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系統識別號 U0007-1704200715034706
論文名稱(中文) 帶狀?疹的疼痛經驗及其對生活品質影響之探討
論文名稱(英文) Pain Experiences and Its Impacts On Quality of Life in Patients With Herpes Zoster.
校院名稱 臺北醫學大學
系所名稱(中) 護理學研究所
系所名稱(英) Graduate Institute of Nursing
學年度 94
學期 2
出版年 95
研究生(中文) 劉錦心
研究生(英文) Ching-Shing Liu
學號 M406091009
學位類別 碩士
語文別 中文
口試日期
論文頁數 93頁
口試委員 指導教授-賴裕和
中文關鍵字 急性帶狀?疹  帶狀?疹後神經痛  生活品質 
英文關鍵字 Herpes Zoster  Postherpetic Neuralgia  Pain quality of life 
學科別分類
中文摘要 摘 要 論文名稱:帶狀?疹的疼痛經驗及其對生活品質影響之探討 研究所名稱:臺北醫學大學護理學研究所 研究生姓名:劉錦心 畢業時間:九十四學年度第二學期 指導教授: 張碧真 臺北醫學大學護理學研究所副教授 賴裕和 臺大醫學院護理學研究所教授 本研究目的在探討及比較急性帶狀?疹及帶狀?疹後神經痛患者的疼痛經驗及其對生活品質的影響。本研究採取橫斷式的研究設計,以立意方式取樣共94人,急性帶狀?疹46人、帶狀?疹後神經痛48人。統計以描述性統計、t- test、皮爾森相關及逐步回歸。研究結果發現:(1)急性帶狀?疹及帶狀?疹後神經痛在疼痛感覺、疼痛型態有差顯著差異;(2)急性帶狀?疹及帶狀?疹後神經痛在生理、心理層面生活品質低於健康人;(3)疼痛情感、最痛程度、疼痛平均程度、疼痛干擾、焦慮、憂鬱與生理層面生活品質有顯著相關;疼痛感覺、疼痛情感、最痛程度、疼痛平均程度、疼痛干擾、焦慮、憂鬱與心理層面生活品質有顯注相關;(4)疼痛干擾愈大、焦慮愈強對生活品質的生理層面的影響愈大,共同解釋變異量為25%,其中疼痛干擾對生理層面生活品質有最大解釋力;憂鬱愈大、疼痛感覺愈強、焦慮愈大、疼痛干擾愈強,對生活品質的心理層面的影響愈大,整體解釋變異量為56%,其中以憂鬱對心理層面生活品質具最大解釋力。此研究結果期能增加健康照護人員對急性帶狀?疹及帶狀?疹後神經痛的疼痛經驗了解,對提昇該群患者之照護預期提 供實質供獻。
英文摘要 Abstract Title of Thesis: Pain Experiences and Its Impacts On Quality of Life in Patients With Herpes Zoster. Institution: Graduate Institute of Nursing, Taipei Medical Universisty Author: Ching-Shing Liu Thesis dircted by: Pi-Chen Chang, Associate Professor Yeur?Hur Lai, Professor The aims of the cross-sectional study were to compare the experiences of pain and the impacts on quality of life (QOL) in patients with Acute Herpes Zoster (AHZ) and Postherpetic Neuralgia (PHN). A total of 94 patients were recruited, including AHZ (n=46) and PHN (n=48). The descriptive ststistics, t-test, Pearson’s correlation, and multiple regression were used to analyze the date. The results showed that (1) AHZ and PHN were significantly different on pain in its sensory dimension characters and pattern; (2) Physical and mental dimension of QOL in patients with AHZ and PHN were all below health people; (3) Affective of pain, worst pain intensity, average pain intensity, pain interference, anxiety, depression were significantly associated with physical dimension of QOL; Sensory dimension of pain, affective of pain, worst pain intensity, average pain intensity, pain interference, anxiety, depression were significantly associated with mental dimension of QOL; (4) Pain interference and anxiety could negative predict the physical dimension of QOL (R2=25%); Depression, affective dimension of pain, anxiety and pain interference could negative predict the lower mental dimension of QOL (R2=56%). The finding suggest the neuralgia pain is still a critical problem to patients with herpes zoster. Health care providers should put more attention on this issue and to enhance their life quality. Key word: Herpes Zoster, Postherpetic Neuralgia, Pain, quality of life
