Drug use evaluation of opioid analgesics in pain management among patients with hematopoietic stem cell transplantation
Hyun Jin Oh1, So Yeon Hong1, Young Mi Jeong1, Kyung Suk Choi1, Eunsook Lee1, Euni Lee2, Yu Jung Kim3, Soo-Mee Bang3
1Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, 2College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 3Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
Correspondence to: Soo-Mee Bang, M.D., Ph.D.
Division of Hematology-Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi 13620, Korea
E-mail: smbang7@snu.ac.kr
Published online: September 4, 2020.
© The Korean Journal of Hematology. All rights reserved.

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Background: Hematopoietic stem cell transplantation (HSCT) patients usually experience mucositis, musculoskeletal pain associated with high-dose chemotherapy, radiation, post-HSCT infection, or graft-versus-host disease. Pain management is important for the patients’ quality of life. We evaluated appropriate opioid analgesic use in HSCT patients to propose effective pain management strategies.
Methods: A retrospective analysis was conducted using electronic medical records of adult patients with HSCT treated with opioids for moderate to severe pain at Seoul National University Bundang Hospital. The numeric rating scale (NRS) was used in pain management. NRS scores of 4-10 correspond to moderate to severe pain. Appropriate opioid analgesic use was evaluated following published cancer pain management guidelines.
Results: In total, 119 cases were evaluated, including 369 episodes of moderate to severe pain. Mucositis-related, musculoskeletal, and headache pain occurred in 62.6%, 25.8%, and 6.0% of episodes, respectively. Frequently used opioids were intravenous tramadol (84.9%), fentanyl patch (73.9%), and intravenous morphine sulfate (68.9%). Intravenous and topical administrations were used for mucosal pain. In total, 95.0% of patients received appropriate short-acting opioids for initial pain management, 80.5% received appropriate doses of short-acting opioids, appropriate opioids dose adjustment was done after first assessment in 95.5% of patients, and 85.6% were converted to appropriate long-acting opioids.
Conclusion: Short-acting opioid analgesic use for initial pain management and dose adjustment after assessment were appropriate. However, initial and conversion dosages recommended by guidelines may be difficult to implement considering the severity of HSCT patients. Pain management guidelines specific for HSCT patients should be developed in the future.
Keywords: Hematopoietic stem cell transplantation, Opioid, Analgesics, Pain management


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