World Workshop on Oral Medicine VII: Non‐opioid pain management of head and neck chemo/radiation‐induced mucositis: A systematic review

Christoforou, Janina; Karasneh, Jumana; Manfrēdi, M.; Dave, Bella; Walker, Jennifer; Dios, Pedro Diz; Epstein, Joel B.; Kumar, Nand; Glick, Michael; Lockhart, Peter B.; Patton, Lauren L.

doi:10.1111/odi.13074

Cited by 17 publications

(15 citation statements)

References 35 publications

(83 reference statements)

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“…At a cumulative radiation dose of 20 to 30 Gy, the intact mucosa begins to break down and develop ulceration 29 . A systematic review showed that topical doxepin, amitriptyline, diclofenac, and benzydamine provided relief from pain due to mucositis and could reduce the use of opioids for pain control 30 . These topical mouthwashes are not readily available in Japan; therefore, a topical steroid ointment for oral mucositis was used in our study.…”

Section: Discussionmentioning

confidence: 97%

“…29 A systematic review showed that topical doxepin, amitriptyline, diclofenac, and benzydamine provided relief from pain due to mucositis and could reduce the use of opioids for pain control. 30 These topical mouthwashes are not readily available in Japan; therefore, a topical steroid ointment for oral mucositis was used in our study. However, this ointment cannot suppress the occurrence of BRT/CRT-induced severe oral mucositis.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors associated with the development of aspiration pneumonia in patients receiving radiotherapy for head and neck cancer: retrospective study

et al. 2020

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Background Patients with head and neck cancer who are receiving radiotherapy can develop aspiration pneumonia. Determination of the incidence of aspiration pneumonia and the associated risk factors could facilitate the identification of high‐risk patients. Methods In this retrospective study, we determined the incidence of aspiration pneumonia in 357 patients receiving radiotherapy along with oral care for head and neck cancer. We also performed univariate and multivariable logistic regression analyses to investigate the risk factors for this complication. Results The incidence of aspiration pneumonia was 17.6%. Hypopharyngeal cancer, grade 3 oral mucositis, and nasogastric tube feeding were independent risk factors. Moreover, the development of aspiration pneumonia was one of the major effects on the discontinuation of radiotherapy. Conclusion Approximately, one‐sixth of the patients developed aspiration pneumonia despite appropriate oral care during radiotherapy for head and neck cancer. Aspiration pneumonia during radiotherapy could adversely affect head and neck cancer management.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Risk factors associated with the development of aspiration pneumonia in patients receiving radiotherapy for head and neck cancer: retrospective study

et al. 2020

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“…For more specific anti-inflammatory and pain control effect comparing to steroid use, COX inhibitor has excellent anti-inflammatory capacity and pain management allowing reduction in use of opioids (32). In managing mucositis in patients receiving RT dose >50 Gy, benzydamine improved grade 3 mucositis from 62.1% to 36.4%, with reduction in needs of tube feeding, intravenous supplementations (18).…”

Section: Discussionmentioning

confidence: 99%

Preliminary study of therapeutic effect of parecoxib on severe radiation mucositis and dermatitis

