Öz
Amaç: Kemik iliği aspirasyon ve biyopsisi (KİAB) hematolojik hastalıkların tanısında
kullanılan önemli bir yöntemdir. İşlem sonrası en sık bildirilen yakınma ağrı olmakla birlikte;
bu ağrı hastalar tarafından çok farklı düzeylerde tariflenmektedir. Çalışmamızda özellikle
durumluk ve süreklilik anksiyetesini merkeze alarak, bu ağrıyı etkileyen faktörleri araştırmak
istedik.
Gereç ve Yöntem: Merkezimizde KİAB planlamış 110 hasta, uygun şekilde bilgilendirilerek
işlemden hemen önce Durumluk ve Süreklilik Anksiyete Ölçeği (State Trait Anxiety
Inventory, STAI) ile değerlendirildi. Bu Likert tipi ölçekde “Durumluk Kaygı Ölçeği”,
katılımcıların “o anda” nasıl hissettiklerini sorarak mevcut kaygı durumunu değerlendirir.
“Süreklilik Kaygı Ölçeği” ise genel güven, sakinlik ve güvenlik durumları dahil olmak üzere
“kaygı eğiliminin” nispeten istikrarlı yönlerini değerlendirir. Biyopsi işlemi tamamlandıktan
hemen sonra da hastaların ağrı düzeyleri “vizüel analog skala” ile değerlendirildi.
Bulgular: Hastaların çoğu (% 71,8) hafif ağrı tarifledi ancak orta ve şiddetli ağrı; hem
yüksek “Durumluk kaygı” hem de yüksek “sürekli kaygı” gruplarında anlamlı olarak daha
sıktı. Ağrı şiddeti ile sürekli kaygı arasında pozitif ancak zayıf bir korelasyon olmakla
birlikte, durum kaygısı ile ilişkili bulunmadı. Hastaların bildirdiği ağrı düzeyleri ileri yaşla
ilişkiliydi ancak biyopsi endikasyonu, hastanın performans durumu, komorbiditeleri veya
önceki KİAB deneyimleri ile ilişkili değildi.
Sonuç: Çalışmamızın sonuçları, hastayla iyi bir iletişim kurmanın ve işlemden günler önce
olası sonuçlar hakkında konuşmanın kaygısını azaltmada rol oynayabileceğini ancak yaş ve
“sürekli kaygı” hızlı etkili anksiyolitik ilaçlar kullanılarak değiştirilemeyeceği için;
anksiyolitiklerle premedikasyonun ağrı azaltmada avantajının sınırlı olacağını
düşündürmüştür.
Kaynakça
- 1. Bain BJ. Bone marrow biopsy morbidity and mortality. Br J Haematol. 2003;121(6):949-51.
- 2. Degen C, Christen S, Rovo A, Gratwohl A. Bone marrow examination: a prospective survey on factors associated with pain. Annals of hematology. 2010;89(6):619-24. doi:10.1007/s00277-010-0934-0.
- 3. Brunetti GA, Tendas A, Meloni E, Mancini D, Maggiore P, Scaramucci L et al. Pain and anxiety associated with bone marrow aspiration and biopsy: a prospective study on 152 Italian patients with hematological malignancies. Annals of hematology. 2011;90(10):1233-5. doi:10.1007/s00277-011-1166-7.
- 4. von Gunten CF, Soskins M. Bone marrow biopsy symptom control and palliative care consultation. J Pain Symptom Manage. 2007;33(3):236-7. doi:10.1016/j.jpainsymman.2006.11.003.
- 5. Watmough S, Flynn M. A review of pain management interventions in bone marrow biopsy. J Clin Nurs. 2011;20(5-6):615-23. doi:10.1111/j.1365-2702.2010.03485.x.
- 6. Vanhelleputte P, Nijs K, Delforge M, Evers G, Vanderschueren S. Pain during bone marrow aspiration: prevalence and prevention. J Pain Symptom Manage. 2003;26(3):860-6.
- 7. Lord S, Bhuller K. Managing pain and anxiety in adult bone marrow examinations: combining pharmacological and psychological approaches. J Pain Symptom Manage. 2012;44(5):757-62. doi:10.1016/j.jpainsymman.2011.11.005.
- 8. Hjortholm N, Jaddini E, Halaburda K, Snarski E. Strategies of pain reduction during the bone marrow biopsy. Annals of hematology. 2013;92(2):145-9. doi:10.1007/s00277-012-1641-9.
- 9. Sollazzo F, Tendas A, Conte E, Bianchi MP, Niscola P, Cupelli L et al. Bone marrow aspiration and biopsy-related pain management. Annals of hematology. 2014;93(6):1061-2. doi:10.1007/s00277-013-1926-7.
