疼痛為癌症病患最常面臨的症狀，是多層面的複雜經驗，因此疼痛處理需要多方的處置方式，故本研究目的擬探討及比較癌痛衛教、癌痛衛教加伸展運動訓練與病房照顧對癌症病患疼痛改善的效果。
本研究從94年2月至94年6月，共4個月，於北部2所醫學中心之腫瘤相關病房選取研究對象，研究設計採類實驗法，以隨機分派將符案病患分為（1）衛教組，每天接受10-15分鐘的癌痛衛教方案並連續五天（實驗組Ⅰ，12人），（2）衛教+伸展組，每天接受15分鐘的癌痛衛教及執行15分鐘伸展運動連續5天（實驗組Ⅱ，12人），（3）控制組為接受一般病房常規照顧(12人)，共36人，所有的個案在研究期間（共28天）接受4次評量，分別為前測（T0）、第6天（第一次後測，T1）、第14天（第二次後測，T2）、第28天（第三次後測，T3）。
分別以簡明疼痛量表－臺灣版（Brief Pain Inventory Short Form Taiwanese [BPI - T)]）評估疼痛強度及疼痛干擾，疼痛及麻醉性止痛藥信念（Pain and Opioid Analgesic Beliefs Scale - Cancer [POABS - CA]）評估研究對象之疼痛及麻醉性止痛藥信念、情緒量表簡明版（Profile of Mood State short Form [POMS-SF]）及以10分數字量表（Numeric rating scale [NRS]）評估疲憊、焦慮與憂鬱情緒困擾。研究結果以描述性統計、單因子變異數分析、重複測試變異數分析等統計方法執行資料分析。
本研究結果發現，經過一個月的追蹤：（1）經過介入方案後，測量衛教+伸展組之過去24小時的疼痛干擾日常生活、情緒、與他人關係、睡眠及生活樂趣，有顯著改善；（2）兩組實驗組之研究對象在接受癌痛衛教後，不正確疼痛及麻醉性止痛藥信念得分減少與控制組得分比較，達到顯著差異。
本研究結果顯示，癌痛衛教可改善癌患不正確的疼痛及麻醉性止痛藥信念，癌痛衛教配合伸展運動可減少研究對象之疼痛干擾，並增加癌痛病患的活動能力。

Pain is a frequently symptom in cancer patients and needs many different ways to manage its characters with multiple dimensions. The Structured pain education program has been shown to reduce the severity of this symptom in cancer patients and stretching exercise has been detected to improve other pain experiences. Therefore, this randomized controlled study aimed to assess the effects of two therapies on cancer patients with pain experience. Appropriated cancer patients were assigned to three groups, including (1) pain education group, accepted 10- 15 min per day for 5 days (Experimental group I, n= 12), (2) pain education plus stretching exercise group, 15 min education and 15 min exercise for 5 following day (Experimental groupⅡ, n= 12), (3) standard care control group, accepted usual ward routine care (control group, n= 12). All cases were carried out and evaluated in four times, (Pretest [T0], Day 6 [T1], Day 14 [T2], and Day 28 [T3]) for four weeks ( total 28days).
Pain intensity, Pain interferences with daily life, beliefs about pain and opioids, mood status, and fatigue of all cases were evaluated by the Brief Pain Inventory Short Form Taiwanese (BPI-T), Pain and Opioid Analgesic Beliefs Scale – Cancer (POABS-CA), Profile of Mood State short Form (POMS-SF), and Numeric rating scale (NRS). Data were analyzed by using descriptive statistics, one - way ANOVA, and Repeated measure ANOVA.
The result showed that (1) pain interferences with general activity, mood, relations with other people, sleep, and enjoyment of life were significantly improving in following evaluation in experimental groupⅡ, (2) there were significantly statistic difference between two experimental groups and control group on beliefs about pain and opioids.
In conclusion, the result indicated that, after complete treatment, pain education plus stretching exercise could improve cancer patients’ daily life, and patients who had received structured pain education, had significantly less negative beliefs about pain and opioids than the control group. These interventions should be practiced effetely in clinical nursing care for cancer patients.

