Pain Following Hematopoietic Stem Cell Transplant: A Prospective Observational Study

Introduction: Pain following hematopoietic stem cell transplantation (HSCT) is caused by several factors: chemotherapy, radiotherapy, infections, GVHD, and medications. Difficulties in defining and accurately diagnosing pain symptoms can lead to delays in starting effective analgesia and poorer quality of life. Pain syndromes following HSCT have not been well-studied and the actual prevalence is unknown. The goal of this study was to determine incidence, severity, and the time course of pain following HSCT. 

Method: We designed a prospective, observational study which enrolled 100 patients undergoing HSCT (60% autologous, 40% allogeneic. 19 unrelated, 13 sibling, 8 double cord. Myeloma 44%, leukemia 29%, lymphomas 26%, and aplastic anemia 1%). Patients enrolling on the study completed 5 questionnaires before HSCT and 1, 2, 3, 6, 9, and 12 months after HSCT. The questionnaires were the Brief Pain Inventory (BPI), the EORTC Quality of Life Questionnaire-Chemotherapy Induced Peripheral Neuropathy (EORTC-CIPN), the Muscle and Joint Measure (MJM), the MD Anderson Symptom Index – Graft-versus-Host Disease module (MDASI-cGVHD), and the Hospital Anxiety and Depression Scale (HADS).

Results:  At the 9-month review, we found that there was a significant increase in pain reported after allogeneic HSCT compared to pre-HSCT. (71% increase at 3 months; p=0.01). This difference was independent of conditioning regimen, disease or GVHD. For autologous HSCT, there was an increase in reported neuropathic symptoms (47% increase at 3 months; p=0.02). We also found and increase in muscle cramping and spasms late after HSCT; both autologous and allogeneic (99% increase at 9 months; p=0.03). Muscle cramping interfered with sitting, standing and physical activity (21% at 6 months; p=0.04 and 136% at 9 months; p=0.04). The increase in muscle cramping symptoms was independent of conditioning regimen, disease or GVHD.  

Conclusions: Our current review of this study reveals that pain and muscle cramping is a significant symptom that develops after both allogeneic and autologous HSCT. This appears to be independent of conditioning regimen, disease or GVHD.