The BMT program is not only dedicated to effective clinical treatments for its patients, but also to improving their quality of life. Pain management is one area that is actively being pursued. Recently, we developed a research project to not only improve the management of pain experienced by the patients, but also to provide a means of controlling pain using oral medications thus expediting their transition to home.
Patients and families were taught to assess the pain that the patients were experiencing and express the level of pain into a rating scale used by the nursing staff. This not only allowed families to participate in pain control, but it also prepared families to utilize these skills to administer pain medications at home. When the patients began to recover, the intravenous (IV) pain medications were switched to oral forms of the drug that allowed the patients to be discharged earlier from the hospital. Families could then use the assessment skills acquired during the hospitalization to slowly reduce the doses without the fear of subjecting the child to unnecessary pain. This allowed them to taper the drugs more efficiently and ultimately stop the drugs earlier. This prevents prolonged narcotic use while ensuring that the transplant period is comfortable and pain free.
Justin K. is a bone marrow transplant patient that needed narcotic therapy. Transplant recipients often develop mucus membrane inflammation especially in their mouth, throat and abdomen because of the chemotherapy or radiation therapy used in transplant. It is more severe in autologous transplant patients and those that are heavily pre-treated. Both of these were the case with Justin.
As part of this study, Justin received a twice-daily assessment of his pain by the nursing staff. This ongoing and timely assessment helps to grade pain efficiently and allows for oral medications (when tolerated by the patient) to be administered. The oral medications were gradually tapered off and then stopped as Justin got better. The study showed that narcotic use was decreased by 27% from previous controls and patients came off their IV narcotics much earlier, by 10 to 14 days after transplant.
The pain protocols effectively managed Justin’s pain, allowed him to recuperate pain free and prevented narcotic overuse. He is now 18 months post-transplant and looking forward to starting second grade. It is efforts such as these which continue to improve the care of our patients, not only to treat their disease, but also to maintain a high quality of life. Read more about Justin.