간질성방광염/방광통증증후군 환자의 통증수용, 통증의 파국화가 삶의 질에 미치는 영향

Abstract

본 연구는 예측할 수 없이 찾아오는 방광 관련 통증과 이로 인한 배뇨증상으로 일상생활 및 심리사회적 문제를 겪고 있는 간질성방광염/방광통증증후군(Interstitial cystitis/ Bladder Pain Syndrome, IC/BPS) 환자를 대상으로 하였다. IC/BPS 환자의 만성통증에 대한 정서적 반응 즉 수용과 파국화에 따라 삶의 질에 미치는 영향을 확인하여 이를 향상시키는 간호중재를 개발하는데 기초자료를 마련하고자 시행한 서술적 조사연구이다. 자료 수집은 2019년 6월 14일부터 10월 2일까지로 서울 소재 일개 대학병원 비뇨의학과 외래에 내원한 IC/BPS 환자 중 연구 참여에 동의한 105명을 대상으로 시행하였다. 연구도구로는 한국판 만성통증수용 설문지(Korean version of the Chronic Pain Acceptance; KCPAQ), 한국판 통증 파국화 척도(Korean version of Pain Catastrophizing Scale; K-PCS), 삶의 질 측정을 위한 SF-12 Health Survey를 사용하여 구성한 자가 보고식 설문지를 사용하였다. 설문지를 통해 수집된 자료는 SPSS 22.0 통계프로그램으로 서술통계, t-test, ANOVA, Pearson’s correlation coefficient, Hierarchical Multiple Regression Analysis을 이용하여 분석하였다. 본 연구의 결과는 다음과 같다. 1. 연구 대상자의 일반적 특성으로 평균 연령은 56.61±12.90세였으며, 대부분이 여성으로 96.2%를 차지하였다. 대상자 중 62명(59%)이 중년기에 해당되어 가장 많았으며, 노년기 30명(28.6%), 성인기 13명(12.4%) 순으로 나타났다. 2. 대상자의 통증강도는 시각상사척도(Visual Analogue Scale, VAS)로 측정하였을 때 4.19±2.47점이었으며, 증상기간은 4.95±3.96년으로 최소 6개월에서 최대 20년으로 나타났다. 전자의무기록을 통해 측정한 일일 총 배뇨 횟수는 대상자 105명 중 총 43명에서 측정 가능하였으며, 평균 11.05±5.26회로 최소 5회에서 최대 25회의 범위까지 측정되었다. 통증부위는 하복부가 67.6%로 가장 많았으며, 요도(40.0%)와 질(31.4%)도 많은 대상자가 통증을 느끼는 부위로 보고하였다. 방광 통증과 빈뇨, 절박뇨 등의 증상이 더 악화되어지는 요인으로 몸이 피곤할 때가 69.2%로 가장 많았으며, 스트레스(56.7%)와 카페인 섭취(26.0%)도 주요 요인으로 확인되었다. 3. 통증수용은 0~120점 범위로 46.6±16.53점, 통증의 파국화는 0~52점 범위로 27.64±11.71점, 삶의 질은 0~100점 범위로 54.84±21.77점으로 측정되었다. 4. 대상자의 통증수용 정도는 연령(F=4.045, p=.020)에 따라 통계적으로 유의한 차이가 있었으나 사후검정에서는 유의한 차이를 보이지 않았다. 5. 대상자의 통증의 파국화 정도는 교육정도(F=4.207, p=.018), 통증부위의 개수(t=-3.157, p=.002)에 따라 통계적으로 유의한 차이가 있었으나 사후검정에서는 유의한 차이를 보이지 않았다. 6. 대상자의 삶의 질 총점과 통계적으로 유의한 차이를 보이는 변수가 없었다. 7. 통증강도는 통증의 파국화(r=.234, p=.016)와 양의 상관관계, 삶의 질(r=-.252, p=.009)과는 음의 상관관계를 나타냈고, 동반질환의 개수는 신체적 건강관련 삶의 질(r=-.231, p=.018)과 음의 상관관계를 보였다. 8. 통증수용과 통증의 파국화(r=-.366, p<.001)는 음의 상관관계를, 삶의 질과는 (r=.502, p<.001)는 양의 상관관계를 나타내었고, 통증의 파국화와 삶의 질(r=-.516, p<.001)과는 음의 상관관계를 보여, 통증수용 정도가 높을수록 그리고 통증의 파국화 정도가 낮을수록 삶의 질이 높아지는 것으로 나타났다. 9. 대상자의 삶의 질에 영향을 미치는 요인은 통증수용(β=.364, p<.001), 통증의 파국화(β=-.343, p<.001), 동반질환의 개수(β=-.234, p=.002), 통증강도(β=-.161, p=.038)순으로 나타났으며, 이들 변수의 설명력은 43.2%였다(F=37.438, p<.001). 이상의 연구 결과로 IC/BPS 환자의 통증수용과 통증의 파국화, 동반질환의 개수와 통증강도가 삶의 질에 영향을 미치고 있음을 확인하였다. 대상자의 삶의 질 향상을 위해 만성통증에 대한 비합리적이고 파국적인 생각을 지양하고 통증에도 불구하고 가치 있는 일상을 살아 갈수 있도록 긍정적 대처 능력을 증진 시킬 필요가 있다. 또한 식이요법이나 통증일기 작성 등 통증을 효율적으로 관리할 수 있는 자가간호역량을 높여 통증강도를 감소시킬 수 있는 방법을 모색하고, 만성질환에 대한 교육 및 예방관리로 동반질환의 증가를 최소화하여 삶의 질 향상을 도모할 필요가 있다. ;The study is a descriptive research to investigate the factors of which pain acceptance and catastrophizing of IC/BPS patients affect quality of life (QoL). The subjects of the study were 105 outpatients with IC/BPS who have visited the department of urology of a university hospital located in Seoul, and the data was collected through as a self-report questionnaire in which Korean version of the Chronic Pain Acceptance (KCPAQ), Korean version of Pain Catastrophizing Scale (K-PCS) and the 12-Item Short Form Health Survey (SF-12) were used as the study tool. Descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient and Hierarchical Multiple Regression Analysis were conducted for the collected data using SPSS 22.0 statistics program. The results of this study are as follows. 1. The average age of the subjects was 56.61 ± 12.90 years old, and 96.2 % of them were females. The middle age group was the most (62 patients, 59 %), followed by old age group (30 patients, 28.6 %) and adulthood group (13 patients, 12.4 %). For the marital status, the married group was the most (82 patients, 78.1 %), and for the job status, the employed group was 41 patients (39.0 %), fewer than the non-employed group. 63 patients had fee-for-service health insurance (60.0 %), more than those who did not. For the education level, 39 patients (37.1 %) were college graduates or higher, followed by 36 patients (34.3 %) for those who were middle school graduates or lower and 30 patients (28.6 %) for high school graduates. 