- 10. McGrath P, Rawson-Huff N, Holewa H. Procedural care for adult bone marrow aspiration and biopsy: qualitative research findings from Australia. Cancer Nurs. 2013;36(4):309-16. doi:10.1097/NCC.0b013e31826f3bac.
- 11. Öner N, LeCompte WA. Durumluk-sürekli kaygi envanteri el kitabi. [Bebek, Istanbul]: Bogaziçi Universitesi Yayinlari; 1985.
- 12. Ömer Aydemir EK. Psikiyatride Kullanılan Klinik Ölçekler [Clinical scales used in psychiatry]. Ankara: Hekimler Yayın Birliği; 2014.
- 13. Julian LJ. Measures of anxiety: State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S467-72. doi:10.1002/acr.20561.
- 14. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S240-52. doi:10.1002/acr.20543.
- 15. Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14(7):798-804. doi:10.1111/j.1365-2702.2005.01121.x.
- 16. Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Hals EK et al. Assessment of pain. British journal of anaesthesia. 2008;101(1):17-24. doi:10.1093/bja/aen103.
- 17. Milligan DW, Howard MR, Judd A. Premedication with lorazepam before bone marrow biopsy. Journal of clinical pathology. 1987;40(6):696-8.
- 18. Talamo G, Liao J, Bayerl MG, Claxton DF, Zangari M. Oral administration of analgesia and anxiolysis for pain associated with bone marrow biopsy. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2010;18(3):301-5. doi:10.1007/s00520-009-0652-0.
- 19. Liden Y, Landgren O, Arner S, Sjolund KF, Johansson E. Procedure-related pain among adult patients with hematologic malignancies. Acta anaesthesiologica Scandinavica. 2009;53(3):354-63. doi:10.1111/j.1399-6576.2008.01874.x.
- 20. Cline ME, Herman J, Shaw ER, Morton RD. Standardization of the visual analogue scale. Nurs Res. 1992;41(6):378-80.
- 21. Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: what is moderate pain in millimetres? Pain. 1997;72(1-2):95-7.
- 22. Gronkjaer M, Hasselgren CF, Ostergaard AS, Johansen P, Korup J, Bogsted M et al. Bone Marrow Aspiration: A Randomized Controlled Trial Assessing the Quality of Bone Marrow Specimens Using Slow and Rapid Aspiration Techniques and Evaluating Pain Intensity. Acta haematologica. 2016;135(2):81-7. doi:10.1159/000438480.
- 23. McDowell I. Measuring Health: A guide to rating scales and questionnaires. Third Edition ed. New York: Oxford University Press; 2006.
- 24. Mainwaring CJ, Wong C, Lush RJ, Smith JG, Singer CR. The role of midazolam-induced sedation in bone marrow aspiration/trephine biopsies. Clinical and laboratory haematology. 1996;18(4):285-8.
Öz
Objective: Bone marrow aspiration and biopsy (BMAB) is an essential tool for the diagnosis of hematological disorders. The most frequent complaint after BMAB is pain but the severity of this pain is described very different among patients. We investigated factors predicting this pain focusing on the role of state and trait anxiety.
Methods: One hundred and ten adult patients undergoing BMAB, were informed adequately and assessed with “The State-Trait Anxiety Inventory” (STAI) before the procedure. In this Likert-type inventory, State Anxiety Scale evaluates the current state of anxiety, asking how respondents feel “at that moment”. The Trait Anxiety Scale evaluates relatively stable aspects of “anxiety proneness,” including general states of confidence, calmness, and security. After the biopsy, the pain was measured with visual analog scale.
Results: Most of the patients (71.8%) described mild pain but moderate to severe pain were significantly more frequent in both high state and trait anxiety groups. Pain severity had a positive but weak correlation with trait anxiety but not with state anxiety. The described pain level was associated with older age but was not with an indication of biopsy, performance status, comorbidities or previous BMAB experiences.
Conclusion: Results of our study made us thought that a good communication with the
patient and talking about possible outcomes days before procedure might play a role in reducing
his or her anxiety but because age and trait anxiety cannot be changed by using fast-acting
anxiolytic drugs, the advantage of premedication with anxiolytics in order of reducing pain,
would be limited.
Kaynakça
- 1. Bain BJ. Bone marrow biopsy morbidity and mortality. Br J Haematol. 2003;121(6):949-51.
- 2. Degen C, Christen S, Rovo A, Gratwohl A. Bone marrow examination: a prospective survey on factors associated with pain. Annals of hematology. 2010;89(6):619-24. doi:10.1007/s00277-010-0934-0.
