Gabapentin for the treatment of pain related to radiation‐induced mucositis in patients with head and neck tumors treated with intensity‐modulated radiation therapy

Ad, Voichita Bar; Weinstein, Gregory S.; Dutta, Pinaki; Chalian, Ara A.; Both, Stefan; Quon, Harry

doi:10.1002/hed.21165

Cited by 49 publications

(51 citation statements)

References 12 publications

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“…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.…”

Section: Gabapentinmentioning

confidence: 99%

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

Saunders

Epstein²,

Sharon

et al. 2013

Support Care Cancer

145

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Purpose The aim of this project was to develop clinical practice guidelines on the use of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the prevention and management of oral mucositis (OM) in cancer patients. Methods A systematic review of the available literature was conducted. The body of evidence for the use of each agent, in each setting, was assigned a level of evidence. Based on the evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, or no guideline possible. and doxepin rinse in head and neck radiation therapy (H&N RT) patients. Recommendations were developed against the use of topical antimicrobial agents for the prevention of mucositis. These included recommendations against the use of iseganan for mucositis prevention in HSCT and H&N RT and against the use of antimicrobial lozenges (polymyxintobramycin-amphotericin B lozenges/paste and bacitracinclotrimazole-gentamicin lozenges) for mucositis prevention in H&N RT. Recommendations were developed against the use of the mucosal coating agent sucralfate for the prevention or treatment of chemotherapy-induced or radiation-induced OM. No guidelines were possible for any other agent due to insufficient and/or conflicting evidence. Conclusion Additional well-designed research is needed on prevention and management approaches for OM.

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Section: Gabapentinmentioning

confidence: 99%

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

Saunders

Epstein²,

Sharon

et al. 2013

Support Care Cancer

145

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“…11 Prophylactic gabapentin can reduce the total opioid requirement and unintentional weight loss, delay feeding tube use, and decrease unplanned treatment breaks in patients undergoing CRT for HNC. [12][13][14][15][16] Combining gabapentin with opioids improves pain relief at lower opioid doses and improves daily activity, mood, sleep, and QOL in patients undergoing treatment for HNC. 17 To our knowledge, the dose response of gabapentin is not known.…”

Section: Introductionmentioning

confidence: 99%

A single‐institution, randomized, pilot study evaluating the efficacy of gabapentin and methadone for patients undergoing chemoradiation for head and neck squamous cell cancer

Hermann

Iovoli

Platek

et al. 2019

Cancer

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Background The objective of the current study was to compare the safety and efficacy between 2 analgesic regimens for patients with head and neck cancer (HNC) undergoing definitive chemoradiation (CRT). Methods The current study was a prospective, single‐institution, 2‐arm, randomized pilot study. Patients with American Joint Committee on Cancer seventh edition stage II to stage IV squamous cell carcinoma of the head and neck who were undergoing CRT were randomized to either arm 1, which entailed high‐dose gabapentin (2700 mg daily) with the institutional standard of care (hydrocodone and/or acetaminophen progressing to fentanyl as needed), or arm 2, which comprised low‐dose gabapentin (900 mg daily) with methadone. The primary endpoints were safety and toxicity. Secondary endpoints were pain, opioid requirement, and quality of life (QOL). Differences between the treatment arms at multiple time points were compared using a generalized linear mixed regression model with Sidak correction. Results A total of 60 patients (31 in arm 1 and 29 in arm 2) were enrolled from April 2015 to August 2017. There was no difference between the treatment arms with regard to adverse events or serious adverse events. Pain was not found to be different between the treatment arms. More patients in arm 1 did not require an opioid during treatment (42% vs 7%; P = .002). Patients in arm 2 experienced significantly better QOL outcomes across multiple domains, including overall health (P = .05), physical functioning (P = .04), role functioning (P = .01), and social functioning (P = .01). Conclusions High‐dose prophylactic gabapentin increased the percentage of patients who required no opioid during treatment. Methadone may improve QOL compared with a regimen of short‐acting opioids and fentanyl. However, pain was found to significantly worsen throughout treatment regardless of treatment arm, necessitating further studies to identify a more optimal regimen.

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“…The clinical implications of the results are that careful and repeated attention has to be directed to current and expected pain mechanisms. When systematic analgesics do not provide sufficient OM pain relief, we suggest, according to our very limited clinical experience and to the recent publication of Bar Ad et al (2009) [27], and in absence of other possibilities at present, that additional treatment with gabapentin or pregabalin might be tried. However, the effect of gabapentin and pregabalin on OM pain has to be evaluated in carefully designed studies.…”

Section: Conclusion and Clinical Implicationsmentioning

confidence: 89%

“…We agree with the recent publications [3,11,25] suggesting use of adjuvant medication more frequently and earlier in OM development in order to attain improved pain relief. In a recent study Bar Ad et al (2009) [27] stated, that gabapentin appeared to be promising in reducing the need of opioids for patients with OM pain, which indicates that the role of gabapentin in OM pain therapy ought to be studied.…”

Section: Discussionmentioning

confidence: 99%

Individualized pharmacological treatment of oral mucositis pain in patients with head and neck cancer receiving radiotherapy

Ling

Larsson

2010

Support Care Cancer

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Results: Worsening of soreness in mouth and overall worsening of swallowing difficulties were seen in the patients referred within the third week of radiotherapy, showing increased severity of OM during the current week (n=59). Pain and swallowing difficulties were unchanged in patients referred later than the third week, showing unchanged severity of OM during the current week (n=23). Conclusion:The answers to the questionnaire showed that the individualized pain treatment with systemic analgesics exploited to the highest degree was insufficient. Future development of pharmacological possibilities for treatment of OM related pain is urgent. In addition, development of structured nursing care and patient selfcare can contribute to improved pain relief.

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Gabapentin for the treatment of pain related to radiation‐induced mucositis in patients with head and neck tumors treated with intensity‐modulated radiation therapy

Cited by 49 publications

References 12 publications

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

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

A single‐institution, randomized, pilot study evaluating the efficacy of gabapentin and methadone for patients undergoing chemoradiation for head and neck squamous cell cancer

Individualized pharmacological treatment of oral mucositis pain in patients with head and neck cancer receiving radiotherapy

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