2. The pain intensity of subjects was 4.19 ± 2.47 points, which is measured as VAS score, and the symptom duration was 4.95 ± 3.96 years, ranged from 6-month to 20-year. The majority of the subjects, 59 patients (56%), had comorbidities, and in 43 of 105 patients, the 24 hours mean number of voids was 11.05 ± 5.26, indicating that they voided once every two hours. For the pain area, 67.6 % of subjects answered they had pain in the lower abdomen. In addition, 69.2 % of subjects answered that fatigue was the main cause of worsening symptoms such as bladder pain, urinary frequency and urinary urgency. 3. The pain acceptance was 46.6 ± 16.53 (range from 0 to 120), pain catastrophizing was 27.64 ± 11.71 (range from 0 to 52), and QoL was 54.84 ± 21.77 (range from 0 to 100). 4. There was a statistically significant difference in the degree of pain acceptance by age (F = 4.045, p = .020). The higher the age, the greater pain acceptance, but in the Scheffe's test, there was no significant difference. There was a statistically significant difference in pain willingness subscale depending on whether the pain area(t = 2.078, p = .040) and symptom worsening factors (t = 2.420, p = .017) were one or more than two. 5. There was a statistically significant difference in the degree of pain catastrophizing by education level (F = 4.207, p = .018) and the number of pain area (t = -3.157, p = .002). The degree of catastrophizing was found to be higher in case of lower education level and case of more than one pain area. There was a statistically significant difference in the degree of hopelessness subscale by the fee-for-service health insurance (t = -2.404, p = .018), education level (F = 8.205, p < .001) and the number of pain area (t = -2.468, p = .015). 6. This had no statistically significant variable compared to the total score for QoL of the subjects. However, there was a statistically significant difference in the Physical Composite Scale (PCS) by the fee-for-service health insurance (t = 2.391, p = .019), the comorbidities (t = -1.985, p = .050) and the number of pain area (t = 2.336, p = .021), and there was a statistically significant difference in the Mental Composite Scale (MCS) by marital status (F = -4.196, p = .018) and the number of pain area (t = 2.177, p = .032). 7. The pain intensity was positively with pain catastrophizing (r = .234, p = .016) and negatively correlated with QoL (r = -.252, p = .009). However, it showed no statistically significant correlation with pain acceptance. The symptom duration showed a weak positive correlation with hopelessness (r = .197, p = .044), which was a subscale of pain catastrophizing. In addition, the number of comorbidities was negatively correlated with PCS (r = -.231, p = .018). Thus, it was found that the greater the number of comorbidities, the lower the PCS. 8. Pain acceptance was negatively correlated with pain catastrophizing (r = -.366, p < .001) and positively correlated with QoL (r = .502, p < .001). However, pain catastrophizing was negatively correlated with QoL (r = -.516, p < .001). Thus, it was found that the greater the pain acceptance and the lower the pain catastrophizing, the higher the quality of life. 9. There were four factors that affected the QoL of subjects; pain intensity (β = -.161, p = .038), the number of comorbidities (β = -.234, p = .002), pain acceptance (β = .364, p < .001) and pain catastrophizing (β = -.343, p < .001), and these variables predicted 43.2 % of QoL (F = 37.438, p < .001). In addition, it was found that pain acceptance was the most significant factor. It was found that the greater the pain acceptance, the lower the pain catastrophizing and the pain intensity; and the fewer the number of comorbidities, the higher the quality of life. From the above results of this study, it was confirmed that pain acceptance and pain catastrophizing of patients with IC/BPS affected their quality of life. The results showed that pain acceptance explained quality of life the most, thus intervention strategies are needed to enhance it. And a specific and practical approach should be explored to therapeutically help patients have psychological flexibility about pain. In addition, pain intensity has been shown to affect quality of life, thus it is required to enhance self-care strategy that manage pain with the correct pharmacological intervention and palliative therapy, and to help patients to commit one’s efforts toward living a satisfying life despite pain.