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      Cancer Treatment-Induced Mucositis Pain: Strategies for Assessment and Management

      Therapeutics and Clinical Risk Management

      Dove Medical Press

      mucositis, pain management, stomatitis, assessment

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          Abstract

          Mucositis pain is a major clinical problem associated with cancer treatment. Mucosal tissue injury is a dose-limiting side effect and also limits nutritional intake and oral function, resulting in weight loss and nutritional deficits for many patients. The pathophysiology of mucositis is thought to be a complex array of cytokine-mediated events, which begins with mucosal atrophy and eventually leads to the painful ulceration of the mucosa. This article reviews current research related to pain management for mucositis. Effective treatment for mucositis pain must be targeted at the various factors involved in the pain experience. Although a number of interventions aimed to prevent and treat mucositis have been studied, there is little evidence to recommend any one treatment modality. While current strategies for pain management rely on general treatment for acute pain, research developments are aimed at targeting the specific receptors and enzymes involved in mucositis. As these breakthroughs become available clinically, thorough assessment and timely directed interventions must be implemented in order to limit patient distress from mucositis. This article presents an assessment tool specific to mucositis pain, including physical, functional, and pain parameters.

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          Most cited references 43

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          Mucositis as a biological process: a new hypothesis for the development of chemotherapy-induced stomatotoxicity.

          Mucositis induced by antineoplastic drugs is an important, dose-limiting and costly side effect of cancer therapy. The ulcerative lesions which result are frequent systemic portals of entry for microorganisms which inhabit the mouth and consequently are often sources of systemic infection in the myelosuppressed patient. A number of clinical observations and the inconsistency of responses to a broad range of treatment modalities suggests a physiological complexity to mucositis which has not previously been comprehensively considered. We now propose a hypothesis as to the mechanism by which mucositis develops and resolves, which is based on four phases: an initial inflammatory/vascular phase; an epithelial phase; an ulcerative/bacteriological phase; and a healing phase. The role of cytokines as initiators and ampliers of the process is discussed, as is the potential influence of genetic factors in establishing risk and modifying the course of stomatotoxicity.
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            A biological approach to mucositis.

            Oral mucositis is a common toxicity associated with both antineoplastic head and neck radiation and chemotherapy. In addition to exacting a terrible symptomatic toll, mucositis is associated with a number of adverse health and economic outcomes. Furthermore, its presence may compromise the use of optimum agents, doses, or dosing schedules. The current lack of an approved, effective mucositis treatment has sparked interest in the development of interventions that are based on the biological mechanisms that lead to mucosal injury. While our understanding of the molecular and cellular pathways leading to mucositis is still evolving, it is now clear that the condition represents the culmination of a dynamic sequence of events that involve all cells and tissues in the mucosa. Five phases characterize the pathophysiologic progression that results in mucositis: initiation, upregulation and message generation, signaling and amplification, ulceration, and healing. Each phase offers a potential target for therapeutic intervention.
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              Randomized clinical trial of the effectiveness of 3 commonly used mouthwashes to treat chemotherapy-induced mucositis.

              To test the effectiveness of 3 mouthwashes used to treat chemotherapy-induced mucositis. The mouthwashes were as follows: salt and soda, chlorhexidine, and "magic" mouthwash (lidocaine, Benadryl, and Maalox). A randomized, double-blind clinical trial was implemented in 23 outpatient and office settings. Participants were monitored from the time they developed mucositis until cessation of the signs and symptoms of mucositis, or until they finished their 12-day supply of mouthwash. All participants followed a prescribed oral hygiene program and were randomly assigned a mouthwash. Nurses used the Oral Assessment Guide for initial assessment and taught patients how to assess their own mouths, then phoned the patients every other day to gather status reports. In 142 of 200 patients, there was a cessation of the signs and symptoms of mucositis within 12 days. No significant differences in time for the cessation of the signs and symptoms were observed among the 3 groups. Given the comparable effectiveness of the mouthwashes, the least costly was salt and soda mouthwash.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                September 2006
                September 2006
                : 2
                : 3
                : 251-258
                Affiliations
                Oregon Health Sciences University Portland OR, USA
                Author notes
                Correspondence: Debra J Harris, Nursing Practice & Education Coordinator, OHSU, Portland, OR 97239, USA Tel +1 11 203 589 1895 Email debrajean_harris@ 123456yahoo.com
                Article
                1936261
                18360600
                © 2006 Dove Medical Press Limited. All rights reserved
                Categories
                Review

                Medicine

                mucositis, assessment, stomatitis, pain management

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