論文目次 目錄 頁數 致 謝…………………………………………………………… Ⅰ 中文摘要…………………………………………………………… Ⅱ 英文摘要…………………………………………………………… Ⅳ 目 錄…………………………………………………………… Ⅵ 圖表目次…………………………………………………………… Ⅸ 第一章 緒論…………………………………………………… 第一節 前言與研究動機…………………………………… 1 第二節 研究目的…………………………………………… 5 第二章 文獻查證 第一節 急性帶狀?疹及帶狀?疹後神經痛之定義……… 6 第二節 急性帶狀?疹及帶狀?疹後神經痛流行病學及 治療………………………………………………… 9 第三節 急性帶狀?疹及帶狀?疹後神經痛之疼痛……… 12 第四節 帶狀?疹與帶狀?疹後神經痛的生活品質影響… 15 第五節 憂鬱、焦慮、壓力生活事件與疼痛的關係……… 20 第六節 研究架構及研究假設……………………………… 23 第三章 研究方法 第一節 研究設計…………………………………………… 26 第二節 收案地點…………………………………………… 26 第三節 研究對象…………………………………………… 27 第四節 研究工具…………………………………………… 28 第五節 研究變項及操作性定義…………………………… 32 第六節 研究步驟…………………………………………… 35 第七節 研究對象及保護權益……………………………… 36 第八節 資料分析…………………………………………… 37 第四章 分析與結果 第一節 研究對象之人口學特性與疾病相關資料………… 38 第二節 研究對象之疼痛經驗……………………………… 42 第三節 研究對象之心理因素……………………………… 50 第四節 研究對象的生活品質……………………………… 54 第五節 生理、心理生活品質層面之預測因素……………… 56 第五章 討論 第一節 急性帶狀?疹及帶狀?疹後神經痛的疼痛經驗… 61 第二節 疼痛對生活品質的影響…………………………… 64 第四節 預測生理、心理生活品質層面的相關因素……… 66 第六章 結論與建議 第一節 結論………………………………………………… 68 第二節 護理上的應用……………………………………… 69 第三節 研究限制與建議…………………………………… 71 參考資料 中文部份……………………………………………………… 72 英文部份……………………………………………………… 73 附錄 附錄一 研究同意書………………………………………… 83 附錄二 基本資料表………………………………………… 84 附錄三 簡明麥基爾疼痛問卷量表………………………… 85 附錄四 簡明疼痛量表………………………………………. 87 附錄五 MOS SF-12生活品質量表………………………… 89 附錄六 醫院焦慮憂鬱量表………………………………….. 91 圖表目次 圖一 概念架構圖……………………………………………… 24 表一 人口學特質……………………………………………… 39 表二 疾病相關資料…………………………………………… 41 表三 簡明麥基爾疼痛量表描述性統計……………………… 44 表四 以t-test比較簡明麥基爾疼痛感覺次量…………… 45 表五 以t-test比較簡明麥基爾疼痛感覺次量表………… 46 表六 以t-test比較疼痛程度之差異……………………… 47 表七 以t-test比較疼痛干擾之差異……………………… 48 表八 以卡方檢定比較疼痛型態之差異……………………… 49 表九 以t-test比較焦慮憂鬱量表之差異………………… 51 表十 以卡方檢定比較焦慮憂鬱程度之差異……………… 52 表十一 以卡方檢定比較不同疼痛型態其憂鬱程度之差異…… 53 表十二 以t-test比較SF-12生活品質量及次量表的差異…… 55 表十三 生活品質之相關………………………………………… 58 表十四 預測生活品質的生理健康層面相關變項之逐步回歸… 59 表十五 預測生活品質的心理健康層面相關變項之逐步回歸… 60
參考文獻 參考資料 中文部份 沈祖杰 (1992)?皮蛇纏身-談帶狀?疹?高醫醫誌,12(4),2259。 周笑華 (1997) ?飛蛇纏腰了,怎麼辦?談帶狀?疹後神經痛?高醫醫誌,17(7),3492-3。 陳佩英、史麗珠、王正旭、賴裕和、張獻崑、陳美伶 (1999)? 疼痛對癌症病患的焦慮與憂鬱之影響?台灣醫學3(4),373-381。 蔡麗雲、顧乃平、張澤芸、賴裕和 (民90) ? 癌症病患的焦慮、憂鬱及其相關因素之探討?新台北護理期刊3(1),23-33。 英文部份 Ackerman, W. E., & Ahmad, M. (1999). Multidisciplinary approach for the management of post- herpetic neuralgia in elderly patients. The Journal of the Arkansas Medical Society, 95(12), 528-531. Anderson, R. J., Freedland, K. E., Clouse , R. E., & Lustman, P. J. (2001). The prevalence of comorbid depression in adults with diabetes: A meta-analysis. Diabetes Care, 24, 1069-1078 Banks, S., & Kerns, R. (1996). Explaining high rates of depression in chronic pain: A diathesis-stress framework. Psychiatric Buletinl, 119, 95-110. Baron, R., & Saguer, M. (1995). Mechanical allodynia in postherpetic neuralgia: evidence for central mechanisms depending on nociceptive C-fiber degeneration. Neurology, 45 (Suppl 8), S63-65. Bennett, G. J. (1994). Hypotheses on the pathogenesis of herpes zoster associated pain. Neurology, 35(suppl), S38-42. Bergbom, E. I., Grondahl, G. B., & Thibom, K. (1995). Patients' experiences of herpes zoster and postherpetic neuralgia. Journal of Advanced Nursing, 21, 427-433. Bergner, M., Bobbitt, R. A., & Kressel, S. (1976). The Sickness Impact Profile: Conceptual formulation and methodology for the development of a health status measure. Internal Journal Health Service, 6, 393-415. Beutner, K. R., Friedman, D. J., Forszpaniak, C., Andersen, P. L., & Wood, M. J. (1995). Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults. Antimicrob Agents Chemother, 39, 1546-1553. Bhala, B. B., Ramamoorthy, C., Bowsher, D., & Yelnoorker, K. N. (1998). Shingles and postherpetic neuralgia. Clinical Journal of Pain, 4, 169-174. Boothby, J. L., Thorn B. E., Stroud, M. W., & Jensen, M. P. (1999). Coping with pain. In: Gatcheal, R. J., & Turk, D. C. (Eds.), Psychosocial factors in pain (pp. 343-59). New York: Guilford Press. Bowsher, D. (1993). Sensory change in posttherpetic neuralgia. In: Watson C. P. N. (Ed.), Herpes Zoster and Postherpetic Neuralgia (pp. 97-107). Elsevier: Amsterdam. Bowsher, D. (1997). The effects of preemptive treatment of postherpetic neuralgia with amitriptyline: a randomized, double-blind, placebo-controlled trial. Journal of Pain and Systematic Manage, 87, 121-129. Burckhard, C. S. (1985). The impact of arthritis on quality of life. Nursing Research, 34(1), 11-16. Cohen, S., & Williamson, G. M. (1991). Stress and infectious disease in humans. Psychiatric Buletinl,109, 5-24. Coplan, P., Schmader, K., & Nikas, A. (2001). Evaluation of a modified brief pain inventory to measure pain association with herpes zoster. Pharmacoepidemiology Drug Safety, 10, S149. Gilden, D. H., Dueland, A. N., Cohrs, R., Martin, J. R., Kleinschmidt-DeMaster, B. K., & Mahalingam, R. (1991). Preherpetic neuralgia. Neurology, 41, 121-1218. D'Agostino, R. B., Lerner, D. J., Levin, S., & Malspeis, S. (1994). Job strain health-related quality of life in a national sample. American Journal of Public Health, 84(10), 1580-1585. Dale, F. (1933). Postoperative pain in the elective surgical patient. British Journal of Nursing , 12(17), 842-849. Davies, L., Cossins, L., Bowsher, D., & Drummond, M. (1994). The cost of treatment for post-herpetic neuralgia in UK. PharmacoEconomics, 6, 142-148. Doerr, H. W., & Rabenau, H. (1996). Dermatrotrope Herpesviren. Infektionsbiologie, Epidemiologie und Diagnostik. Chemotherapie Journal, 1,1-8. Donahue, J. E., Choo, P. W., & Manson, J. E. (1995). The incidence of herpes zoster. Archives Internal Medicine,55, 1605-0. Dworkin, R. H., Hartstein, G., Rosner, H. L., Walther, R. R., Sweeney, E. W., & Brand, L. (1992). A high-risk method for studying psychosocial antecedents of chronic pain: the prospective investigation of herpes zoster. Journal of Abnormal Psychology, 101(1), 200-5. Dworkin, R. H., & Portenoy R. K. (1996). Review article Pain and its persistence in herpes zoster. Pain, 67, 241-251. Faucett, J. A . (1994). Depression in painful chronic disorders: the role of pain and conflict about pain. Journal of Pain and Symptom Management , 9, 520-6. Fekiman, S. I., Downey, G., & Schaffer-Neitz, R. (1999). Pain, negative mood, and perceived support in chronic pain: a daily diary study of people with reflex sympathetic dystrophy syndrome. Journal Consult Clinic Psycho, 76, 776-785. Ferrans, C. E., & Powers, M. J. (1985). Quality of life index: Development and psychometric proprieties. Advances in Nursing Science, 8(1), 15-24. Fishbain, D. A., Cutler, R., Rosomoff, H. L., & Rosomoff , R. S. (1997). Chronic pain-associated depression: Antecedent or consequence of chronic pain? A review. Clinic