目 錄
頁碼
致 謝 …………………………………………………………………… Ⅰ
摘 要 …………………………………………………………………… Ⅲ
目 錄 …………………………………………………………………… Ⅶ
圖表目次 …………………………………………………………………… Ⅹ
第一章 緒論………………………………………………………………. 1
第一節 研究動機與重要性……………………………………………. 1
第二節 研究目的...…………………………………………………….. 5
第三節 研究假設...…………………………………………………….. 6
第二章 文獻查證...………………………………………………………. 7
第一節 疼痛概念...……………………………………………………. 7
第二節 癌症病患疼痛經驗與相關因素……………………………… 15
第三節 癌痛衛教...……………………………………………………. 20
第四節 疼痛症狀與伸展運動………………………………………… 24
第五節 名詞解釋……………………………………………………… 31
第三章 研究方法…………………………………………………………. 32
第一節 研究設計...……………………………………………………. 32
第二節 研究對象、收案場所及時間...……………………………… 34
第三節 研究工具...……………………………………………………. 35
第四節 研究方案...……………………………………………………. 39
第五節 研究進行步驟……………………………………………….... 43
第六節 資料處理與分析……………………………………………… 45
第七節 量表信度……………………………………………………… 47
第四章 分析與結果……………………………………………………… 49
第一節 研究對象之基本資料……………………………………….... 49
第二節 研究對象使用止痛藥物情形………………………………… 52
第三節 研究對象疼痛情形………………………………………...... 57
第四節 研究對象疼痛干擾情形……………………………………… 67
第五節 研究對象疼痛與止痛藥物認知信念情形…………………… 78
第六節 研究對象情緒狀態情形……………………………………… 87
第七節 研究對象疲憊之狀態……………………………………….... 99
第五章 討論………………………………………............... 105
第一節 接受癌痛衛教及伸展運動訓練後改善疼痛強度之成效…… 105
第二節 接受癌痛衛教及伸展運動訓練後改善疼痛干擾之成效…… 108
第三節 接受癌痛衛教及伸展運動訓練後改善錯誤疼痛認知之成效 111
第四節 接受癌痛衛教及伸展運動訓練後情緒之變化……………… 113
第五節 癌痛衛教及伸展運動訓練後改善疲憊之成效……………… 116
第六章 結論與建議………………………………………............ 119
第一節 結論………………………………………............... 119
第二節 研究建議與限制……………………………………………… 121
參考資料 …………………………………………………………………… 122
中文部份…………………………………………………………………. 122
英文部份…………………………………………………………………. 125
附 件 ……………………………………………………………………. 139
附錄一 研究同意書…………………………………………………… 139
附錄二 基本資料表…………………………………………………… 140
附錄三 簡明疼痛量表………………………………………………… 142
附錄四 疼痛信念及看法……………………………………………… 144
附錄五 數字量表……………………………………………………… 145
附錄六 POMS - SF簡明情緒量表－焦慮、憂鬱、疲憊子量表………. 146

圖表目次
頁碼
圖一 三組研究期間使用止痛藥物人數分佈變化…………………… 56
圖一 三組研究期間使用止痛藥物人數分佈變化…………………… 56
圖二 三組研究對象研究期間－過去24小時最重疼痛強度變化…… 64
圖三 三組研究對象研究期間－過去24小時平均疼痛強度變化…… 65
圖四 三組研究對象研究期間－過去24小時疼痛緩解程度變化…… 66
圖五 三組研究對象研究期間－疼痛干擾日常活動程度變化……… 72
圖六 三組研究對象研究期間－疼痛干擾情緒程度變化…………… 73
圖七 三組研究對象研究期間－疼痛干擾行走能力程度變化……… 74
圖八 三組研究對象研究期間－痛干擾與他人關係程度變化……… 75
圖九 三組研究對象研究期間－疼痛干擾睡眠程度變化…………… 76
圖十 三組研究對象研究期間—疼痛干擾生活樂趣變化…………… 77
圖十一 三組研究對象研究期間－POABS - CA麻醉性止痛藥認知得分變化……………………………………………………………………………… 84
圖十二 三組研究對象研究期間－POABS - CA忍耐疼痛認知變化得分變化……………………………………………………………………………… 85
圖十三 三組研究對象研究期間—POABS 癌痛認知得分變化………… 86
圖十四 三組研究對象研究期間—NRS焦慮量表變化…………………… 95
圖十五 三組研究對象研究期間—POMS - SF焦慮次量表變化………… 96
圖十六 三組研究對象研究期間－NRS憂鬱量表變化………………… 97
圖十七 三組研究對象研究期間－POMS - SF憂鬱次量表變化……… 98
圖十八 三組研究對象研究期間—NRS 疲憊程度變化………………… 101
圖十九 三組研究對象研究期間—POMS－SF 疲憊次量表變化……… 102
圖二十 三組研究對象研究期間—NRS疲憊數字量表前測 v.s.第三次後測……………………………………………………………………………… 103
