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

Abstract

Pain is a prominent symptom in radiotherapy-induced oral mucositis (OM). This study assesses the effect of pharmacological treatment in head and neck cancer patients with OM-induced pain and swallowing difficulties. This study included 82 patients with head and neck cancer undergoing radiotherapy and referred to the Pain and Rehabilitation Centre at Linkoping University Hospital in Sweden because of OM-induced pain. During 1 week, pain assessment, onset of individually tailored choice of drugs, treatment evaluation, and adjustments, were undertaken. Combinations of acetaminophen, non-steroid anti-inflammatory drug (NSAID), and opioids were by steps applied. To evaluate effects, the patients answered the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-head and neck 35 in connection with the initial pain assessment and 1 week later. 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). 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 self-care can contribute to improved pain relief.