Oral morphine gargles: A cost effective approach for pain relief in patients with chemoradiation induced acute oral mucositis in head and neck cancers

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20504-e20504
Author(s):  
C. Haritha ◽  
V. Shankar
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Supportive Care ◽  
Head And Neck ◽  
Oral Mucositis ◽  
Oral Morphine ◽  
Head And Neck Cancers ◽  
Control Group ◽  
Morphine Group ◽  
Systemic Side Effects

e20504 Background: Painful oral mucositis is the most significant dose-limiting toxicity in head & neck cancer patients treated with conc. CT-RT protocol. The purpose of this study is to evaluate the efficacy of oral morphine gargles in reducing the severity of chemoradiation induced mucositis pain & thus, its impact on nutrition, quality of life & cost of supportive care, during the treatment period. Methods: 106 consecutive patients, recruited between May 2006 through Dec. 2007, with adv. head and neck cancers (54 oropharynx, 42 hypopharynx & 10 nasopharynx) were included in the study. All patients underwent treatment under conc. CT-RT (Inj.CDDP 40mg/m2 weekly, RT: 66–70gy/33–35# @200cgy/# delivered by 3D- CRT). Patients who had painful mucositis (RTOG Grade 3 or more) not controlled with magic mouthwash, Tab. Acetaminophen 500mg qds or Tab.Tramdol 50–100 mg tds were randomized into 2 groups: morphine group (MOP) -53 patients & Control group (CON) - 53 patients. Patients in both groups received adjusted doses of oral steroids based on the severity of oral mucositis. While CON group patients were given adjusted doses of tramadol, MOP group patients were assigned to 15ml of 2% morphine gargles administered every 4th hourly. Patients were instructed not to swallow the rinses and to hold the solution in the mouth for 3mins duration. All patients underwent weekly recording of (1) response to pain rated on VAS (2) weight (3) morphine systemic side-effects (4) QOL Questionnaire. Mann-Whitney test and ’T’ Test are used for statistical analysis of the data. Results: Patients in the MOP group had significant lower pain intensity scores, better QOL scores & less weight loss compared to patients in the CON group. The duration of the severe pain was atleast 1 week shorter in the MOP group. Systemic side-effects secondary (nausea, vomiting, constipation) to opiod use were significantly lower in the MOP group. The Cost of supportive care for pain management was less in the MOP group, with greater compliance for the treatment. Conclusions: Morphine gargles, in our experience, is an effective approach for pain relief in patients with CT-RT induced acute mucositis in head and neck cancers thus leading to better nutrition & compliance in the treatment. No significant financial relationships to disclose.

scholarly journals A Bioadhesive Barrier-Forming Oral Liquid Gel Improved Oral Mucositis and Nutritional Status in Patients With Head and Neck Cancers Undergoing Radiotherapy: A Retrospective Single Center Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Jinlong Wei ◽  
Jie Wu ◽  
Huanhuan Wang ◽  
Bin Wang ◽  
Tingting Zhao ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Head And Neck ◽  
Oral Mucositis ◽  
Head And Neck Cancers ◽  
Lower Percentage ◽  
Control Group ◽  
Oral Liquid ◽  
Status Assessment ◽  
Hematological Indicators ◽  
High Level

BackgroundEpisil® is a bioadhesive barrier-forming oral liquid gel that can relieve oral mucositis (OM) caused by radiotherapy (RT) and hence relieves pain effectively. In this study, we observed the effects of Episil® on the OM and nutritional status of patients with head and neck cancers (HNCs) undergoing RT.MethodsA total of 50 HNC patients were divided into the Episil® (25 patients) and control (25 patients) groups. Patients in the Episil® group were sprayed with Episil®. In the control group, the kangfuxin solution or Kangsu™ oral gargle was used. Medical staff assessed the OM extent and timing as well as the nutritional status during treatment and recorded adverse reactions other than OM. The nutritional status assessment included the following indicators: Patient Generated-Subjective Global Assessment (PG-SGA) score, body mass index (BMI), body weight, albumin levels, and other hematological indicators.ResultsThe incidence of high-level OM (III–IV) after RT was lower in the Episil® group than in the control group (P < 0.05). Nutritional status assessments showed that the Episil® group had a lower percentage of weight loss than the control group at weeks 4 and 7 after RT. Similar results were also obtained for BMI and albumin levels (P < 0.05). Moreover, according to PG-SGA scores, fewer patients in the Episil® group were malnourished and more patients were well-nourished (P < 0.05) compared with the control group.ConclusionEpisil® effectively improved OM and malnutrition in HNC patients who received RT and has a good clinical application value.

