Background: Pain catastrophizing is a group of negative irrational cognitions in the context of anticipated or actual pain. The aim of this study was to decipher the possible role of catastrophism on pain expression and outcomes after a comprehensive palliative care treatment. Methods: A consecutive sample of patients with uncontrolled pain was assessed. Demographic characteristics, symptom intensity included in the Edmonton symptom assessment system (ESAS), and opioid drugs used were recorded at admission (T0). The Pain Catastrophizing Scale (PCS) was measured for patients. Patients were also asked about their personalized symptom goal (PSG) for each symptom of ESAS. One week after a comprehensive palliative care treatment (T7), ESAS and opioid doses used were recorded again, and the number of patients who achieved their PSG (PSGR) were calculated. At the same interval (T7), Minimal Clinically Important Difference (MCID) was calculated using patient global impression (PGI). Results: Ninety-five patients were eligible. A significant decrease in symptom intensity was reported for all ESAS items. PGI was positive for all symptoms, with higher values for pain, poor well-being, and poor sleep. Only the rumination subscale of catastrophism was significantly associated with pain at T0 (B = 0.540;p= 0.034). Conclusions: Catastrophism was not associated with the levels of pain intensity, PSG, PSGR, and PGI for pain, except the rumination subscale that was associated with pain intensity at T0. A comprehensive palliative care management provided the relevant changes in symptom burden, undoing the pain expression associated with rumination.
背景：疼痛灾难化是指在预期或实际疼痛情境下产生的一系列消极非理性认知。本研究旨在探讨综合性姑息治疗后，灾难化思维对疼痛表达及治疗结果可能产生的影响。方法：连续纳入疼痛控制不佳的患者样本，在入院时（T0）记录人口学特征、埃德蒙顿症状评估系统（ESAS）涵盖的症状强度及阿片类药物使用情况。采用疼痛灾难化量表（PCS）进行评估，同时记录患者对ESAS各症状设定的个体化症状目标（PSG）。综合性姑息治疗一周后（T7）再次记录ESAS评分及阿片类药物剂量，计算达到个体化症状目标的患者比例（PSGR）。同期（T7）采用患者整体印象变化量表（PGI）计算最小临床重要差异（MCID）。结果：共纳入95例合格患者。所有ESAS项目症状强度均显著下降，PGI显示各症状均有改善，其中疼痛、健康状况不佳及睡眠障碍改善程度更为显著。仅灾难化思维中的反复思虑维度与T0时疼痛强度显著相关（B=0.540；p=0.034）。结论：除反复思虑维度与T0时疼痛强度相关外，灾难化思维与疼痛强度水平、PSG、PSGR及疼痛PGI均无显著关联。综合性姑息治疗能有效改善症状负担，消除与反复思虑相关的疼痛表达。
肿瘤(癌症)患者之家