Effectiveness of Adjunctive Analgesics in Head and Neck Cancer Patients Receiving Curative (Chemo-) Radiotherapy: A Systematic Review (original) (raw)
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Oral Diseases, 2019
Objective: To evaluate the current evidence regarding the effectiveness of nonopioid interventions for the therapeutic management of pain in head and neck cancer patients with oral mucositis resulting from radiotherapy only or chemoradiotherapy. Materials and Methods: A literature search was conducted which included randomised controlled trials that assessed patient-related outcome of pain in patients with oral mucositis associated with radiation therapy only or chemoradiotherapy. Literature searches were conducted in MEDLINE via Pubmed, Embase, Scopus and CINAHL. Results: The electronic searches identified 846 articles. Screening revealed that six articles met all eligibility inclusion criteria. Interventions showing statistically significant benefits to reduce oral mucositis associated pain compared to placebo included doxepin (p < 0.001, 95% CI −6.7 to −2.1), amitriptyline (p = 0.04), diclofenac (p < 0.01) and benzydamine (p = 0.014). Conclusions: Non-opioid interventions, including topical doxepin, amitriptyline, diclofenac and benzydamine, were found to provide relief of pain due to mucositis, and when effective may allow for reduction in the use of opioids in pain management. K E Y W O R D S chemoradiotherapy, head and neck cancer, mucositis, non-opioid analgesia, pain management, radiotherapy | 183 CHRISTOFOROU eT al.
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2011
The aim of this multi-center phase II study was to clarify the clinical benefit of an opioid-based pain control program for head and neck cancer patients during chemoradiotherapy. Head and neck cancer patients who were to receive definitive or postoperative chemoradiotherapy were enrolled. The opioid-based pain control program consisted of a three-step ladder, with basic regimens of: The primary endpoint of this study was compliance with radiotherapy. A total of 101 patients from 10 institutions were registered between February 2008 and May 2009 and included in the analysis. The major combination chemotherapy regimen was cisplatin alone (76%). The rate of completion of radiotherapy was 99% and the rate of unplanned breaks in radiotherapy was 13% (13/101, 90% confidence interval: 9.9-16.5%). Median maximum quantity of morphine used per day was 35 mg (range 0-150 mg). Use of a systematic pain control program may improve compliance with CRT.
Pain Management in Patients with Head and Neck Carcinoma
Otorhinolaryngology Clinics An International Journal, 2010
Pain is one of the feared effects of advancing cancer and can affect a vast majority of head and neck cancer (HNC) patients. HNC's have a devastating impact on patient's lives as both disease and treatment can affect the ability to speak, swallow and breathe due to involvement of the aerodigestive tract. The etiology of pain in this subgroup of patients could be as a result of direct tumor progression, nerve root compression or as a result of the treatment modalities including surgery radiotherapy and chemotherapy. Pain experienced could be nociceptive or neuropathic. A thorough initial and ongoing assessment of the patient is essential for diagnosis and planning the treatment bearing in mind its modification during treatment. Treatment involves a comprehensive approach which is centred around systematic pharmacotherapy, and supplemented by a range of therapeutic interventions and physical and behavioral approaches. In this article we discuss the incidence, etiology, assessment and treatment of this challenging problem using current modalities.
Head and Neck Cancer Pain: Systematic Review of Prevalence and Associated Factors
Journal of Oral and Maxillofacial Research, 2012
Objectives: Pain is a major symptom in patients with cancer; however information on head and neck cancer related pain is limited. The aim of this review was to investigate the prevalence of pain and associated factors among patients with HNC. Material and Methods: The systematic review used search of MEDLINE, EMBASE and CINAHL databases to December 2011. Cancers of the oral mucosa, oropharynx, hypopharynx and larynx were included in this review with pain as main outcome. The review was restricted to full research reports of observational studies published in English. A checklist was used to assess the quality of selected studies. Results: There were 82 studies included in the review and most of them (84%) were conducted in the past ten years. Studies were relatively small, with a median of 80 patients (IQR 44, 154). The quality of reporting was variable. Most studies (77%) used self-administered quality of life questionnaires, where pain was a component of the overall scale. Only 33 studies reported pain prevalence in HNC patients (combined estimate from meta-analysis before (57%, 95% CI 43%-70%) and after (42%, 95% CI 33%-50%) treatment. Only 49 studies (60%) considered associated factors, mostly tumour-or treatment-related. Conclusions: The study has shown high levels of pain prevalence and some factors associated with higher levels of pain. There is a need for higher quality studies in a priority area for the care of patients with head and neck cancer.
