Pain Management for Children during Bone Marrow and Stem Cell Transplantation

Vasquenza, Kelly J.; Ruble, Kathy; Chen, Allen; Billett, Carol; Kozlowski, Lori J.; Atwater, Sara; Kost‐Byerly, Sabine

doi:10.1016/j.pmn.2014.05.005

Cited by 24 publications

(59 citation statements)

References 37 publications

(38 reference statements)

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“…Researches, conducted in the United States, have revealed incidences of mucositis above 90.0% in children submitted to hematopoietic stem cell transplantation (5,9) . According to the localizations of the pains of the children participating in the research presented here, with prevalence in the hypo pharyngeal region, mouth, including the abdomen and epigastric regions, in the category of 'others', it can be reiterated the problem of the mucositis in the transplant.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of pain in children submitted to hematopoietic stem cell transplantation

Sampaio¹,

Mercês²,

Tacla³

et al. 2019

Rev Rene

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Objective: to evaluate pain in children undergoing transplantation of hematopoietic stem cells. Methods: longitudinal and analytical research with children hospitalized for transplant of hematopoietic stem cells with Faces Pain Scale Revised, every four hours from hospital admission to hospital discharge analyzed with relative absolute frequency and chi-square test. Results: nine children aged four to nine years old were evaluated, totaling 1,095 ratings in 23.4% were reported with some pain score; of these, 38.9% were in hypo pharynx region; 78.8%, moderate pain. The chi-square showed significance between pain scores weeks post-transplantation and pain existence among the analyzed children. Conclusion: although the pain has not affected large proportion of children, moderate and strong pain covered around 80.0% of complaints along the hematopoietic stem cell transplantation process. Thus, it is suggested that the evaluation of pain is one of the signs to be inserted in the protocols of nursing interventions in this context of caring.

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Section: Discussionmentioning

confidence: 99%

“…In the initial phase, it presents edema and pain, and when advanced, ulcerations and bleeding. This process causes intense pain, with consequent need for continuous analgesic medication (5,(8)(9) .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of pain in children submitted to hematopoietic stem cell transplantation

Sampaio¹,

Mercês²,

Tacla³

et al. 2019

Rev Rene

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“…En pacientes que pasaron por trasplante de células madre hematopoyéticas (TCMH) el cuadro de dolor puede estar aún más agudizado como resultado de los efectos colaterales de los quimioterápicos y complicaciones durante el período post-trasplante. Entre dichos efectos, las complicaciones gastrointestinales, como mucositis oral, enfermedad veno-oclusiva y Enfermedad de Injerto Contra Huésped (EICH) (8) .…”

Section: Introductionunclassified

“…La finalidad del TCMH es regular la hematopoyesis a través de la sustitución de las células enfermas del individuo por células hematopoyéticas saludables del donador (10) . A pesar de sus beneficios, la vulnerabilidad de esos pacientes después de trasplante les vuelve susceptibles a múltiples comorbilidades, llevándoles a un cuadro doloroso y debilitante, que puede incluir los siguientes síntomas: náusea, vomito, EICH, infecciones, complicaciones gastrointestinales y mucositis (8) .…”

Section: Introductionunclassified

“…Estudios realizados con pacientes pediátricos apuntan que el auto-relato del dolor en el período post-TCMH puede variar entre 43% y 69%, teniendo en cuenta la mucositis oral y demás complicaciones del sistema gastrointestinal como sus principales causas (8) . Gestionar el dolor en este contexto es una tarea difícil, ya que depende principalmente de la resolución del factor causal y del empeño de los profesionales para utilizar diferentes estrategias de gestión, considerando el bienestar del niño o adolescente, tal como demuestra el estudio cualitativo en el que niños y padres relatan la necesidad de mejorar la gestión del dolor, pues consideraron que hubo fallas durante la evaluación y orientaciones sobre la terapia farmacológica por parte del equipo de enfermeros (11) .…”

Section: Introductionunclassified

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Gestión del dolor de niños y adolescentes durante el período post- trasplante de células-tronco hematopoyéticas: una revisión integradora