圖二十一 三組研究對象研究期間—POMS - SF疲憊次量表前測v.s.第三次後測……………………………………………………………………………… 104
表一 研究設計………………………………………………………… 33
表二 研究方案及研究測量表量在研究進行時間一覽表…………… 44
表三 處理研究資料之統計分析方法………………………………… 46
表四 研究評估量表之內在一致性…………………………………… 48
表五 研究對象基本屬性之分佈情形與比較………………………… 51
表六 三組研究期間使用止痛藥物人數分佈變化（以WHO analgesic Ladder分類）……………………………………………………………………………… 55
表七 以單因子變異數分析（one - way ANOVA）、重複測量變異數 (repeated measures ANOVA) 檢定簡易疼痛量表（BPI - T）－疼痛強度之前後測變化比較…………………………………………………………………………… 62
表八 以單因子變異數分析 (one - way ANOVA)、重複測量變異數 (repeated measures ANOVA) 檢定簡易疼痛量表（BPI-T）－痛干擾之前後測變化比較…………………………………………………………………………… 70
表九 以單因子變異數分析 (one-way ANOVA )、重複變異數分析 ( repeated measures ANOVA) 檢定疼痛信念（POABS-CA）前後變化比較…………………………………………………………………………… 82
表十 以單因子變異數分析 (one-way ANOVA )、重複變異數分析 (repeated measure ANOVA) 檢定簡明情緒量表（POMS-SF）前後變化比較……………………………………………………………………………… 91
表十一 以單因子變異數分析 (one-way ANOVA )、重複變異數分析 (repeated measures ANOVA) 檢定數字量表（NRS）前後變化比較……………………………………………………………………………… 93

參考資料
中文部分
何善台、葛魯萍、鄭澄寰、王志中（1996）・台灣地區癌症疼痛之流行病學，載於孫惟仁（主編），癌症疼痛治療學 （pp.32-36）・台北：財團法人大地之愛癌症基金會。
行政院衛生署（2003）・中華民國九十二年衛生統計重要指標：死因統計類・摘自1月6日，2004，http://www.doh.gov.tw/statistic/data/衛生統計重要指標/8.xls・
行政院衛生署（2003）・中華民國九十二年衛生統計（一）公務統計-保健・摘自1月6日，2005，http://www.doh.gov.tw/statistic/統計年報/st2_92_4.htm。
杜佳玲（2004）・癌痛衛教及放鬆訓練改善癌痛病患之立即與中效果比較・未發表的碩士論文，臺北醫學大學，臺北。
林佳靜（1998）・癌症疼痛因應量表之發展與癌症疼痛因應行為之探討・護理研究，6（5），405-416。
林佩欣、莊天佑（2003）・癌症疲勞症候群的復健治療・臨床醫學，52（3），173-177。
邱泰源 (1999)・緩和醫療癌末照顧綜論・台大醫院家庭醫師繼續教育常見疾病之診斷與治療（26－12）・摘自7月6日，2005，http://med.mc. ntu.edu.tw/~fm/fmdata/CE26-12.html。
洪福建、鄭逸如、邱泰源、胡文郁、陳慶餘、吳英璋（1999）・癌末患者的心理社會問題、因應策略與負向情緒・應用心理研究，3，19-104・
陳文銓（1994）・如何藉由伸展運動來改善柔軟度並預防運動傷害・學校體育雙月刊，4（2），39-45・
陳佩英、史麗珠、王正旭、賴裕和、張獻崑，陳美伶（1999）・疼痛對癌症病患焦慮與憂鬱之影響・台灣醫學，3，373-382‧
陳聰毅及杜春治（2001）・伸展運動在運動健身的意義・大專體育，57，83-87・
黃采薇、賴裕和、鄭安理、史麗珠、張正雄及向肇英（2001）・背部按摩對化學治療期間疲憊及焦慮之成效・台灣醫學，5（4），369-378.
張碧華（2002）・走路方案對急性骨髓性白血病病患接受化學治療期間疲憊改善之效・未發表的碩士論文，臺北醫學大學，臺北・
郭淑柳（2002）・癌痛衛教及放鬆訓練對改善癌症疼痛之效果探討・未發表的碩士論文，臺北醫學大學，臺北・
彭熙寧（2003）・癌痛衛教及運動對改善癌症病患疼痛經驗之探討・未發表的碩士論文，台北醫學大學，臺北・
侯文詠（1996）・癌症疼痛處理的基本原則・孫維仁主編，癌症疼痛治療學（pp.40-54），台北：財團法人大地之愛癌症基金會・
曾清楷 （1996）・慢性疼痛對精神方面和行為方面的效果・孫維仁主編，癌症疼痛治療學（p.15），台北：財團法人大地之愛癌症基金會。
劉淑樺（2001）・疲憊之概念分析・護理雜誌，48（4），73-77・
孫秀卿、賴裕和（2001）・癌症相關之疲憊・腫瘤護理雜誌，1（2），31-36・
蔡麗雲、顧乃平（1997）・癌痛病患的疼痛因應策略及相關因素之探討・護理研究，5（2），137-147・
蔡麗雲、顧乃平、張澤雲、賴裕和（2001）・癌痛病患的焦慮、憂鬱及其相關因素之探討・新台北護理期刊，3（1），23-33。
賴裕和（2000）・病人對癌痛及麻醉性止痛藥之信念量表探討—量表發展與現況・護理研究，8（5），557-565・
趙叔蘋（1996）・預防下背痛之伸展運動及肌力訓練・國立臺灣體專學報，8，21-39・
鄭逸如、呂碧鴻（1997）・癌症末期患者心理層面的照顧・台灣醫學，1（2），209-213・

英文部分
Aass, N., Fossa, S. D., & Dahl, A. A. (1997). Prevalence if anxiety and depression incancer patients seen at Norwegian Radium Hospital. European Journal of Cancer, 33, 1597-1604.