Pain, 2015
Pain is a common symptom in patients with head and neck cancer (HNC) that is associated with significant decrements in physical and psychological functioning. Only four studies have evaluated for changes in, as well as predictors of different pain characteristics in these patients. In this longitudinal study of patients with HNC, changes in pain intensity (i.e., average pain, worst pain), pain interference with function, and pain relief were evaluated from the initiation of radiotherapy and through the following six months. Hierarchical linear modeling was used to evaluate for changes over time in these four pain characteristics, as well as to identify predictors of inter-individual variability in each characteristic. Overall, pain intensity and interference with function scores were in the mild to moderate range, while pain relief scores were in the moderate range. The occurrence of pain, as well as scores for each pain characteristic, increased from the initiation to the completio...
BMC Cancer, 2021
Background Studies suggest a high prevalence of pain in head and neck cancer (HNC) patients at diagnosis, during and after treatment; however, these studies had small sample sizes and did not comprehensively assess factors known to influence pain. We surveyed a large cohort of HNC survivors to determine variations in the prevalence of pain, its treatment and management by duration of survivorship, and assessed a comprehensive list of risk factors. Methods A cross sectional survey of post-treatment survivors of HNC during routine follow-up clinic visits. Results A total of 505 HNC survivors with a median follow up of 3 years from cancer diagnosis were included in the study. Overall, 45% (n = 224) reported pain and 14.5, 22 and 7% reported use of prescribed pain medication, over-the-counter pain medication and alternative pain therapies, respectively. Prevalence of severe pain was 7.3% and did not vary significantly by years of survivorship (< 1 year = 5.7%; 1 to < 3 years = 7.1...
Breakthrough pain in patients with head & neck cancer. A secondary analysis of IOPS MS study
Oral Oncology, 2019
To characterize breakthrough pain (BTcP) in patients with Head and neck (H&N) cancer. Methods: This was a secondary analysis of multicenter study of BTcP. Background pain intensity and opioid dose were recorded. The number of BTcP episodes, their intensity, predictability, onset, duration and interference with daily activities were collected. Opioids used for BTcP, and the mean time to meaningful pain relief after taking medication, were assessed. The presence of mucositis was also assessed. Results: 205 patients with H&N cancer were examined. The mean number of BTcP episodes was 2.8/day, which was higher than in general population. The mean intensity of BTcP was 7.4. BTcP was more predictable in H&N cancer than in other tumors. The main trigger of predictable BTcP was the ingestion of food (76.5%). BTcP onset was fast in 148 patients (72.2%). The mean time to meaningful pain relief after taking a BTcP medication was 15.3 min and BTcP interference with daily activity was relevant in most patients (89.2%). Transdermal drugs and nasal fentanyl preparations were more frequently used for background pain and BTcP, respectively. A consistent number of patients with H&N cancer (38.5%) exhibited different levels of oral mucositis. Conclusion: BTcP in patients with H&N cancer is characterized by a larger number of episodes/day and the predictability, particularly with ingestion of food. The use of drugs for background analgesia and BTcP were conditioned by the possible interference with swallowing or local mucosal damage.
2020
Background: One of the common side effects of radiotherapy and chemotherapy in patients with head and neck cancer is oral mucositis. This painful complication restricts the ability to eat and drink and increases the risk of oral infections. The aim of this study was to investigate the effect of doxepin oral rinse 0.5% in comparison with persica mouthwash on reducing the pain of oral mucositis in patients with head and neck cancer after radiotherapy and chemotherapy. Methods: This clinical trial was performed on 56 patients admitted in the oncology ward of Shahid Sadoughi Hospital and Shahid Ramezanzadeh radiotherapy center in Yazd, who received more than 45 gray of radiation and had mucositis and their pain score was more than 4 on the basis of the Visual Analogue Scale (VAS). Patients were randomly divided into two groups of persica and doxepin 0.5%. The data collection tool was a questionnaire including visual analogue scale for pain, taste satisfaction and possible complications. Data were analyzed by using SPSS19 software and Chi-square test. Results: There was no signi cant difference between the mean score of pain in doxepin and persica groups 5,15,30, 120,240 minutes and 24 hours after taking the mouthwash; just in the doxepin group, the