Sousa

Mercês

Silva

et al. 2018

eglobal

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Este estudo teve como objetivo identificar, em produções científicas, as estratégias utilizadas para o gerenciamento da dor de crianças e adolescentes no período pós-transplante de células-tronco hematopoéticas. Para tanto, utilizou-se como metodologia a revisão integrativa da literatura a partir das seguintes fontes de informação: MEDLINE, LILACS, ScIELO, BDENF, SCOPUS, Web of Science e Plataforma de periódicos CAPES. Os descritores utilizados para a busca foram: pain, pain management; pain pediatric; hematopoietic stem cell transplantation; bone marrow transplantation; e as siglas BMT e HSCT. A amostra final foi constituída por sete artigos científicos, com base nos critérios de inclusão e exclusão. As estratégias de gerenciamento da dor identificadas nos estudos foram: analgesia controlada pelo paciente, analgesia controlada pelo cuidador; terapias complementares, tais como: aromaterapia; fototerapia extra oral com diodos infravermelhos; aplicação de calor; crioterapia; música, jogos, massagem; e indicadores de resultados para monitorar a eficácia do gerenciamento da dor. Concluiu-se que as estratégias mais eficazes foram: analgesia controlada pelo paciente ou cuidador e o indicador de resultados que possibilitou o controle da dor em tempo hábil. Não obstante, é importante ressaltar que outros estudos são necessários para avaliar a eficácia das estratégias complementares citadas. Este estudio tuvo como objetivo identificar, en producciones científicas, las estrategias utilizadas en la gestión del dolor de niños y adolescentes durante el período post trasplante de células-tronco hematopoyéticas. Para ello, utilizó como metodología la revisión integradora de la literatura a partir de las siguientes fuentes de información: MEDLINE, LILACS, ScIELO, BDENF, SCOPUS, Web of Science y Plataforma de periódicos CAPES. Se utilizó como descriptores: pain, pain management; pain pediatric; hematopoietic stem cell transplantation; bone marrow transplantation; y las siglas BMT e HSCT. La muestra final fue constituida por siete artículos científicos, a partir de los criterios de inclusión y exclusión. Las estrategias para la gestión del dolor identificadas en los estudios fueron: analgesia controlada por el paciente, analgesia controlada por el cuidador; terapias complementarias, tales como: aromaterapia; fototerapia extra oral con diodos infrarrojos; aplicación de calor; crioterapia; música, juegos, masaje; e indicadores de resultados para medir la eficacia de la gestión del dolor. La conclusión es que las estrategias más eficaces fueron: analgesia controlada por el paciente o cuidador y el indicador de resultados que posibilitó el control del dolor en tiempo hábil. Sin embargo, es necesario hacer hincapié en la importancia de invertir en otros estudios para evaluación de la eficacia de dichas estrategias complementarias. This study aims at the identification of strategies used for pain management in children and teenagers during the hematopoietic stem cells post-transplant period. An integrative review of literature was employed as methodology for this work, using as sources of information the following databases: MEDLINE, LILACS, SCIELO, BDENF, SCOPUS, Web of Science and CAPES periodic portal. The terms used for searching were: pain, pain management, pain pediatric, hematopoietic stem cell transplantation, bone marrow transplantation; and the acronyms BMT and HSCT. The final sample comprised seven articles, based on inclusion and exclusion criteria. The identified strategies for pain management in the studies were: patient-controlled analgesia, caregiver-controlled analgesia; complementary therapies such as: aromatherapy, extra-oral phototherapy with infrared diodes, heat application, cryotherapy, music, games, massage; and results indicators, in order to monitor the pain management effectiveness. As a conclusion, the most effective strategies were: patient or caregiver-controlled analgesia, and the results indicators that allowed pain management in adequate time. Nevertheless, it is important to highlight that other studies are necessary to evaluate the effectiveness of the complementary strategies employed.

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The management of pain during pediatric hematopoietic stem cell transplantation: A qualitative study of contextual factors that influenced pain management practices

Plummer,

McCarthy,

Newall

et al. 2023

Pediatric Blood & Cancer

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BackgroundChildren hospitalized following hematopoietic stem cell transplantation (HSCT) experience complex and prolonged pain in response to the intensity of this treatment.ObjectivesTo describe how pain was managed for children during HSCT therapy and how contextual factors related to the clinical environment influenced healthcare providers' and parents' pain management practices.MethodsA qualitative case study was conducted and involved semi‐structured interviews at two time points following transplantation (30 and 90 days) with parents (n = 10) and naturalistic observations of pain‐related care provided to children (n = 29) during HSCT therapy by their healthcare providers (n = 10). Semi‐structured interviews were also conducted with healthcare providers (n = 14).ResultsThe effectiveness of pain management interventions was hindered by the multifactorial nature of pain children experienced, a gap in the provision of psychosocial interventions for pain and a lack of evidence‐based guidelines for the sustained, and often long‐term, administration of opioids and adjuvant medications. Misconceptions were demonstrated by healthcare providers about escalating pain management according to pain severity and differentiating between opioid tolerance and addiction. Parents were active in the management of pain for children, especially the provision of nonpharmacological interventions. Collaboration with external pain services and the impact of caring for children in protective isolation delayed timely management of pain.ConclusionsThere is a pressing need to create evidence‐based supportive care guidelines for managing pain post transplantation to optimize children's relief from pain. If parents and children are to be involved in managing pain, greater efforts must be directed toward building their capacity to make informed decisions.

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Pain Management for Children during Bone Marrow and Stem Cell Transplantation

Cited by 24 publications

References 37 publications

Evaluation of pain in children submitted to hematopoietic stem cell transplantation

Evaluation of pain in children submitted to hematopoietic stem cell transplantation

Gestión del dolor de niños y adolescentes durante el período post- trasplante de células-tronco hematopoyéticas: una revisión integradora

The management of pain during pediatric hematopoietic stem cell transplantation: A qualitative study of contextual factors that influenced pain management practices

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