Agency for Health Care Policy and Research [AHCPR](1994). Nonpharmacologic Management: Physical and Psychological Modalities. In A. Jocox et al. (Eds.), Management of Cancer Pain: No. 9 (pp.75-87). U.S. Depart- ment of Health and Human Services.
Ahles, T. A., Blanchard, E. B., & Ruchdeschel, J. C. (1983). The multi- dimensional nature of cancer-related pain. Pain, 17, 272-288.
Ballenge, J. C., Dvidson, J. R. T., Lecrubier, Y., Nutt, D. J., Jones, R. D., & Berard, R. M. F. (2001). Consensus statement on depression ,anxiety, and oncology. Journal Clinical Psychiatry, 62 (suppl 8), 64-67.
Barbour, L. A., MuGuire, D. B., & Kirchhoff, K. T. (1986). Nonanalgesic methods of pain control used by cancer outpatients. Oncology Nursing Forum, 13(6), 56-60.
Barnes, E. A., & Bruera, E. (2002). Fatigue in patients with advanced cancer: A review. International Journal of Gynecology Cancer, 12, 424-428.
Berman, B. M., & Bausell, R. B. (2000). The use of non-pharmacological therapies by pain specialists. Pain, 85, 313-315.
Bloch, S. D. (2000). Assessing and managing depression in the terminal ill patient. Annals of Internal Medicine, 132(3), 209-218.
Bottomley, A. (1998). Group cognitive behavioral therapy with cancer patients: the views of women participants on a short-term intervention. European Journal of Cancer Care (English), 7(1), 23-30.
Breitbart, W. (1994). Psycho - Oncology: depression, anxiety , delirium. Seminar in Oncology, 21(6), 754-769.
Bruera, E., Strasser, F., Shen, L., Palmer, J. L., Willey, J., & Driver, L. C., et al. (2003). The effect of donepezil on sedation and other symptoms in patients receiving opioids for cancer pain: a pilot study. Journal of Pain Symptom Manage., 26(5), 1049-54.
Carig, K. D. (1999). Emotion and psychobiology, In P. D. Wall & R. Melzack (4 th ed.), Textbook of pain (pp. 331-343). London: Churchill Livigstong.
Chang, M. C., Chang, Y. C., Chiou, J. F., Tsou, T. S., & Lin, C. C. (2002). Overcoming Patient - related Barriers to cancer pain management for home care patients. A pilot study. Cancer Nursing, 25(6), 470-476.
Chen, M. L. (1999). Validation of the structure of the perceived meaning of cancer pain inventory. Journal of Advanced Nursing, 30(2), 344-351.
Chen, M. L., Chang, H. K., & Yeh, C. H. (2000). Anxiety and depression in Taiwanese cancer patients with and without pain. Journal of Advanced Nursing, 32(4), 944-951.
Cheung, Y. L., Molassiotis, A., & Chang, A. M. (2002). The effect of progressive muscle relaxation training on anxiety and quality of life after stoma surgiry in colorectal cancer patients. Psycho - Oncology , 12, 254-266.
Chiang J.S. (2000). New developments in cancer pain therapy. Acta Anaesthesiologic Sinica, 38, 31-36.
Chiu, T. Y. (1997). Pain control in terminal cancer patients. Formosan Journal of Mediccine, 1, 198-208.
Chung, T. K., French, P., & Chan, S. M. (Eds.). (1999). Patient - related barrier to cancer pain management in a palliative care setting in Hong Kong. Cancer Nursing, 22(3), 196-203.
Cohen, L., Warneke, C., Fouladi, R. T., Rodriguez, M. A., & Chaoul - Reich, A. (2004). Psychological adjustment and sleep quality in a randomized trial of the effects of a tibetan yoga intervention in patients with lymphoma. Cancer, 100(100), 2253-2260.
Courneya, K. S., Friedenreich, C. M., Quinney, H. A., Fiflds, A. L. A., & Jones, L. W., & Fairey, A. S. (2003). A randomized trial of exercise and quality of life in colorectal cancer survivors. European Journal of Cancer Care, 12, 347-357.
