Janina Christoforou1, Jumana Karasneh2, Maddalena Manfredi3, Bella Dave4, Jennifer S Walker5, Pedro Diz Dios6, Joel Epstein7, Navdeep Kumar8, Michael Glick9, Peter B Lockhart10, Lauren L Patton11. 1. University of Western Australia, Crawley, Western Australia, Australia. 2. Department of Oral Medicine and Surgery, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan. 3. Dipartimento di Medicina e Chirugia, University of Parma, Parma, Italy. 4. Department of Oral Medicine, Leeds Dental Institute, Leeds, UK. 5. Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 6. Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain. 7. Cedars-Sinai Medical Center, Los Angeles, California. 8. Eastman Dental Hospital for Oral Healthcare Sciences, London, UK. 9. School of Dental Medicine, University at Buffalo, The State University of New York, Buffalo, New York. 10. Carolinas Medical Center, Charlotte, North Carolina. 11. University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Abstract
OBJECTIVE: To evaluate the current evidence regarding the effectiveness of non-opioid 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.
OBJECTIVE: To evaluate the current evidence regarding the effectiveness of non-opioid interventions for the therapeutic management of pain in head and neck cancerpatients 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.