Gabapentin for the treatment of pain syndrome related to radiation‐induced mucositis in patients with head and neck cancer treated with concurrent chemoradiotherapy

Abstract

BACKGROUND: This retrospective study evaluated the efficacy of gabapentin for the treatment of pain syndromes related to radiation-induced mucositis in patients with head and neck cancers treated with concurrent chemoradiation. METHODS: Data from 42 patients with head and neck malignancies treated with concurrent chemoradiotherapy using an intensity-modulated radiotherapy technique were analyzed. Gabapentin was initiated in the second week of radiotherapy. Opiates were prescribed in addition to gabapentin as clinically indicated to obtain adequate pain control. RESULTS: At a median dose of 2700 mg/day of gabapentin, only 33% and 55% of patients required additional low-dose narcotic medications for pain control during the third and fourth week of treatment, respectively, despite exhibiting a grade 2 or higher mucositis in 71% and 86% of the patients, respectively. Furthermore, during the last weeks of treatment, 71% of the patients required additional low-dose opiates for adequate pain control, despite the presence of grade 2 or higher mucositis in 95% and 100% of patients at Weeks 5 and 6, respectively. Only 1 patient had a treatment-related interruption of >3 days during chemoradiotherapy. CONCLUSIONS: Gabapentin appears to be promising in reducing the need for high total doses of opioids and avoiding unplanned treatment interruptions for patients with head and neck malignancies treated with concurrent chemoradiotherapy and should be further evaluated prospectively in controlled clinical trials. Cancer 2010;116:4206-13.

Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients

“…The efficacy of gabapentin was assessed by examining the need for opioids for pain relief. The authors concluded that gabapentin can provide pain relief and reduce the need for opioids [5,6]. No guideline was possible due to insufficient evidence.…”

American Cancer Society Head and Neck Cancer Survivorship Care Guideline

“…Pretreatment assessment of dental status and treatment of preexisting dental and gingival disease can prevent osteonecrosis. In patients with pain syndrome related to radiation‐induced oral mucositis in cases of concomitant chemotherapy, gabapentin has been shown to significantly reduce oral pain …”

“…This mucositis may be aggravated by preexisting dental and gingival disease and may make eating and swallowing very difficult. Although pain medicine will likely be necessary, topical and/or systemic treatments that may be necessary include antibacterial and antifungal medications or gabapentin . Primary care clinicians should be aware that oral antibiotics for unrelated, systemic infections increase the likelihood of fungal overgrowth and infection in the oral cavity.…”

The management of cancer pain

“…A review of cancer trials found that adjuvant analgesics added to opioids provide additional relief, usually within 4 to 8 days, with the strongest evidence for gabapentin 138. Another report described the successful use of gabapentin to reduce mucositis pain in patients receiving concomitant radiotherapy and chemotherapy 139…”