Benzydamine for prophylaxis of radiation induced oral mucositis in head and neck cancers: Double-blind clinical trial

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 9042-9042
Author(s):  
S. Kamian
Keyword(s):  
Placebo Group ◽  
Head And Neck ◽  
Oral Mucositis ◽  
Treated Group ◽  
Head And Neck Cancers ◽  
Control Group ◽  
Oral Rinse ◽  
Neck Tumors ◽  
Radiation Induced ◽  
Grade 3

9042 Background: Oral mucositis is one of the most common adverse effects of radiotherapy in head and neck tumors. We determined the efficacy of oral rinse benzydamine in prevention of radiation induced mucositis. Methods: Patients with head and neck cancers were enrolled in a randomize, placebo-controlled clinical trail to receive either benzydamine or placebo. All the cases received at least 50 Gy radiation to the oral cavity and oropharyngeal areas. The end points were comparison of highest grade of mucositis at the end of radiotherapy, frequency of grade 2 or more, the interval days to establishing grade 2 in the groups. Results: 100 patients with head and neck cancers were randomized in this trail. At the end of the study, 19 patients were excluded of the analysis due to minor side effects of drug, or stopping the radiotherapy. In 39 cases in the treated group, the frequency of mucositis grade 3 or more was 43.6% (17 cases) in contrast to 78.6% (33 cases) in 42 cases in the placebo group, which was significant (p=0.001). Mucositis grade 3 or more was 2.6 times frequent in placebo group (CI=95%, relative risk=1.38–5). At the end of RT, at least 42% of the treated group had mucositis grade 3 or more in contrast to at least 76% in the control group which was statistically significant. Intensity of mucositis was increased up to forth week of treatment in both groups to grade 2. In the treated group the grade of mucositis was approximately constant to the end of therapy; but in the control group it raised to grade 3 (p<0.001). The highest grade of mucositis during the treatment time was significantly different between two groups (p=0.049). The median interval days of establishing grade 2 mucositis was 3.6 days sooner in the placebo group (p=0.12). Conclusions: According to these results it seems that oral rinse benzydamine was effective, safe, and well tolerated for prophylactic treatment of radiation-induced oral mucositis in head and neck tumors. [Table: see text]

Oral enzymes preventing side effects of radiation therapy in patients with head and neck cancers

1999 ◽  
Vol 35 ◽  
pp. S168-S169
Author(s):  
M.S. Gujral ◽  
P.M. Patnaik ◽  
R. Kaul ◽  
G.V. Daftary ◽  
H.K. Parikh ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Side Effects ◽  
Head And Neck ◽  
Head And Neck Cancers ◽  
Effects Of Radiation

Preventive Intervention Possibilities in Radiotherapy- and Chemotherapy-induced Oral Mucositis: Results of Meta-analyses

2006 ◽  
Vol 85 (8) ◽  
pp. 690-700 ◽  
Author(s):  
M.A. Stokman ◽  
F.K.L. Spijkervet ◽  
H.M. Boezen ◽  
J.P. Schouten ◽  
J.L.N. Roodenburg ◽  
...  
Keyword(s):  
Head And Neck ◽  
Cancer Patients ◽  
Oral Mucositis ◽  
Randomized Clinical Trials ◽  
Intervention Group ◽  
Control Group ◽  
Colony Stimulating Factor ◽  
Gm Csf ◽  
Meta Analyses ◽  
Stimulating Factor