Journal of Pain, 13, 116-137. Frank-Stromboprg, M. (1984). Selecting on instrument to measure quality of life. Oncology Nursing Forum, 11, 88-91. Fukuda, H., Kasuda, H., Nakaigawa, Y., Nemoto, K., & Shimizu, R. (1994). Psychological evaluation of patients by state-trait anxiety inventory in pain clinic. Masui, 43(10), 1506-8. Gershon, A. A. (1996). Epidemiology and management of postherpetic neuralgia. Seminars in Dermatology, 15(2), 8-13. Gross, G., Schofer, H., & Wassilew, K. (2003). Herpes zoster guideline of German Dermatology Society. Journal of Clinical Virology, 26, 277-289. Harding, S. P., Lipton, J. R., & Wells, J. C. D. (1987). Natural history of herpes zoster ophthalmicus; predictor of postherpetic neuralgia and ocular involvement. British Journal of Opthalmology, 71, 353-358. Heim, H. M., & Oei, T. P. S. (1993). Comparison of prostate cancer patient with and without pain. Pain, 53, 159-62. Hill, A., Niven, C. A., & Knussen, C. (1995). The role of coping in adjustment to phantom limb pain. Pain, 62, 79-86. Hollinworth, H. (1994). No Pain? Nursing Time, 90(1), 24-27. Hope-Simpson, R. E. (1965). The nature of herpes zoster: a long term study and new hypothesis. Journal of the Royal Society of Medicine,58, 9-20. Hope-Simpson, R. E. (1975). Postherpatic neuralgia. Journal of the Royal College of General Practitioners, 25, 571-5. Haythornthwaite, J. A., Clark, M. R., Pappagallo, M., & Raja, S. N. (2003). Pain coping strategies play a role in the persistence of pain in post-herpetic neuralgia. Pain, 106, 435-460. Hunt, S. M., McEwen, J., & McKennay, S. P. (1985). Measuring health stats: a new tool for clinicians and epidemiologists. Journal of the Royal College of General Practitioners,35, 185-88. Jensen, M. P., Ehde, D. M., Hoffman, A. J., Patterson, D. R., Czerniecki, J. M. , & Robinson, L. R. (2002). Cognition, coping and social environment predict adjustment to phantom limb pain. Pain, 95, 133-42. Jensen, M. P., Turner, J. A., Romano, J. M., Karoly, P. (1991). Coping with chronic pain: a critical review of the literature. Pain, 47, 249-83. Johnson, R. W., & Whitton, T. L. (2004). Management of herpes zoster and postherpetic neuralgia. Expert Opinion Pharmacotherapy, 5(3), 551-558. Keefe, F. J., Crisson, J. E., Urban, B. J., & Williams, D. A. (1990). Analyzing chronic low back pain: The relative contribution of pain coping strategies. Pain , 40, 293-301. Kennrth, S., Stephanie. S., Julia , M., Seymour, G., & Harvey, J. C. (1990). Are stressful life events risk factors for herpes zoster? American Geriatric Society , 38(11), 1188-1194. Kleinpell, R. M. (1991). Concept analysis of quality of life. Dimensions of Critical Care Nursing, 10(4), 223-229. Lai, Y. H. (1996). The use of cognitive-behavioral pain coping in Taiwanese cancer patients. Doctoral Dissertantion, Unpublished manuscript. Unpublished manuscript. University of North Carolina at Chapel Hill. L'azaro, M. D., Caseras, X., Banos, M. D., & Catalonia Group. (2003). Postherpetic neuralgia: a descriptive analysis of patients seen in pain clinics. Regional Anesthesia and Pain Medicine, 28(4), 315-320. Lydic, E., Epstein, R. S., Himmelberger, D., & White, C. J. (1995). Herpes zoster and quality of life: a self-limited disease with sever impact. Neurology, 45(Suppl. 