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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The purpose of this study was to describe the incidence, onset, duration, severity, and other relevant characteristics of mucositis and pain in patients undergoing bone marrow transplant (BMT) who were receiving high-dose chemotherapy (cytoxan, busulfan, and etoposide) without total body irradiation. A descriptive, longitudinal design was used to study a sequential sample of 47 patients undergoing allogeneic and autologous BMT. Each day, from 9 days prior to BMT through 21 days after BMT, nine anatomic regions of patients' mouths were assessed for extent and severity of mucositis. Oral pain was measured using the Short-Form McGill Pain Questionnaire. Forty-two patients (89%) developed mucositis, which, on average, began 3 days after transplant, lasted 9.5 days, and resolved by 12.6 days post-transplant. Thirty-six patients (86%) reported pain that began, on average, 4.5 days after transplant, lasted 6.5 days, and resolved by 11 days post-transplant. During the initial weeks following BMT, systematic assessment of the oral cavity areas that are at high risk for mucositis should assist nurses in detecting early oral complications and in initiating specific interventions. Additionally, attention needs to be given to the assessment and management of mucositis-related oral pain. Future nursing research should be conducted to examine efficient clinical methods of assessing mucositis and oral pain and to test prophylactic and therapeutic interventions.
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PMID:Patterns of mucositis and pain in patients receiving preparative chemotherapy and bone marrow transplantation. 827 77

While the potent analgesic properties of clonidine, a centrally-acting antihypertensive agent, in humans is well described, its analgesic effect when administered into the pleural cavity is largely unknown. We have used intrapleural clonidine as a primary analgesic agent for postoperative pain control in two patients who had undergone cholecystectomy. Clonidine was instilled into the pleural space at the end of the operation via a silastic catheter placed through the seventh intercostal space. Oral pain medications were resumed within 48 hours after removal of the intrapleural catheter. In both patients, there was a substantial improvement in pulmonary function correlating with adequate pain control. No complications were noted secondary to the use of intrapleural clonidine. We conclude that intrapleurally administered clonidine is sufficient to provide adequate postoperative analgesia following abdominal surgery.
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PMID:The use of intrapleural clonidine for postoperative pain control. 867 28

The problem of unresolved pain in hospitalized patients is costly both in monetary terms and in patient comfort. Concern about patients' satisfaction and well-being led to a study to determine the characteristics of the pain experience as reported by the hospitalized patients. This study also examined the recently revised American Pain Society Patient Outcome Questionnaire (APS-POQ), particularly in regard to results from newly added items and overall reliability and validity. The data provide a cross-sectional description of patients' experience with pain in a large, urban teaching hospital. One hundred fifty-seven adult subjects reported moderate to high levels of current pain intensity, worst pain, and general level of pain in the last 24 hr, as well as moderate to high rates of pain-related interference with care activities. While patients indicated that they were satisfied with their pain management and with the responses of physicians and nurses to complaints of pain, patient satisfaction was inversely and significantly correlated with pain now and general level of pain in the last 24 hr. When patients with high pain intensity (> 7) were separated into satisfied and dissatisfied groups for analysis, no significant differences were found regarding pain-related interference with various activities including mood, relationships, sleep, etc. The majority of patients indicated that they were still in pain, but 41% did not wish to receive a stronger dose of pain medication. Significant differences between those who did and did not want more pain medication were found in that younger patients were more likely to want more pain medication. Additionally, analysis of these two groups found that patients who were still in pain and desired more pain medication reported significantly higher levels of pain-related interference with activity and sleep. The inverse correlation of current pain intensity and general level of pain with overall satisfaction with pain management differs from findings of previous studies. One added item queried patients regarding approaches they had used to manage pain in the last 24 hr. Oral pain medications, prayer, intravenous and intramuscular injections were the top-ranked methods. The findings guide further analysis of the APS-POQ questionnaire. Recommendations of items to be retained in the questionnaire are made based on data analysis. Refining the questionnaire will allow health-care providers to increase their understanding of issues related to pain management. The findings provoke several questions for further study, such as what are age and ethnic differences regarding pain intensity and satisfaction, as well as the predictors of aversion of receiving more pain medication when pain persists.
J Pain Symptom Manage 1998 Jul
PMID:Assessing clinical outcomes: patient satisfaction with pain management. 970 55