Huang¹,

Liu²,

Huang³

et al. 2020

Ther Radiol Oncol

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Background: Pain and inflammatory lesions are the main symptom and sign of radiotherapy (RT)-induced severe mucositis and dermatitis (RISMAD). Simultaneous treatment for pain and inflammation of RISMAD remains unsatisfactory. We collected the therapeutic information of parecoxib, a cyclooxygenase-2 (COX-2) inhibitor, on RISMAD in clinical observation.Methods: A cohort of 11 cancer patients underwent radiotherapy between 2016 to 2020 was retrospectively analyzed. Intensity modulated RT was delivered by linear accelerators with various fractionation. Patients with grade 3 or 4 RISMAD and pain were treated by short-term daily administration of parecoxib via intramuscular injection. Severity of the symptoms was graded with CTCAE 4.0.Results: Total eleven lesions were treated and analyzed. The incidence of mucositis, dermatitis and pain were 90.9%, 54.5% and 63.6% respectively. For patients with grade 3 or 4 mucositis and dermatitis, all the cases improved to grade 1 after receiving parecoxib (mucositis: 60% vs. 0%, P<0.001, dermatitis: 50% vs. 0%, P<0.001). Pain score improved from 5.8 to 0.9 (P<0.001) by visual analogue scale. Time to improvement for dermatitis, mucositis and pain was 6.3±3.1, 10.2±6.9 and 7.5±5.1 days, respectively. The average dose of parecoxib needed for improvement was 40 mg per day for 3.8±2.0 days. During the treatment and followup, there was no significant adverse effects noted in this cohort, such as skin rash, gastrointestinal bleeding, altered platelet function or cardiac events.Conclusions: Parecoxib appears to be a safe and effective agent for managing severe RT induced mucositis, dermatitis and accompanied pain.

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“…There is a paucity of evidence guiding the pharmacological management of RIM pain in HNC [ 2 , 26 , 27 ]. To our knowledge, this randomized trial will be the first study to assess multimodal analgesia as the optimal analgesic regimen for HNC patients undergoing radiation treatment.…”

Section: Introductionmentioning

confidence: 99%

Opioid therapy vs. multimodal analgesia in head and neck Cancer (OPTIMAL-HN): study protocol for a randomized clinical trial

et al. 2021

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Background Radiation-induced mucositis (RIM) pain confers substantial morbidity for head and neck cancer (HNC) patients undergoing radiotherapy alone (RT) or chemoradiotherapy (CRT), often reducing treatment compliance. However, no standard currently exists for the treatment of RIM, and high dose opioid therapy, with its associated side effects and increased risk for chronic opioid use, remains the cornerstone of HNC pain management. The goal of this randomized clinical trial is to compare multimodal analgesia using analgesic medications with different mechanisms of action, to the institutional standard of opioid analgesia alone, in order to ascertain the optimal analgesic regimen for the management of RIM pain in HNC patients. Methods In this open-label, single-institution, non-inferiority, randomized clinical trial, sixty-two patients with mucosal head and neck malignancies treated with curative-intent radiation will be randomized in a 1:1 ratio, stratified by RT or CRT, between Arm 1: opioid analgesia alone as per the institutional standard, or Arm 2: multimodal analgesia using Pregabalin, Acetaminophen, and Naproxen, in addition to opioids, if required. The primary endpoint is the average 11-Numeric Rating Scale (11-NRS) score for pain during the last week of radiation treatment. Secondary endpoints include: average weekly opioid use, duration of opioid requirement, average daily 11-NRS score for pain, average weekly opioids dispensed, quality of life, hospitalizations for analgesic medication-induced complications, time to feeding tube insertion, weight loss, toxicity, treatment interruptions, and death within 3 months of completing RT treatment. Patients are eligible once analgesia is required for moderate 4/10 pain. Discussion This study will assess the efficacy and safety of multimodal analgesia and its impact on opioid requirements, clinical outcomes, and quality of life, as a potential new standard treatment for RIM pain in HNC patients undergoing definitive RT or CRT. Trial registration ClinicalTrials.gov Identifier: NCT04221165. Date of registration: January 9, 2020. Appendix 2 reports the World Health Organization trial registration dataset.

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World Workshop on Oral Medicine VII: Non‐opioid pain management of head and neck chemo/radiation‐induced mucositis: A systematic review

Cited by 17 publications

References 35 publications

Risk factors associated with the development of aspiration pneumonia in patients receiving radiotherapy for head and neck cancer: retrospective study

Risk factors associated with the development of aspiration pneumonia in patients receiving radiotherapy for head and neck cancer: retrospective study

Preliminary study of therapeutic effect of parecoxib on severe radiation mucositis and dermatitis

Opioid therapy vs. multimodal analgesia in head and neck Cancer (OPTIMAL-HN): study protocol for a randomized clinical trial

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