8), S52-S53. Magni, G., Marchetti, M., Roreschi, C., Merskey, H., & Rigatti-Luchini, S., (1993). Chronic musculoskeletal pain and depressive symtopms in the National Health and Nutrition Examination I: Epidemiologic follow-up study. Pain, 53, 163-168. Max, M. B., Schafer, S. C., Culnane, M., Smoller, B., Dubner, R., & Gracely, R. H. (1988). Amitriptyline, but not lorazepam, relieves postherpetic neuralgia. Neurology, 38, 1427-1432. Mauskopf, J., Austin, R., Dix, L., & Berzon, B. (1994). The Nottingham Health Profile as a measure of quality of life in zoster patients: convergent and discriminant validity. Quality Life Reserche, 3, 431-435. McCrae, R. R. (1984). Situational determinants of coping responses: loss, threat, and challenge. Journal of Personality and Social Psychology, 46, 919-928. McDowell, I., & Newell, C. (1996). Measuring Health: A guide to rating scales and questionnaires. USA: Oxford. Meeberg, G. A. (1993). Quality of life: A concept analysis. Journal of Advanced Nursing, 18(1), 32-38. Meier, J. L., & Strauss, S. E. (1992). Comparative biology of latent varicella zoster virus and herpes simplex virus infection. Journal of Infection Disease,166(Suppl), S13-23. Meister, W., Neiss, A., & Gross, G. (1998a). Dermography, symptomatology and course of disease in ambulatory patient. Intervirology, 41, 272-7. Meister, W., Neiss, A., & Gross, G. (1998b). A prognostic score for postherpetic neuralgia in ambulatory patients. Infection, 26(6), 359-63. O'Leary, A. (1990). Stress, Emotion, and Human Immune Function. Psychological Bulletin, 108(3), 363-382. Pilowsky, I. (1977). Psychological aspects of post-herpetic neuralgia: some clinical observations. British Journal of Medical Psychology , 50, 283-288. Ragozzino, M. W., Melton, L. J., Kurland, L. T., Chu, C. P., & Perry, H. O. (1982). Population-based study of herpes zoster and its sequelae. Medicine, 61, 310-316. Rose, M. J., Klenerman, L., Atchison, L., & Slade, P. D. (1992). An application of the fear avoidance model to three chronic pain conditions. Behaviour Research and Therapy, 30, 359-365. Rowbotham, M. C., & Fields, H. L. (1989). Postherpetic neuralgia: the relation of pain complain, sensory disturbance, and skin temperature. Pain ,39, 129-144. Rowbotham, M., Harden, N., & Stacey, B. (1998 ). Gabapentin for the treatment of post-herpetic neuralgia: a randomized controlled trial. Journal of the American Medical Association, 280, 1837-42. Schmader, K., George, L. K., Burchett, B. M., Pieper, C. F., & Hamilton, J. D. (1995). Racial differences in the occurrence of herpes zoster. The Journal of Infectious Diseases, 171, 701-704. Schmader, K. (1998). Postherpetic neuralgia in immunocompetent elderly people. Elsevier Science, 16(18), 1768-70. Smith, T. W., Christensen, A. J., & Peck, J. R. (1994a). Cognitive distortion, helplessness, and depressed mood in rheumatoid arthritis: A four year longitudinal analysis. Health Psychoogylp, 13, 