Painful oral mucositis is a common complication after bone marrow transplantation (BMT). Glutamine is a nutrient for rapidly dividing cells and the major energy source for intestinal epithelium. This study tested whether an oral glutamine preparation could decrease the severity of oral mucositis in patients undergoing BMT. Glutamine or a placebo (glycine) were administered from admission until day +28 in 193 BMT patients in a randomized, double-blind, placebo-controlled study at a dose of 1.0 g amino acid/m2/dose swish and swallow four times a day. In autologous BMT patients (n = 87) glutamine was associated with significantly less mouth pain by self report and by opiate use (5.0+/-6.2 days of morphine for glutamine vs 10.3+/-9.8 days for placebo; P= 0.005). Matched sibling BMT patients had no effect by self report and an increased duration of opiate use (23.2+/-5.7 days for glutamine vs 16.3+/-8.3 days for placebo) (P = 0.002). However, day 28 survival of allogeneic patients was improved by glutamine. No significant differences in TPN use, rate of relapse or progression of malignancy, parenteral antibiotic use, acute or chronic GVHD, or days of hospitalization were observed in either autologous or allogeneic recipients. No toxicity of glutamine was observed. We conclude that oral glutamine can decrease the severity and duration of oropharyngeal mucositis in autologous BMT patients but not in allogeneic BMT patients, possibly due to interaction with methotrexate.
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PMID:Effect of low-dose oral glutamine on painful stomatitis during bone marrow transplantation. 972 68

An 11-item face-to-face survey was conducted in 99 consecutive patients with advanced cancer to determine the prevalence, intensity, reporting and treatment, presumed cause(s), and importance of mouth pain and dryness. Sixteen of the 99 patients (16%) reported experiencing mouth pain at a mean intensity corresponding to 5.5 +/- SD 2.21 on a 0 (no pain) to 10 (worst possible pain) numerical scale, and 88 (88%) patients reported dry mouth at a mean intensity corresponding to 6.2 +/- SD 2.21. Nine (56%) of the 16 patients with mouth pain and 39 (44%) of the 88 patients with mouth dryness reported these symptoms to their attending physician(s). Sixty-nine percent (27/39) of patients who reported having a dry mouth were advised by their physician(s) to pursue one or more treatments. The most common treatments recommended (and frequencies) were drinking water/taking sips of fluid (13), gargling with bicarbonate mouthwash (4), using an artificial saliva spray (4), and using an oral fungal suspension for thrush (4). The most common findings on oral examination included: possible thrush (53 patients), upper and lower dentures (33 patients), and multiple dental restorations (23 patients). The causes most frequently assumed to be responsible were ill-fitting dentures for mouth pain, and medications and possible oral fungal infections for mouth dryness. The mean values given for the importance of the symptoms of mouth pain and dryness relative to other symptoms or problems experienced by the patients were 4.4 +/- SD 1.84 and 3.6 +/- SD 1.67, respectively, on a Likert scale ranging from 1 (not important) to 7 (great importance). Mouth dryness was more frequently reported than mouth pain. The mean rating for the intensity of mouth pain was higher than that for mouth dryness, although both were of moderate importance to patients relative to other symptoms or problems experienced at the time. Patients tended to underreport mouth pain and dryness, and physicians tended to address such complaints inadequately.
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PMID:A survey of mouth pain and dryness in patients with advanced cancer. 1097 82

Oral mucositis is a treatment limiting toxicity of cancer therapy. The purpose of this study was to assess the impact of doxepin oral rinse in the management of oral mucosal pain in cancer patients. Forty-one cancer patients with oral mucosal pain were provided a solution of doxepin (0.5%) for oral rinsing. Oral pain was assessed prior to rinsing, and following rinsing for 4 h using a visual analogue scale (VAS). Adverse effects were recorded. Doxepin rinse resulted in a reduction of pain intensity of more than 50%, with pain relief extending for more than 3 h with pain not returning to baseline 4 h after rinsing. The rinse was tolerated by patients with mucosal damage, and had acceptable taste, and infrequent mucosal stinging with use. Some patients reported sedation after use, likely due to systemic absorption. The results of this single dose trial suggest that topical doxepin rinse has significant ability to provide clinically significant pain relief in patients with mucosal damage with an extended duration of effect.
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PMID:Oral topical doxepin rinse: analgesic effect in patients with oral mucosal pain due to cancer or cancer therapy. 1159 72