Courneya, K. S., Friedenreich, C. M., Sela, R. A., Quinney, H. A., Rhodes, R. E., & Handman, M. (2003). The Group psychotherapy and home-based physical exercise (group - hope) trial in cancer survivors: physical fitness and quality of life outcomes. Psycho - Oncology, 12, 357-374.
Coward, D. D., & Wilkie, D. J. (2000). Metastatic bone pain: meaning associated with self - report and self - management decision making. Cancer Nursing, 23(2).101-108.
de Gier, M., Peters, M. L., & Vlaeyen, J. W. S. (2003). Fear of pain, physical performance, and attemtional processes in patients with Fibromyalgia. Pain, 104, 121-130.
de Wit, R., & van Dam, F. (2001). From hospital to home care: a randomized controlled trial of a Pain Education Programme for cancer patients with chronic pain. Journal of Advanced Nursing, 36(6), 742-754.
de Wit, R. van Dam, F., Zandlbelt, L., van Buuren, A., van der Heijden, K., & Leenhouts, G., et al. (1997). A pain education program for chronic cancer pain patients: follow-up results from a randomized controlled trial. Pain, 73, 55.
Dimeo, F. C. (2001). Effect of exercise on cancer-related fatigue. Cancer, 92 (suppl. 6), 1689-1693.
Dimeo, F., Rumberger, B.. G., & Keul, J. (1998). Aerobic exercise as therapy for cancer fatigue. Medicine and Science in Sports & Exercise, 30(4), 475-478.
Dodd, M. J., Miaskowski, C., & Paul, S. M. (2001). Symptom clusters and their effect on the functional statue of patients with cancer. Oncology Nursing Forum, 28(3), 465-470.
Dodd, M. J., Miaskowski, C., & Lee, K. A. (2004). Occurrence of symptom clusters. Journal of National Cancer Institute Monograph, 32, 76-78.
Ersek, M., Kraybill, B. M., & Pen, A. D. (1999). Factors hiding patients’ use of medications for cancer pain. Cancer Practice, 7(5), 226-232.
Ferrell, B.R. (1995). The impact of pain on quality of life a decade of research. The Nursing Clinics of North Americ, 30(4), 609-624.
Ferrell, B. R., Ferrell, B. A., Ahn, C., & Tran, K. (1994). Pain management for elderly patients with cancer at home. Cancer, 1(suppl. 7), 2139-2146.
Fialka-Moser, V., Crevenna, R. Korpan, M., & Quittan, M. (2003). Cancer rehabilitation. particularly with aspects on physical impairments. Journal of Rehabiitation. Medicine, 35, 153-162.
Field, T., Delage, J., & Hernandez - Reif, M. (2003). Movement and massage therapy reduce Fibromyalgia pain. Journal of bodywork and movement therapies, 7(10), 49-52.
Ger, L. P., Ho, S. T., Sun, W. Z., Wang, M. S., & Cleeland, C. S. (1999). Validation of the brief pain inventory in a taiwanese population. Journal of Pain Symptom Manage, 18(5), 316-22.
Giordano, A., Calvani, M., Petillo, O., Carteni, M., Melone, M. R. A. B., ＆Peluso, G. (2003). Skeletal Muscle Metabolism in Physiology and in Cancer Disease. Journal of Cellular Biochemistry, 90, 170-186.
Glajcben M. (2001). Chronic Pain: treatment barriers and strategies for clinical practice. Medical Practice, 14(3), 211-218.
Glover, J., Dibble, S. L., Dodd, M. J., ＆ Miaskowski, C. (1995). Mood states of oncology outpatients: dose pain make a differences? Journal of Pain and Symptom Management, 10(2),120-128.
Guez, M., Hijdingsson, C., Stegmayr, B., & Toolanen, G. (2003). Chronic neck pain of traumatic and non-traumatic origin: a population-based study. Acta Oorthopaedica Scandinavica, 74(5), 576-579.
Hadjistavropoulos, H. D., & LaChapelle, D. L. (2000). Extent and nature of anxiety experienced during physical examination of chronic low back pain. Behaviour Research and Therapy, 38, 13-29.
Hagberg, M., Harms-Ringdahl, K., Nisell, R., & Hjelm, E. W. (2000). Rehabilitation of neck-shoulder pain in women industrial workers: A randomized trial comparing isometric shoulder endurance training with isometric shoulder strength training. Archives of Physical Medicine and Rehabiitationl, 81(8), 1051-1058.
Hanten, W. P., Olson, Sharon. L., Butts, N. L., & Nowicki, A. L. (2000). Effectiveness of a home program of ischemicpressure followed by sustained stretch for trearment of myofascial trigger points. Physical Therapy, 80(10), 997-1003.
