Pain and distress in adults and children undergoing peripheral blood stem cell or bone marrow transplant

To examine the pattern of self-report of pain, opioids received, and nurses' assessments of pain, somatic distress, mood/behavior, cooperation/compliance, and activity in adults and children undergoing stem cell or bone marrow transplant.

Descriptive, longitudinal design; quantitative approach.

A 32-bed bone marrow transplant unit in an urban tertiary-care center.

20 adults (10 males and 10 females) 21-54 years of age and 20 children (10 males and 10 females) 5-17 years of age.

Once daily over a period of 22 days, study participants used the Patient Self-Report of Pain Log to record their pain level and nurses used a Nurse Observations tool to record patient assessments. Researchers used a Patient Record Data form to record demographic data and daily totals of opioids given.

Pain, somatic distress, mood/behavior, cooperation/compliance, activity, and daily totals of opioids received.

Means of adults' and children's daily self-reported pain levels were low to moderate. Means of morphine equivalents/kg that children received daily were between 3 and 5.6 times more than means of morphine equivalents/kg that adults received. Nurses' assessments of somatic distress, mood/behavior, and cooperation/compliance were similar in adults and children. Cooperation/compliance was not related consistently to pain or somatic distress.

Continuous infusion of an opioid with titration or bolus doses as needed allows patients to experience low to moderate pain levels. Although children received far more opioids/kg than adults received, children's and adults' self-reported pain levels were similar. Thus, children may need greater relative amounts of opioids than do adults to maintain a comparable level of comfort.

Administering opioid therapy by continuous infusion with titration or bolus doses as needed was effective in managing pain in transplant recipients. Nurses should be prepared to give children more opioids/kg than adults receive to maintain a comparable level of comfort. Self-reported pain level should not be expected to correlate with level of patient cooperation/compliance with care.