The aim of these meta-analyses was to evaluate the effectiveness of interventions for the prevention of oral mucositis in cancer patients treated with head and neck radiotherapy and/or chemotherapy, with a focus on randomized clinical trials. A literature search was performed for reports of randomized controlled clinical studies, published between 1966 and 2004, the aim of which was the prevention of mucositis in cancer patients undergoing head and neck radiation, chemotherapy, or chemoradiation. The control group consisted of a placebo, no intervention, or another intervention group. Mucositis was scored by either the WHO, the National Cancer Institute-Common Toxicity Criteria (NCI-CTC) score, or the absence or presence of ulcerations, or the presence or absence of grades 3 and 4 mucositis. The meta-analyses included 45 studies fulfilling the inclusion criteria, in which 8 different interventions were evaluated: i.e., local application of chlorhexidine; iseganan; PTA (polymyxin E, tobramycine, and amphotericin B); granulocyte macrophage-colony-stimulating factor/granulocyte colony-stimulating factor (GM-CSF/G-CSF); oral cooling; sucralfate and glutamine; and systemic administration of amifostine and GM-CSF/G-CSF. Four interventions showed a significant preventive effect on the development or severity of oral mucositis: PTA with an odds ratio (OR) = 0.61 (95% confidence interval [CI], 0.39–0.96); GM-CSF, OR = 0.53 (CI: 0.33–0.87); oral cooling, OR = 0.3 (CI: 0.16–0.56); and amifostine, OR = 0.37 (CI: 0.15–0.89). To date, no single intervention completely prevents oral mucositis, so combined preventive therapy strategies seem to be required to ensure more successful outcomes.

Comparison of Morphine, Ketorolac, and Their Combination for Postoperative Pain

2005 ◽  
Vol 103 (6) ◽  
pp. 1225-1232 ◽  
Author(s):  
Maria Soledad Cepeda ◽  
Daniel B. Carr ◽  
Nelcy Miranda ◽  
Adriana Diaz ◽  
Claudia Silva ◽  
...  
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Confidence Interval ◽  
Pain Intensity ◽  
Controlled Trial ◽  
Morphine Group ◽  
Opioid Sparing ◽  
Numbers Needed To Treat ◽  
Sparing Effect ◽  
Analgesic Administration

Background Meta-analyses report similar numbers needed to treat for nonsteroidal antiinflammatory drugs (NSAIDs) and opioids. Differences in baseline pain intensity among the studies from which these numbers needed to treat were derived may have confounded the results. NSAIDs have an opioid-sparing effect, but the importance of this effect is unclear. Therefore, the authors sought to compare the proportions of subjects who obtain pain relief with ketorolac versus morphine after surgery and to determine whether the opioid-sparing effect of an NSAID reduces the magnitude of opioid side effects. Methods The study was a double-blind, randomized controlled trial. The authors randomly assigned 1,003 adult patients to receive 30 mg ketorolac or 0.1 mg/kg morphine intravenously. They calculated the proportion of subjects who achieved at least 50% reduction in pain intensity 30 min after analgesic administration. Further, so long as pain intensity 30 min after analgesic administration was 5 or more out of 10, patients received 2.5 mg morphine every 10 min until pain intensity was 4 or less out of 10. The authors assessed the presence of opioid-related side effects. Results Five hundred patients received morphine and 503 received ketorolac. Fifty percent of patients in the morphine group achieved pain relief, compared with 31% in the ketorolac group (difference, 19%; 95% confidence interval, 13-25%). The ketorolac-morphine group required less morphine (difference, 6.5 mg; 95% confidence interval, -5.8 to -7.2) and had a lower incidence of side effects (difference, 11%; 95% confidence interval, 5-16%) than the morphine group. Conclusions Opioids are more efficacious analgesics than NSAIDs, although historic data for these two drugs yield similar numbers needed to treat. Adding NSAIDs to the opioid treatment reduces morphine requirements and opioid-related side effects in the early postoperative period.

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