Patient-controlled analgesia and oral mucositis pain in hematological malignancies

Swaetha Koneru, MBBS (Hons), FANZCA, MMed (Hons); Natalie Lukas, BPhty, MBBS (Hons); Matthew Doane, MD, MPH, DABA, FANZCA; Gavin Pattullo, BMedSci, MBBS (Hons), FANZCA, FFPMANZCA; Ross MacPherson, PhD, FANZCA

doi:10.5055/jom.2022.0726

Authors

Swaetha Koneru, MBBS (Hons), FANZCA, MMed (Hons) https://orcid.org/0000-0003-1556-8849
Natalie Lukas, BPhty, MBBS (Hons)
Matthew Doane, MD, MPH, DABA, FANZCA https://orcid.org/0000-0002-1620-9613
Gavin Pattullo, BMedSci, MBBS (Hons), FANZCA, FFPMANZCA https://orcid.org/0000-0001-6640-6714
Ross MacPherson, PhD, FANZCA https://orcid.org/0000-0003-3404-1102

DOI:

https://doi.org/10.5055/jom.2022.0726

Keywords:

acute pain, cancer pain, patient-controlled analgesia

Abstract

Oral mucositis (OM) pain is an anticipated complication of immunosuppressive therapies for hematological malignancies. Opioids are effective for OM-associated pain and dysfunction that is refractory to simple measures. At the study institution, parenteral opioids are preferentially prescribed for the treatment of complicated OM.

This audit explores the efficacy of opioids for the management of OM pain using morphine, oxycodone, and fentanyl patient-controlled analgesia (PCA). Pain scores, opioid consumption, resumption of oral intake, and the duration of admission were retrospectively analyzed from patient records over an 18-month period. Two-thirds of included patients had ceased PCA therapy by day 6, by which time there was a meaningful 35.4 percent reduction in pain scores, with very few side effects reported. Interagent comparison demonstrated no significant differences in mean daily pain scores; however, a larger sample size would facilitate an investigation of clinically significant nuances in treatment differences, if they exist.

Author Biographies

Swaetha Koneru, MBBS (Hons), FANZCA, MMed (Hons)

Royal North Shore Hospital, Sydney, New South Wales, Australia

Natalie Lukas, BPhty, MBBS (Hons)

Royal North Shore Hospital, Sydney, New South Wales, Australia

Matthew Doane, MD, MPH, DABA, FANZCA

Staff Specialist Anesthesiologist, Department of Anaesthesia and Pain Management, Royal North Shore Hospital, Sydney, New South Wales, Australia; Departmental Head, Academics & Research, Royal North Shore Hospital, Sydney, New South Wales, Australia; Department Head & Conjoint Senior Lecturer, Academics & Research, Sydney University Medical School, University of Sydney, Sydney, New South Wales, Australia

Gavin Pattullo, BMedSci, MBBS (Hons), FANZCA, FFPMANZCA

Director, Acute Pain Service, Department of Anaesthesia and Pain Management, Royal North Shore Hospital, Sydney, New South Wales, Australia; Clinical Senior Lecturer, Anaesthesia, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia

Ross MacPherson, PhD, FANZCA

Clinical Professor, Senior Staff Specialist Anesthesiologist, Department of Anaesthesia and Pain Management, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia

References

Riley P, Glenny AM, Worthington HV, et al.: Interventions for preventing oral mucositis in patients with cancer receiving treatment: Cytokines and growth factors. Cochrane Database Syst Rev. 2017; 11: CD011990.

The Oral Cancer Foundation: Mucositis. Available at https://oralcancerfoundation.org/complications/mucositis/. Accessed December 2019.

Lalla RJ, Sonis ST, Peterson DE: Management of oral mucositis in patients with cancer. Dent Clin North Am. 2008; 52(1): 61-77.

Maria OM, Eliopoulos N, Muanza T: Radiation-induced oral mucositis. Front Oncol. 2017; 7: 1-23.

Clarkson JE, Worthington HV, Furness S, et al.: Interventions for treating oral mucositis for patients with cancer receiving treatment. Cochrane Database Syst Rev. 2004; CD001973.

Pillitteri LC, Clark RE: Comparison of a patient-controlled analgesia system with continuous infusion for administration of diamorphine for mucositis. Bone Marrow Transplant. 1998; 22(5): 495-498.

New South Wales Agency for Clinical Innovation: Patient controlled analgesia chart (adult) explanatory notes. 2017. Available at https://www.aci.health.nsw.gov.au/resources/pain-management/acute-sub-acute-pain/acute-pain-forms. Accessed December 2019.

Faculty of Pain Medicine: Opioid calculator. Available at http://www.opioidcalculator.com.au/. Accessed December 2019.

Farrar JT, Young JP, LaMoreaux L, et al.: Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001; 94: 149-158.

Younger J, McCue R, Mackey S: Pain outcomes: A brief review of instruments and techniques. Curr Sci Inc. 2009; 13(1): 39-43.

Hill HF, Iverson K, Mackie AM, et al.: Patient-controlled analgesic administration. A comparison of steady-state morphine infusions with bolus doses. Cancer. 1991; 67(4): 873-882.

Mackie AM, Coda BC, Hill HF: Adolescents use patient-controlled analgesia effectively for relief from prolonged oropharyngeal mucositis pain. Pain. 1991; 46(3): 265-269.

Karanges EA, Blanch B, Buckley NA, et al.: Twenty-five years of prescription opioid use in Australia: A whole-of-population analysis using pharmaceutical claims. Br J Clin Pharmacol. 2016; 82: 255-267.

Gisev N, Campbell G, Lalic S: Current opioid access, use, and problems in Australasian jurisdictions. Curr Addict Rep. 2018; 5: 464-472.

Coda BA, O’Sullivan B, Donaldson G, et al.: Comparative efficacy of patient-controlled administration of morphine, hydromorphone, or sufentanil for the treatment of oral mucositis pain following bone marrow transplantation. Pain. 1997; 72(3): 333-346.

Rubenstein EB, Peterson DE, Schubert M, et al.: Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis. Cancer. 2004; 100(9): 2026-2046.

Lemberg KK, Heiskanen T, Kontinen VK, et al.: Pharmacology of oxycodone: Does it explain why oxycodone has become a bestselling strong opioid? Scand J Pain. 2009; 1: S18-S23.

Lalovic B, Kharasch E, Hoffer C, et al.: Clin Pharmacol Ther. 2006; 79: 461-479.

Kalso E: How different is oxycodone from morphine? Pain. 2007; 132: 227-228.

Krupski MC, Ding L, Lane A, et al.: How much does it hurt? New approaches for grading and scoring mucositis pain are needed. Biol Blood Marrow Transplant. 2018; 24: S119-S290.

Sonis ST, Eilers JP, Epstein JB, et al.: Validation of a new scoring system for the assessment of clinical trial research of oral mucositis induced by radiation or chemotherapy. Cancer. 1999; 85(10): 2103-2113.