| Objective: To construct Auricular Point Acupressure(APA)methods for the treatment of mild cancer pain and compare the treatment efficacy and safety of level three ladder analgesic,APA and APA combined with level three ladder analgesic of mild cancer pain,in order to provide references for clinical treatment of mild cancer pain.Methods:(1)The study was guided by the symptom management theory.The literature research,group discussion method and Delphi method were used to construct the "APA methods for mild cancer pain treatment " from the aspects of symptom management strategy and management outcome.(2)105 cases eligible for the study were randomly divided into level three ladder analgesic group,APA group and APA combined with level three ladder analgesic group;medical treatment,APA intervention and medical treatment combined with APA intervention were given separately for treatment.The use of the Brief Pain Inventory(BPI),the Medication Quantification Scale Version III(MQS III),Cancer Pain and Quality of Life Questionnaire for Chinese Cancer Patients(CPQLQ),Pain Self-Efficacy Questionnaire(PSEQ),the Analgesic and Treatment Satisfaction Questionnaire and the semi-structured interviews to evaluate treatment outcomes.Results:(1)The APA methods for mild cancer pain treatment included the following 7 items:(1)Where: implementation site of APA intervention;(2)Who: the operator;(3)What: APA techniques;(4)to Whom: person who receives APA;(5)When: duration of APA intervention;(6)How much: frequency of pressure application and replacement;(7)Outcome measures.The expert authority score of two rounds was 0.863 and 0.913,and the coordination coefficient(W)was >0.35(all P<0.05),indicating the expert authority and coordination were well.(2)Comparison of the efficacy and safety of level three ladder analgesic,APA and APA combined with level three ladder analgesic in the treatment of mild cancer pain:(1)Average pain intensity: The average pain intensity of the 3 groups of D10 was lower than D1(all P<0.001).The average pain intensity of the 3 groups from D1 to D10 decreased gradually and the APA combined with analgesic group showed the most obvious decline.Compared with APA group,the average pain intensity of analgesic group from D1 to D2 decreased faster and the two groups decreased similar from D3 to D10.The results showed that the APA intervention could effectively relief mild cancer pain and APA combined with analgesics are more effective.(2)Intensity and frequency of breakthrough pain: The intensity and frequency of breakthrough pain of the three groups in D10 were declined than D1,but only the difference in APA combined with analgesic group was statistically significant.The frequency of breakthrough pain in analgesic group showed statistical difference.It indicated that APA combined with analgesic intervention could effectively relief the intensity of breakthrough pain and reduce the occurrences of breakthrough pain.(3)Degree of pain interference: The impact of pain on daily work and life(including general activities,emotions,work,relationships with others,mood,sleep and enjoyment of life)of 3 groups were declined after intervention(all P<0.001).Comparison between groups showed that the impact of pain on emotions,relationships with others and sleep of the three groups had statistical difference(all P<0.05).but there was no statistical significance between the two groups.(4)Pain self-efficacy: The pain self-efficacy of APA combined with analgesic group and APA group was higher than that before intervention(all P<0.001).Comparison between groups showed that the pain self-efficacy of APA combined with analgesic group and APA group was higher than that of analgesic group(both P<0.001).(5)Drug dosage: The MQS scores of analgesic group and APA combined with analgesic group on D10 were lower than D1(all P<0.001).The 10-day total MQS scores of APA combined with analgesic group and the 10-day total MQS scores after subtracting the dose of outbreak pain was lower than that of analgesic group.It indicated that the analgesics consumption of APA combined with analgesic group were less than that in analgesic group within 10 days treatment.(6)Analgesic satisfaction,treatment satisfaction and quality of life: The analgesic satisfaction,treatment satisfaction and quality of life of 3 groups were statistically significant after intervention(all P<0.05).The analgesic satisfaction of APA group and APA combined with analgesic group was higher than that of analgesic group(both P<0.05).The treatment satisfaction and quality of life of APA combined with analgesic group were higher than analgesic group(both P<0.001).(7)Adverse reactions: The incidence of nausea,vomiting and constipation in the three groups of D10 was less than D1(both P<0.05).There were fewer cases of nausea and vomiting,constipation,dizziness and drowsiness,simultaneous dizziness,drowsiness and constipation in APA group and APA combined with analgesic group than that in analgesic group,but the difference was not statistically significant.(3)Patients experience: With the deepening of treatment,the experience of patients applying APA was gradually improved,which can be summarized as 3 stages:(1)pre-application of APA(sustained suspicion,lack of compliance);(2)during APA treatment(increased self-efficacy,pain relief);(3)late period of APA treatment(active learning,want to continue to use).Conclusions: The established APA methods for mild cancer pain treatment which based on the symptom management theory,including symptom management strategy and management outcome were scientific,reasonable and high operability.It can be used as a useful supplement to the level three ladder analgesic.Used APA intervention alone can effectively relief average pain intensity of patients,improve pain self-efficacy and satisfaction,and improve the patient's experience of pain treatment.Meanwhile,APA combined with level three ladder analgesic could enhance analgesic effect,decrease the adverse reactions,relieve the intensity of the breakthrough pain and reduce the number of occurrences. |
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