Recent research has shown that cancer patients undergoing bone marrow transplantation (BMT) experience moderate to severe mouth pain due to treatment-related mucositis in spite of morphine therapy. Treatment-related emotional distress in BMT patients is also described widely. This study examined several biomedical, psychological and social variables as possible predictors for the intensity of treatment-related mouth pain and anxious mood in 63 cancer patients undergoing BMT or stem cell transplantation (SCT) within a prospective longitudinal design. Biomedical predictors included biomedical risk, mucositis, the mode of transplantation, total body irradiation, age and gender. Psychological predictors were depression (BDI), BMT-related distress, chronic stress and resources in everyday life (KISS), pain-related coping behaviour (KPI-17) and social support (ISSS). Among the social variables we evaluated education, being married and the living situation. Criteria variables were the intensity of mouth pain and anxious mood which were assessed daily by numeric self-rating scales for 24 days after transplantation. Results of stepwise multiple regressions indicated that psychological and social variables were important predictors of mouth pain, besides biomedical variables. Whereas the biomedical variables revealed the most predictive power during the second week after BMT, psychological predictors were more important during the early and late phases of the treatment. Daily anxious mood was best predicted by psychological and social variables. Among the biomedical variables mucositis was most strongly related to mouth pain besides mode of transplantation, risk, TBI and age. Among the psychological variables BMT-related distress was the most important predictor, with resources in private life or at work and pain-related coping modes as further significant predictors. These results imply that relevant predictors should be assessed as high risk factors for an increased vulnerability for treatment-related side-effects before treatment starts indicating an additional offer of psychological treatment in high risk patients.
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PMID:The role of biomedical and psychosocial factors for the prediction of pain and distress in patients undergoing high-dose therapy and BMT/PBSCT. 1189 32

Our objective was to establish the short-term outcomes for successful tobacco cessation of a programme offering UK resident Bangladeshi women chewing paan with tobacco nicotine replacement therapy (NRT) in addition to brief advice and encouragement alone. We used a short-term longitudinal, quasi-experimental study design, in the setting of two local authority housing estates in Tower Hamlets, London. Bangladeshi women volunteers were recruited following presentations to community groups. The volunteers were assigned, after matching for age, number of paan with tobacco chewed daily and medical screening, to receive one of two tobacco cessation interventions (NRT with brief encouragement and advice, and brief advice and encouragement alone). The main outcome measures were changes in tobacco use and nicotine dependence, assessed by questionnaire and intake measures, adverse effects, and withdrawal symptoms. In total, 130 volunteers were recruited. Their mean age was 42.5 years (SD = 11.3). Mean number of paan quid with tobacco chewed daily was 10.7 (SD = 9.3) and the average age of starting to add tobacco to paan was 24 years (SD = 12). Ninety-one percent completed the 4-week trial. We found that 19.5% had stopped tobacco use, of whom 22% had received NRT, and 17% brief advice and encouragement alone. The successful members of the NRT group made a significantly greater reduction in their salivary cotinine scores at final review compared to baseline. Oral pain was reported as a barrier to successful oral tobacco cessation by 62% of the volunteers at final review. We conclude that methods identified as helping tobacco smokers successfully stop smoking can be used with Bangladeshi women chewing paan with tobacco. More research is needed to investigate these short-term outcomes and to explore the particular barriers to successful cessation for this group such as oral pain.
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PMID:Oral tobacco cessation with UK resident Bangladeshi women: a community pilot investigation. 1272 80