213-217. Spitzer, W. O., Dobson, A. J., & Hall, J. (1981). Measuring the quality of life of cancer patient: A concise QL-Intex for use by physicians. Journal Chronic Disease, 34, 585-597. Sternbach, R. S. (1976). Psychological factors in pain. In Bonica, J. J., AlbeFessard, D. (Ed.), Advaces in Pain Research and Therapy (pp. 293-299). New York: Raven Press. Sullivan, M. J., Thorn, B., Haythornthwaite, J. A., Keefe, F., Martin, M., & Bradley, L. A. (2001). Theoretical perspectives on the relation between catastrophizing and pain. Clinic Journal of Pain, 17, 52-54. Turner, J. A., Jensen, M. P., Warms, C. A., & Cardenas, D. D. (2002). Catastrophizing is associated with pain intensity, psychological distress, and pain-related disability among individual with chronic pain after spinal cord injury. Pain, 98, 127-34. Watsons, C. P. N., Chipman, M., Reed, K., Evans, R. J., & Birkett, N. (1992). Amitriptyline versus maprotiline in postherpetic neuralgia: a randomized, double-blind, crossover trial. Pain, 48, 29-36. Ware, J. E., Kosinski, M., & Keller, S. D. (1996). A 12-item short form health survey construction of scales and preliminary test of reliability and validity. Medical Care, 34(3), 220-223. Ware, J. E., & Sherbourne, C. D. (1992). The Mos 36-item short-form health survey (SF-36): Conceptual framework and item selection. Medical Care, 30(6), 473-438. Wassilew, S. W., Wutzler, P., & Brivudin herpes zoster study group. (2003). Oral brivudin in comparison with acyclovir for herpes zoster: a survey study on postherpetic neuralgia. Antiviral, 59(1), 57-60. Wood, M. J., Johnson, R. W., Mckendrick, M. W., Tayor., J., Mandal, B. K., & Crooks, J. A. (1994). Randomized trial of acyclovir for 7 days or 21 days with and without prednisolone for treatment of acute herpes zoster. New England Journal Medicine, 330, 896-900. Weisse, C. S. (1992). Depression and Immunocompetence: A Review of the Literature. Psychological Bulletin, 111(3), 475-489. World Health Organization. (1993). Study protocol for the WHO project to develop a quality of life assessment instrument(WHOQOL). Quality of Life Research, 2(2), 153-159. World Health Organization Quality of Life Group. (1995). The World Health Organization Quality of Life assessment (WHOQOL): Position paper from the World Health Organization. Social Science Medicine, 41(10), 1403-1409. World Health Organization Quality of Life Group. (1998). The World Health Organization Quality of Life assessment (WHOQOL): Development and general psychometric properties. Social Science Medicine, 46(12), 1569-1585. Winnie, A., Hartwell, P. W. (1993). Relationship between time of treatment of acute herpes zoster with sympathetic blockade and prevention of post-herpetic neuralgia: Clinical support for a new theory of the mechanism by which sympathetic blockade provides therapeutic benefit. Regional Anesthesia, 18, 277-282. Wood, M. J. (1995). How should we measure pain in herpes zoster? Neurology, 45(Suppl 8), S61-S62. Zhan, L. (1992). Quality of life: Conceptual and measurement issues. Journal of Advanced Nursing, 17(7), 795-800.
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