深部热疗联合中药穴位外敷治疗对癌性疼痛影响的临床研究-现代医学

深部热疗联合中药穴位外敷治疗对癌性疼痛影响的临床研究

作者：王鹰

单位：常熟市第一人民医院肿瘤科, 江苏常熟 215500

分类号：R730;R454

出版年·卷·期（页码）：2026·54·第七期（1155-1164）

摘要：

目的：评估深部热疗联合中药穴位外敷对癌症患者疼痛强度与生活质量的影响。方法：纳入2022年1月至2026年3月经本院病理学确诊的168例晚期恶性肿瘤患者，按基线疼痛强度及疼痛类型分层后随机分为2组：对照组(84例)予以规范化三阶梯止痛治疗，试验组(84例)在规范化三阶梯止痛治疗的基础上联合热疗配合中药穴位外敷进行治疗，疗程4周。主要疗效终点为第4周数字评分量表(NRS)评分较基线的变化值；关键次要终点包括疼痛缓解达标率(NRS下降≥50%)、吗啡等效日剂量(MEDD)变化、卡氏功能状态(KPS)评分及欧洲癌症研究与治疗组织生命质量测定量表(EORTC QLQ-C30)评分变化。安全性采用CTCAE 5.0分级评估。结果：试验组第4周NRS评分较基线下降(-3.77±1.95)分，对照组下降(-2.37±1.44)分，组间校正后均值差为-1.35分(95%CI：-1.78~-0.92，P<0.001)。试验组疼痛缓解达标率(71.4% vs. 34.5%，P<0.001)及MEDD减量成功率(91.7% vs. 0，P<0.001)均显著优于对照组。试验组整体健康状况评分较基线提升16.51分，对照组下降2.42分(P<0.001)，躯体、角色、情绪功能及多种症状维度改善均达大效应量(|d|≥0.80)。试验组皮肤不良反应发生率高于对照组(17.9% vs. 4.8%，P=0.012)，但均为1~2级，经对症处理可缓解；恶心呕吐、便秘、嗜睡及食欲丧失等阿片相关不良反应发生率显著低于对照组(均P<0.05)。结论：深部热疗联合中药穴位外敷可在短期内提高疼痛缓解率，降低阿片类药物用量，改善生活质量，呈现“减量增效”效应，并且安全性良好，具备进一步研究价值。

Objective: To evaluate the effects of deep hyperthermia combined with topical acupoint application of Chinese medicine on pain intensity and quality of life in patients with cancer pain. Methods: A total of 168 patients with advanced malignant tumors, pathologically confirmed at our hospital between January 2022 and March 2026, were enrolled and stratified by baseline pain intensity and pain type, then randomly assigned to two groups: the control group(n=84) received standardized three-step analgesic therapy, while the experimental group(n =84) received deep hyperthermia combined with topical acupoint application of Chinese medicine in addition to standardized three-step analgesic therapy, for a treatment course of 4 weeks. The primary efficacy endpoint was the change from baseline in the Numerical Rating Scale(NRS) score at the 4th week. Key secondary endpoints included the pain relief response rate(≥50% reduction in NRS), changes in morphine-equivalent daily dose(MEDD), changes in Karnofsky Performance Status(KPS) score and changes in the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30(EORTC QLQ-C30) scores. Safety was assessed using the CTCAE version 5.0 grading system. Results: At the fourth week, the NRS score decreased by(-3.77±1.95) points from baseline in the experimental group and by(-2.37±1.44) points in the control group, with an adjusted between-group mean difference of -1.35 points(95%CI:-1.78--0.92, P＜0.001). The experimental group demonstrated significantly superior outcomes compared with the control group in terms of pain relief response rate(71.4% vs. 34.5%, P＜0.001) and successful MEDD reduction rate(91.7% vs. 0, P＜0.001). The experimental group showed a 16.51-point improvement from baseline in global health status score, whereas the control group showed a 2.42-point decline(P＜0.001), with improvements in physical, role and emotional functioning as well as multiple symptom domains all reaching large effect sizes(|d| ≥0.80). The incidence of skin adverse reactions was higher in the experimental group than that in the control group(17.9% vs. 4.8%, P=0.012), but all were grade 1-2 and resolved with symptomatic management. The incidences of opioid-related adverse reactions, including nausea/vomiting, constipation, somnolence and appetite loss, were significantly lower in the experimental group than those in the control group(all P＜0.05). Conclusion: Deep hyperthermia combined with topical acupoint application of Chinese herbal medicine can achieve short-term improvements in pain relief, reduce opioid consumption, and enhance quality of life, demonstrating a “dose-sparing and efficacy-enhancing” effect with a favorable safety profile, warranting further investigation.

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