LP-03. Pain syndrome and mental disorders caused by mucositis at an early stage after auto-HSCT in patients with multiple myeloma

Summary

Oral mucositis during neutropenia at the early stages after autologous hematopoietic stem cell transplantation (auto-HSCT) is diagnosed in 75-100% of patients. The pronounced pain syndrome in presence of oral mucosa lesions requires pain management and correction of emerging mental disorders. Our objective was to study the characteristics of pain syndrome caused by oral mucositis during post-transplantation neutropenia, and mental disorders formed against this background in patients with multiple myeloma (MM).

Materials and methods

We included 31 patients with MM (24 women and 7 men, median age was 51 years) after auto-HSCT with high-dose melphalan (140-200 mg/m²) conditioning performed at the National Medical Research Center of Hematology from January to July 2023. Pain syndrome assessment and psychometric testing utilized the pain catastrophizing questionnaire, the McGill pain questionnaire, the Beck Depression and Beck Anxiety Inventory (BDI and BAI) as well as QAA-25 (quantitative assessment of the adherence to treatment).

Results

Severity of oral mucositis was determined by the practical recommendations for mucositis treatment and prevention (Semiglazova et al., 2021). Hence, 23 patients (74%) had lesions on the oral mucous membrane, i.e., 13 cases with grade I; six patients with grade II; 3 cases with grade III, and 1 patient with grade IV mucositis. The remaining 8 patients (26%) had no signs of mucositis during the myelotoxic agranulocytosis. Among 10 patients with pain syndrome (grades II-IV mucositis), four persons classified their pain as “moderate” or “severe” according to the McGill questionnaire, which corresponds to grade III-IV lesions. The other six patients with grade II mucositis rated their pain as “mild.” The affective scale of this questionnaire indicated that 60% with grade II mucositis had no significant emotional pain response, whereas 40% of the patients with grades III-IV showed an intense emotional reaction. Upon evaluation with pain catastrophizing scale, the key scores were assigned to “obsession” and “helplessness”, with lower scores for the “exaggeration” parameter. A significant correlation between pain and depression was identified via the BDI scale. Conversely, the BAI indicated anxiety levels did not surpass the significant thresholds. According to the QAA-25 questionnaire, among those with pain syndrome, only one patient with grade II mucositis demonstrated high adherence to treatment, while 3 patients had a medium degree of adherence, and another 6 had a low degree of adherence. The adherence levels among the patients without pain syndrome were as follows: 9, high levels; 8, medium level, and 4 patients had low adherence to treatment.

Conclusions

Oral mucositis developed in 74% of patients with MM during neutropenia at the early stages after auto-HSCT. Of them, 13% had III-IV degree lesions accompanied by pain syndrome. Severe mucositis with pain syndrome correlates closely with depressive disorders and the cognitive and behavioral aspects of the pain catastrophizing.

Keywords

Hematopoietic stem cell transplantation, multiple myeloma, oral mucositis.