Managing Pain
Pain associated with oral mucositis (OM) can range from mild to excruciating;
many patients have described the pain of severe OM as “off the scale.” Patients
can help manage OM pain by maintaining a clean, healthy mouth.1 Physicians
can help patients manage OM pain by assessing the pain and then prescribing
appropriate treatment such as systemic analgesics.2
Frequent assessment of the patient’s oral status is important to determine
when OM pain begins, the location of the pain and the nature of the pain. This
will help decide the proper treatment for the pain.2
There are a variety of palliative analgesic options, including topical and
systemic analgesics. The latest treatment guidelines do not recommend
topical analgesics, however, because they have not been proven effective in
clinical trials.3
Clinical practice guidelines recommend systemic patient-controlled agalgesia
for relieving severe pain.2,3 Additionally, the World
Health Organization’s (WHO) Pain Management Ladder is an effective guide
for OM pain management. It calls for managing the patient’s analgesia
dosing on the basis of time rather than on increasing pain. The first step
of the ladder is nonopioid analgesics. When these fail to provide relief, the
next step is mild opioids. The final step is strong opioids. Morphine is recommended
for helping hematopoietic stem-cell transplantation patients relieve severe
OM pain.2
The medications included along the WHO ladder are nonsteroidal anti-inflammatory
drugs, acetaminophen, opioids and adjuvant medications. Typical adjuvant medications
are tricyclic antidepressants and other central reacting analgesics.2
These agents also can promote sound sleep, which is a critical component of
the patient’s psychological well-being and pain control.2
In addition to medications, other techniques may help patients cope with
their pain. These strategies include hypnosis, acupuncture, transcutaneous
nerve stimulation, relaxation, imagery, cognitive behavioral therapy and massage
therapy.2
To learn about OM treatments on the horizon, visit the Latest Developments page.
References
- Eilers J. When the mouth tells us more than it says-the impact of mucositis
on quality of life. Oncology Supportive Care Quarterly 2004; 1:31-43.
- Epstein JB, Schubert MM. Managing pain in mucositis. Semin Oncol Nurs 2004;
20:30-7.
- 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; 100:2026-46.
