Randomized Trial of Opioids Versus Tricyclic Antidepressants for Radiation-Induced Mucositis Pain in Head and Neck Cancer

Patients who receive radiotherapy for head and neck cancer are likely to develop painful mucositis. The pain is characterized by a burning or stinging sensation similar to neuropathic pain sensations. The purpose of the present study was to compare the analgesic effect of a tricyclic antidepressant...

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Bibliographic Details
Published in:Acta oncologica 2001, Vol.40 (6), p.745-750
Main Author: Ehrnrooth, Cai Grau, Robert Zachariae, Jørn Andersen, Eva
Format: Article
Language:English
Subjects:
Aged
Analgesics, Opioid - pharmacology
Antidepressive Agents, Tricyclic - pharmacology
Biological and medical sciences
Female
Head and Neck Neoplasms - radiotherapy
Humans
Male
Medical sciences
Middle Aged
Morphine - pharmacology
Mouth Mucosa - pathology
Mouth Mucosa - radiation effects
Nortriptyline - pharmacology
Otorhinolaryngology (head neck, general aspects and miscellaneous)
Otorhinolaryngology. Stomatology
Pain - drug therapy
Pain - etiology
Radiotherapy - adverse effects
Stomatitis - drug therapy
Stomatitis - etiology
Stomatitis - pathology
Treatment Outcome
Tumors
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Summary:Patients who receive radiotherapy for head and neck cancer are likely to develop painful mucositis. The pain is characterized by a burning or stinging sensation similar to neuropathic pain sensations. The purpose of the present study was to compare the analgesic effect of a tricyclic antidepressant (TC), commonly used in the treatment of neuropathic pain, with the effect of opioids on radiation-induced mucositis pain. Forty-three patients receiving 66–68 Gy external radiation according to the DAHANCA guidelines (the Danish Head and Neck Cancer Study Group) were randomized to either morphine or TC when mucositis pain was insufficiently managed with weak analgesics. Patients with insufficient pain control in either treatment arm received supplementary medication from the opposite treatment arm. Pain was evaluated weekly using a VAS scale and the McGill Pain Questionnaire. The degree of mucositis and the degree of depression were measured at the same time intervals. Twenty-two patients entered the opioid arm and 21 the TC arm. Two patients in each arm were non-evaluable. VAS pain scores were significantly reduced in the opioid treatment arm one week after randomization (p=0.01). Eight patients in the TC arm were managed with TC alone, but for 11 patients it was necessary to add morphine. The 20 evaluable patients in the morphine arm required no additional treatment. There were no significant differences in side effects between the two groups. Higher pain scores in the TC arm, but not in the opioid arm, were significantly correlated with higher BDI scores. Some head and neck cancer patients with radiation-induced nucositis pain may have sufficient pain control on TC alone. This might be useful in patients with relative counter-indications to opioid treatment.
ISSN:0284-186X
1651-226X
DOI:10.1080/02841860152619179