International Association for the Study of Pain [IASP], (1979). Subcommittee on taxonomy of pain terms: A List with definitions and notes on usage. Pain, 6, 249-252.
Jones, R. D. (2001). Depression and Anxiety in Oncology: The oncologist’s perspective. Journal of Clinical Psychiatry, 62 (suppl. 8), 52-57.
Keefe, F. J. (2000). Pain behavior observation: current status and future directions. Current Pain and Headache Reports, 4(1), 12-17.
Lai, Y. H., Chang, J. T. C., Keefe, F. J., Chiou, C. F., Chen, S. C., & Feng, S. C., et al. (2003). Symptom destress, catastrophic thinking, and hope in nasopharyngeal carcinoma patients. Cancer Nursing, 26(6), 485-493.
Lai, Y. H., Dalton, J. A., Belyea, M., Chen, M. L., Tsai, L.Y., & Chen, S. H. (2003). Development and testing of the pain opioid analgesics beliefs scale in taiwanese cancer patients. Journal of Pain and Symptom Management, 25(4), 376-285.
Lai, Y. H., Guo, S. L., Keefe, F. J., Tsai, S. L., Chien, C. C., & Sung, Y. C., et al. (2004). Effects of brief pain education on hospitalized cancer patients with moderate to severe pain. Supportive Care in Cancer, 12, 645-652.
Lai Y. H., Keefe F. J., Sun W. Z., Tsai L.Y., Cheng P. L., & Chiou J.F., et al. (2002). Relationship between pain-specific beliefs and adherence to analgesic regimens in Taiwanese cancer patients：a preliminary study. J. of Pain Symtom Management, 24(4), 415-423.
Lin, C. C. (1998). Enhancing management of cancer pain: contribution of the internal working model. Cancer Nursing, 21(2), 90-96.
Lin, C. C. (2000). Barriers to the analgesic management of cancer pain: a comparision of attitudes of taiwanese patients and their family caregivers. Pain, 88(1), 7-14.
Lin, C. C., Chang, M. L., Chang, Y. C., Chiou, J. F., & Tsou, T. S. (2002). Overcoming patient-related barriers to cancer pain management for home care patients. Cancer Nursing, 25(6), 470-476.
Lin, C. C. & Ward, S. E. (1995). Patient-related barriers to cancer pain management in Taiwan. Cancer Nursing, 18, 16-22.
Lucia, A., Earnest, C., ＆Perez, M. (2003). Cancer-related fatigue: can exercise physiology assist oncologists？The Lancet Oncology, 4, 616-625.
Ludewig, P. M., & Borstad, J. D. (2003). Effects of home exercise programme on shoulder pain and functional status in construction. Occupational and Environmental Medicine, 60(11), 841-849.
MacVicar, M. G., Winningham, M. L., & Nickel, J. L. (1989). Effects of interval training on cancer patients’ functional capacity. Nursing Research, 38(6), 348-351.
McCaffery, M. (1980). Understanding your patient’s pain. Nursing, 10(9), 58-61.
McCaffery, M., & Beebe, A. (1989). Pain: clinical manual for nursing practice. St. Louris: Mosby
McCraken, L. M., Faber, S. D., & Janeck, A. S. (1998). Pain-related anxiety predicts non-specific physical complaints in persons with chronic pain. Behaviour Research and Theraoy, 36, 621-630.
McCraken, L. M., Vowles, K. E., & Eccleston, C. (2004). Acceptance of chronic pain: component analysis and a revised assessment method. Pain, 107, 159-166.
McGuire, D. B. (1987). Advances in control of cancer pain. TheNursing Clinics of North America, 22 (3), 677-690.
McGurire, D.B., & Sheidler, V. R. (1997). Pain. In Groenwald, S. L., Frogge, M. H., Goodman, M., & Yarbor, C. H. (Eds.), Cancer Nursing: Principle and Practice (4th ed., pp.527-584). London: Jones and Bartlett Publishers.
McMillan, S. C. (1996). Pain and pain relief experienced by hospital patients with cancer. Cancer Nursing, 19(4), 298-307.
Melzack, R. (1999). From the gate to the neuro-matrix. Pain, Aug (suppl. 6), 121-126.
Melzack, R. & Casey, C. L. (1968). Sensory, motivational and central control determination of pain: A new conceptual model. In D. Kenshalo (Ed.), The Skin Sense (pp.423-443). Spring-field, IL: Charles C. Thomas.
Melzack, R., & Wall, P. (1965). Pain mechanism: a new theory. Science, 150(3699), 971-978.
Messias, D. K. H., Yeager, K. A., Dibble, S. L., & Dodd, M. J. (1997). Patient’s perspectives of fatigue while undergoing chemotherapy. Oncology Nursing Forum,24(1), 43-48.
