Effect of topical morphine for mucositis-associated pain following concomitant chemoradiotherapy for head and neck carcinoma.
BACKGROUND
Oral mucositis is the dose-limiting toxicity for patients receiving concurrent chemoradiotherapy regimens for tumors of the head and neck area. Currently, the management of established mucositis includes the use of topical anesthetics and systemic analgesics. Based on the clinical evidence of pain alleviation by topical morphine in patients with some inflammatory and painful conditions, a clinical study was undertaken to determine this effect on mucositis-associated pain.


METHODS
Twenty-six patients with head and neck malignancies treated with concomitant chemoradiotherapy for head and neck carcinoma who had severe painful mucositis (World Health Organization Grade 2 or higher) were enrolled. Patients were randomly assigned to morphine mouthwash (MO; 14 patients) or magic mouthwash (MG), a mixture of equal parts of lidocaine, diphenhydramine, and magnesium aluminum hydroxide (12 patients).


RESULTS
The duration of severe pain was 3.5 days less in the MO group compared with the MG group (P = 0.032). The intensity of oral pain was also significantly lower in the MO group compared with the MG group (P = 0.038). No patient in the MO group required third-step opiates for alleviation of the mouth pain. There was a significant difference in duration of severe functional impairment (P = 0.017). Five patients in the MG group complained of local side effects and only one in the MO group (P = 0.007).


CONCLUSIONS
For patients with head and neck carcinomas receiving concomitant chemoradiotherapy, MO is a simple and effective treatment to decrease the severity and duration of pain and the duration of functional impairment.
Cerchietti
Leandro C A
LC
Supportive Care Division, Department of Medical Oncology, Angel H. Roffo Cancer Institute, University of Buenos Aires, Buenos Aires, Argentina. lccerchi@intramed.net.ar
Navigante
Alfredo H
AH
Bonomi
Marcelo R
MR
Zaderajko
Mariel A
MA
Menéndez
Pablo R
PR
Pogany
Catalina E
CE
Roth
Berta M C
BM
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000009:adverse effects; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use*; D009061:Mouth Mucosa; D009067:Mouthwashes; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects*; D013280:Stomatitis / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000970:Antineoplastic Agents; D009067:Mouthwashes; D009020:Morphine; D008012:Lidocaine; D002945:Cisplatin