- 3. Brunetti GA, Tendas A, Meloni E, Mancini D, Maggiore P, Scaramucci L et al. Pain and anxiety associated with bone marrow aspiration and biopsy: a prospective study on 152 Italian patients with hematological malignancies. Annals of hematology. 2011;90(10):1233-5. doi:10.1007/s00277-011-1166-7.
- 4. von Gunten CF, Soskins M. Bone marrow biopsy symptom control and palliative care consultation. J Pain Symptom Manage. 2007;33(3):236-7. doi:10.1016/j.jpainsymman.2006.11.003.
- 5. Watmough S, Flynn M. A review of pain management interventions in bone marrow biopsy. J Clin Nurs. 2011;20(5-6):615-23. doi:10.1111/j.1365-2702.2010.03485.x.
- 6. Vanhelleputte P, Nijs K, Delforge M, Evers G, Vanderschueren S. Pain during bone marrow aspiration: prevalence and prevention. J Pain Symptom Manage. 2003;26(3):860-6.
- 7. Lord S, Bhuller K. Managing pain and anxiety in adult bone marrow examinations: combining pharmacological and psychological approaches. J Pain Symptom Manage. 2012;44(5):757-62. doi:10.1016/j.jpainsymman.2011.11.005.
- 8. Hjortholm N, Jaddini E, Halaburda K, Snarski E. Strategies of pain reduction during the bone marrow biopsy. Annals of hematology. 2013;92(2):145-9. doi:10.1007/s00277-012-1641-9.
- 9. Sollazzo F, Tendas A, Conte E, Bianchi MP, Niscola P, Cupelli L et al. Bone marrow aspiration and biopsy-related pain management. Annals of hematology. 2014;93(6):1061-2. doi:10.1007/s00277-013-1926-7.
- 10. McGrath P, Rawson-Huff N, Holewa H. Procedural care for adult bone marrow aspiration and biopsy: qualitative research findings from Australia. Cancer Nurs. 2013;36(4):309-16. doi:10.1097/NCC.0b013e31826f3bac.
- 11. Öner N, LeCompte WA. Durumluk-sürekli kaygi envanteri el kitabi. [Bebek, Istanbul]: Bogaziçi Universitesi Yayinlari; 1985.
- 12. Ömer Aydemir EK. Psikiyatride Kullanılan Klinik Ölçekler [Clinical scales used in psychiatry]. Ankara: Hekimler Yayın Birliği; 2014.
- 13. Julian LJ. Measures of anxiety: State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S467-72. doi:10.1002/acr.20561.
- 14. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S240-52. doi:10.1002/acr.20543.
- 15. Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14(7):798-804. doi:10.1111/j.1365-2702.2005.01121.x.
- 16. Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Hals EK et al. Assessment of pain. British journal of anaesthesia. 2008;101(1):17-24. doi:10.1093/bja/aen103.
- 17. Milligan DW, Howard MR, Judd A. Premedication with lorazepam before bone marrow biopsy. Journal of clinical pathology. 1987;40(6):696-8.
- 18. Talamo G, Liao J, Bayerl MG, Claxton DF, Zangari M. Oral administration of analgesia and anxiolysis for pain associated with bone marrow biopsy. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2010;18(3):301-5. doi:10.1007/s00520-009-0652-0.
- 19. Liden Y, Landgren O, Arner S, Sjolund KF, Johansson E. Procedure-related pain among adult patients with hematologic malignancies. Acta anaesthesiologica Scandinavica. 2009;53(3):354-63. doi:10.1111/j.1399-6576.2008.01874.x.
- 20. Cline ME, Herman J, Shaw ER, Morton RD. Standardization of the visual analogue scale. Nurs Res. 1992;41(6):378-80.
- 21. Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: what is moderate pain in millimetres? Pain. 1997;72(1-2):95-7.
- 22. Gronkjaer M, Hasselgren CF, Ostergaard AS, Johansen P, Korup J, Bogsted M et al. Bone Marrow Aspiration: A Randomized Controlled Trial Assessing the Quality of Bone Marrow Specimens Using Slow and Rapid Aspiration Techniques and Evaluating Pain Intensity. Acta haematologica. 2016;135(2):81-7. doi:10.1159/000438480.
- 23. McDowell I. Measuring Health: A guide to rating scales and questionnaires. Third Edition ed. New York: Oxford University Press; 2006.
- 24. Mainwaring CJ, Wong C, Lush RJ, Smith JG, Singer CR. The role of midazolam-induced sedation in bone marrow aspiration/trephine biopsies. Clinical and laboratory haematology. 1996;18(4):285-8.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 7 Haziran 2021 |
| Kabul Tarihi | 9 Ocak 2021 |
| Yayımlandığı Sayı | Yıl 2021 Cilt: 13 Sayı: 2 |
