Adolescents use patient-controlled analgesia effectively for relief from prolonged oropharyngeal mucositis pain

Mackie, Adam M.; Coda, Barbara C.; Hill, Harlan F.

doi:10.1016/0304-3959(91)90109-b

Cited by 71 publications

(55 citation statements)

References 12 publications

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“…All seven studies found PCA to be an effective mode of opioid administration in the management of mucositis pain. Studies comparing PCA to a continuous infusion reported that total opioid use was lower in patients receiving PCA [43,56,67]. One study examined the use of a PCA system where patients adjusted the rate of a continuous morphine infusion to increase or decrease their plasma morphine concentration.…”

Section: Patient-controlled Analgesiamentioning

confidence: 99%

Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients

Saunders

Epstein²,

Sharon

et al. 2013

Support Care Cancer

148

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Purpose The aim of this project was to develop clinical practice guidelines on the use of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the prevention and management of oral mucositis (OM) in cancer patients. Methods A systematic review of the available literature was conducted. The body of evidence for the use of each agent, in each setting, was assigned a level of evidence. Based on the evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, or no guideline possible. and doxepin rinse in head and neck radiation therapy (H&N RT) patients. Recommendations were developed against the use of topical antimicrobial agents for the prevention of mucositis. These included recommendations against the use of iseganan for mucositis prevention in HSCT and H&N RT and against the use of antimicrobial lozenges (polymyxintobramycin-amphotericin B lozenges/paste and bacitracinclotrimazole-gentamicin lozenges) for mucositis prevention in H&N RT. Recommendations were developed against the use of the mucosal coating agent sucralfate for the prevention or treatment of chemotherapy-induced or radiation-induced OM. No guidelines were possible for any other agent due to insufficient and/or conflicting evidence. Conclusion Additional well-designed research is needed on prevention and management approaches for OM.

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Section: Patient-controlled Analgesiamentioning

confidence: 99%

Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients

Saunders

Epstein²,

Sharon

et al. 2013

Support Care Cancer

148

View full text Add to dashboard Cite

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“…Furthermore, the study design of mixed paired and unpaired observations decreases uneven distribution of unknown confounders. Although our study is of comparable size as other trials with PCA [9][10][11][12][13][14][15][16][17][18][19][20], a larger trial will be needed to demonstrate whether the use of PCA in vaso-occlusive crisis will result in a reduction in length of hospital stay and complications such as acute chest syndrome. Second, the PCA design of our study made a complete blinding of the study impossible and could therefore be subject to bias.…”

Section: Side Effects and Adverse Eventsmentioning

confidence: 94%

“…A possible explanation for this effect, which also could explain the low morphine consumption in the PCA-treated patients in the present study, may be that a more rapid analgesic effect is induced by bolus administration of morphine rather than CI. However, comparative trials with PCA in patients with other causes of pain have demonstrated conflicting results on the cumulative morphine consumption [9][10][11][12][13][14][15][16][17][18][19][20].…”

Section: Side Effects and Adverse Eventsmentioning

confidence: 99%

Patient‐controlled analgesia versus continuous infusion of morphine during vaso‐occlusive crisis in sickle cell disease, a randomized controlled trial

et al. 2007

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Intravenous morphine is the treatment of choice for severe pain during vaso‐ occlusive crisis in sickle cell disease (SCD). However, side effects of morphine may hamper effective treatment, and high plasma levels of morphine are associated with severe complications such as acute chest syndrome. Furthermore, adequate dosing remains a problem since no objective measurement of pain severity exists and analgesia should be titrated upon the patient's reported pain. Patient‐controlled analgesia (PCA) may therefore be an interesting alternative since patients can titrate the level of analgesia themselves. In this randomized controlled study, the efficacy of intravenous morphine administration with PCA was compared with continuous infusion (CI) of morphine in patients with SCD during vaso‐occlusive crisis. Twenty five consecutive episodes of vaso‐occlusive crisis in 19 patients with SCD were included in the study. Patients in the PCA‐group had a markedly and significant lower mean and cumulative morphine consumption when compared with the patients in the CI‐group (0.5 mg/hr versus 2.4 mg/hr (P < 0.001) and 33 mg versus 260 mg (P = 0.018, respectively). The mean daily pain scores were comparable (4.9 versus 5.3). The lower mean and cumulative morphine consumption in the PCA‐group led to significant less nausea and constipation during treatment when compared with the CI‐group (area under the curve, respectively, 11 versus 18 (P = 0.045) and 30 versus 45 (P = 0.021). Furthermore, a nonsignificant reduction in the duration of hospital admission of 3 days was observed in the PCA‐group. PCA results in adequate pain relief at a much lower morphine consumption and should considered to be the first choice in morphine administration to sickle cell patients admitted with vaso‐occlusive crisis. Am. J. Hematol., 2007. © 2007 Wiley‐Liss, Inc.

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“…In patients aged 12 to 18 years, morphine by PCA or continuous infusion provided similar analgesia, but morphine intake and opioid-related side effects were lower in the PCA group (Mackie et al, 1991 Level II). A systematic review (which included this study and additional adult studies) found no difference in pain control between PCA and continuous infusion, but reduced hourly opioid requirement and shorter duration of pain with PCA (Clarkson et al, 2007 Level I).…”

Section: Treatment-related Painmentioning

confidence: 98%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

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Objectives: This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain. Design: A pragmatic, multicentre, randomised, assessor‐blinded, equivalence and non‐inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department. Setting, participants: Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain, migraine, or ankle sprain, and with a pain score on a 10‐point verbal numerical rating scale (VNRS) of at least 4. Main outcome measures: The primary outcome measure was pain at one hour (T1). Clinically relevant pain relief was defined as achieving a VNRS score below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units. Results: 1964 patients were assessed between January 2010 and December 2011; 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). Equivalence and non‐inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention‐to‐treat and per protocol (PP) analyses, except in the PP equivalence testing of the ankle sprain group. 15.6% of patients had clinically relevant pain relief and 36.9% had statistically relevant pain relief at T1; there were no between‐group differences. Conclusion: The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. Acupuncture is a safe and acceptable form of analgesia, but none of the examined therapies provided optimal acute analgesia. More effective options are needed. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12609000989246.

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Adolescents use patient-controlled analgesia effectively for relief from prolonged oropharyngeal mucositis pain

Cited by 71 publications

References 12 publications

Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients

Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients

Patient‐controlled analgesia versus continuous infusion of morphine during vaso‐occlusive crisis in sickle cell disease, a randomized controlled trial

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

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