Miaskowski, C. (2002). The need to assess multiple symptoms. Pain management nursing, 3(4), 115.
Miaskowski, C., Dodd, M., & Lee, K. (2004). Symptom clusters: the new frontier in symptom management research. Journal of National Cancer Institute Monograph, 32, 17-21.
Miaskowski, C., & Lee, K. A. (1999). Pain, fatigue and sleep disturbances in oncology outpatients receiving radiation therapy for bone metastasis: a pilot study. Journal of Pain and Symptom Management, 17(5), 320-332.
Mock, V., Burke, M. B., Sheehan, P., Creaton, E. M., Winningham, M. L., & McKenney-Tedder, S., et al. (1994). A nursing regabilitation program for women with breast cancer receiving adjuvant chemotherapy. Oncology Nursing Forum, 21(5), 899-907.
Mobily, R. R. (1994). Non-pharmacologic interventions for the management of chronic pain in older women. Journal of Women and Aging, 6(4), 89-109.
Nieman, D. C. (2003). Exercise testing and prescription. A health-related approach. (5th ed., pp.255-257). NY: McGraw - Hill.
O’Leary, U. (2002). Psychological influences on pain perception in cancer. Nursing Time, 22(43), 36-38.
Oldervo, L. M., Kaasa, S., Hjermstad, M. J., Lund, J. A., & Loge, J. H. (2004). Physical exercise results in the improved subjective well - being of a few or is effective rehabilitation for all cancer patients? European journal of cancer, 40, 951-962.
Paice, J. A., & Cohen, F. L. (1997). Validity of a verbally administered numeric rating scale to measure cancer pain intensity. Cancer Nursing, 20(2), 88-93.
Pargeon, K. L., & Hailey, B. J. (1999). Barriers to effective cancer pain management: a review of the literature. J Pain Symptom Manage, 18(5), 358-68.
Pinto, B. M., Trunzo, J. J., Relss, P., & Shiu, S. Y. (2002). Exercise participation after diagnosis of breast cancer: trends and effects on mood and quality of life. Psycho - Oncology, 11, 389-400.
Pinto, B. M., Trunzo, J. J., Reiss, P., & Shiu, S. (2002). Exercise participation after diagnosis of breast cancer: trends and effects on mood and quality of life. Psycho - Oncology , 11, 389-400.
Portenoy, R. K. (2000). Cancer-related fatigue: an immense problem. Oncologist, 5(5), 350-352.
Porock, D., KristJanson, L. J., Tinnelly, K., Duke, T., & Blight, J. (2000). An exercise intervention for advanced cancer patients experiencing fatigue: a pilot study. Journal of Palliative Care, 16(3), 30-36.
Rao, A., & Cohen, H. J. (2004). Symptom management in the elderly cancer patient: fatigue, pain, and depression. Journal of the Naional Cancer Institute. Monographs, 32, 150-157.
Ream, E., & Richardson, A. (1996). Fatigue: A concept analysis. International Journal of Nusing Studies, 33(5), 519-529.
Redd, W. H., Montgomery, G. H., & DuHamel, K. N. (2001). Behavioral intervention for cancer treatment. Journal of the national cancer Institute, 93(11), 810-823.
Reuter, K., & Härter, M. (2004). The concepts of fatigue and depression in cancer. European Journal of Cancer, 13, 127-134.
Reyes-Gibby, C. C., Mendoza, T. R., Wang, X. S., Anderson, K. O., & Cleeland, C. S. (2003). Pain and fatigue in community-dwelling adults. Pain Medicine, 4(3),231-237.
Richards, S. C. M., & Scott, D. L. (2002). Prescribed exercise in people with fibromyalgia: parallel group randomized controlled trial. British Medical Journal , 325(27), 185-187.
Ridner, S. H. (2004). Psychological distress: concept analysis. Journal of Advanced Nursing, 45(5), 536-545.
Rao, A., & Cohen, H. J. (2004). Symptom management in the elderly cancer patient: fatigue, pain, and depression. Journal of the National Cancer Institute Monograph, 32, 250-257.
Shaffer, S. D., & Yucha, C. B. (2004). Relaxation and Pain management. The relaxation response can play a role in management chronic and acute pain. American Journal of Nursing, 104(8), 75-79.
Schumacher, K. L., West, C., Dodd, M. J., Paul, S. M., Tripathy, D., Koo, P., & Miaskowski, C. A. (2002). Pain management autobiographies and reluctance to use opioids for cancer pain management. Cancer Nursing, 25(2), 125-33.
Schwartz, A. L. (1998). Exercise and weight gain in breast cancer patients receiving chemotherapy. Cancer Practice: a Multidisciplinary Journal of Cancer Care, 8(5), 231-237.
