pain ； pain interference ； emotional disturbance ； pain beliefs ； pain education ； relaxation training

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