This pilot study was designed to compare the efficacy of 0.2% wt/vol chlorhexidine gluconate and 0.15% wt/vol benzydamine hydrochloride oral rinses in alleviating irradiation oropharyngeal mucositis for patients with head and neck cancer. This was a prospective, randomized, and double-blinded study. Fourteen subjects were stratified based on nasopharyngeal cancer and non-nasopharyngeal head and neck cancer, and were randomly assigned to receive oral care protocol either containing with chlorhexidine (n = 7) or benzydamine (n = 7) from the first day to 2 weeks after the completion of radiotherapy. Subjects were evaluated twice weekly through days 1 to 64 using the World Health Organization mucositis scale and the 10 cm visual analogue scale for mouth pain and dysphagia. In the chlorhexidine arm, 4 subjects (57%) had grade 2, and 3 subjects (43%) had grade 3 mucositis. In the benzydamine arm, 5 subjects (71%) had grade 2, and 2 subjects (29%) had grade 3 mucositis (P > .05). The mean area-under-the-curve values of mucositis were 26.5 +/- 13.6 (median 26) and 24.1 +/- 6.1 (median 22) in the chlorhexidine group and benzydamine group, respectively (P > .05). The mean area-under-the-curve values of pain and dysphagia were 70.8 +/- 33 (median 88.5) and 71.5 +/- 39 (median 101), and 62.1 +/- 17.2 (median 72) and 66 +/- 22.3 (median 57.5) in the chlorhexidine and benzydamine groups, respectively (P > .05). A trend has emerged of a lessening of severity of mucositis, pain, and dysphagia for patients with head and neck cancer receiving benzydamine oral rinse. The beneficial effects, however, need to be confirmed in a larger trial.
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PMID:A pilot study of chlorhexidine and benzydamine oral rinses for the prevention and treatment of irradiation mucositis in patients with head and neck cancer. 1700 17

Oral chronic graft-versus-host disease (cGVHD) is a significant and serious complication following allogeneic hematopoietic stem cell transplantation (HSCT). The purpose of this study was to characterize the distribution, type, and extent of lesions and their correlation with patient-reported symptoms such as pain and discomfort. The effect of time since transplantation on these measures was also assessed. Consecutive patients with oral cGVHD referred to the Center for Oral Disease at Brigham and Women's Hospital, Boston, MA, were evaluated over a 2-year period. Subjective data included the responses to 4 targeted symptom questions (yes/no) and a visual analog scale pain score (0-10). Objective data included the location and extent of reticulation, erythema, and ulcerations using a previously published scoring system as well as time since HSCT. Multiple linear regression analyses were performed using SAS. We evaluated 27 patients, for a total of 79 clinic visits (median 2, range: 1-8). The median time since HSCT was 18 months (range: 5-157 months). The buccal and labial mucosa and tongue were the sites of 93% of all ulcerations, 72% of all erythematous lesions, and 76% of all reticular lesions, and were the most frequently affected sites. The gingiva, floor of mouth, and hard and soft palate were infrequently affected. Although uncommon, ulceration of the soft palate was the objective finding most highly correlated with increased pain (P < .0001), and there was a generalized significant trend for increased pain scores with increased extent of ulceration. Overall, 95% of pain scores were <or=5 (scale from 0-10, range: 0-7), with 40% reporting a score of zero. However, 80% admitted to avoiding certain foods because of mouth pain. After controlling for the presence and extent of ulcerations, we found that time since HSCT was inversely related to the pain score (P < .04). There was a statistically significant inverse relationship between the overall presence of ulceration and time since HSCT. We found that oral cGVHD most frequently affects the buccal and labial mucosa and the tongue. The functional impact was significant, as most patients had to restrict oral intake because of discomfort. Both the signs and symptoms associated with oral cGVHD tend to decrease over time. The association between ulceration of the soft palate and patient-reported pain highlights the significance of the location of involvement and the need for targeted approaches to therapy. Our findings, in large part, support the recently introduced National Institutes of Health response criteria for oral cGVHD, which is critical for the conduct of effective and meaningful research in this field; however, prospective application in clinical and investigative settings is necessary for evaluating its utility and efficacy in practice.
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PMID:Clinical evaluation of oral chronic graft-versus-host disease. 1815 67


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