Schwartz, A. L., Mori, M., Gao, R., Nail, L. M., & King, M. E. (2001). Exercise reduces daily fatigue in women with breast cancer receiving chemotherapy. Medicine & Science in Sports & Exercise, 33(5), 718- 723.
Sharpe, M., & Wilks, D. (2002). Fatigue. British Medical Journal, 325(31), 480-483.
Spiegel, D. (1996). Cancer and depression.The British journal of Psychiatry Suppltment, 30, 109-116.
Speigel, D., & Giese-Davis, J. (2004). Depression and Cancer: mechanisms and disease progressions. Biological psychiatry, 54(3), 269-282.
Speigel, D., & Moore, R. (1997). Image and hypnosis in the treatment of cancer patients. Oncology(Huntingt), 11(8), 1179-1189.
Speigel, D., Scands, L., & Koopman, C. (1994).Pain and depression in patient with cancer. Cancer, 78, 2570-2578.
Sullivan, M. J., Stanish, W., Waite, H., Sullivan, M., & Tripp, D. (1998). Catastrophizing, pain, and disability in patients with soft-tissue injuries. Pain, 77, 253-260.
Tanaka, T. H., Leisman, G., Mori, H., & Nishijo, K. (2002). The effect of massage on localized lumbar muscle fatigue. BMC Complementary and Alternative Medicine, 2(9), 1-8.
Tegeder, I., Zimmermann, J., Meller, S. T., & Geisslinger, G. (2002). Release of algesic substances in human experimental muscle pain. Inflammation Research, 51, 393-402.
Thomas, E. M., & Weiss, S. M. (2000). Nonpharmacological interventions with chronic cancer pain in adults. Cancer Control, 7(2), 157-164.
Tiamela, S., Taklk, E-P., & Asklof, T. (2000). Active treatment of chronic neck pain. A prospective randomized intervention. Spine, 25(8), 1021-1027.
Turk, D. C. & Okifuji, A. (1997). Evaluation the role of physical, operant, cognitive, and affective factors in the pain behaviours of chronic pain patients. Behavivour Mdification, 21(3), 259-280.
Vickers, A., & Cassileth, B. R. (2001). Unconventional therapies for cancer and cancer-related symptoms. The Lance Oncology, 2, 226-232.
Viljanen, M., Malmivaara, A., Uitti, J., Rinne, M., Palmroos, P., & Laippala, P. (2003). Effectiveness of dynamic muscle training, relaxation training, or ordinary activity for chronic neck pain: randomized controlled trail. British Medical Journal, 327, 475-477.
Vowles, K. E., Zvolensky, M. J., Gross, R. T., & Sperry, J. A. (2004). Pain- related Anxiety in the low-back pain distress. Journal of Behavioral Medicine, 27(1), 77-89.
Wang, K. Y., Ho, S. T., Ger, L. P., Wang, J. J., Cherng C. H., & Lin, C. C. (1997). Patient barriers to cancer pain management: from the viewpoint of the cancer patient receiving analgesics in a teaching hospital of Taiwan. Acta Anaesthesiological Sinica, 35(4), 201-208.
Ward, S. E., Goldberg, N., Miller - McCauley, C., Nolan, A., & Pawlik - Plank, D. (1993). Patients-related barriers to management of cancer pain. Pain, 52(3), 319-324.
Ward, W., Donovan, H. S., Owen, B., Grosen, E., & Serlin, R. (2000). An individualized intervention to overcome patient-related barrier to pain management in women with gynecologic cancer. Research in Nursing & Health, 23(5), 393-405.
Waters, S. J., Keefe, K. J., & Strauman, T. J. (2004). Self-Discrepancy in chronic low back pain: relation to pain, depression, and psychological distress. Journal of Symptom Management, 27(3),251-259.
World Health Organization [WHO](1990). Cancer pain relief and palliative care. (World Health Organization Technical Report Series, 804). Geneva: World Health Organization.
Wyke, B. D. (1976). Neurological aspects of low back pain: In Jayson MIV (Ed.), The Lumbar Spine and Back Pain. London: Sector Publishing.
Ylinene, J., Takala, E., Kautiainen, H., Nykanen, M., Hakkinen, A., & Pohjolainen, T. (2003). Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial. The Journal of the American Medical Association., 289(19), 2509-16.,
Zaza, C., & Baine, N. (2002). Cancer Pain and Psychosocial Factors: A Critical Review of the Literature. Journal of pain and symptom management, 24(5), 526-542.
Zimmerman, Z., Story, K. T., Gaston-Johansson, F., & Rowles, J. R. (1996). Psychological variables and cancer pain. Cancer Nursing, 19(1), 44-53.