Effect of topical morphine for mucositis-associated pain following concomitant chemoradiotherapy for head and neck carcinoma
Version of Record online: 31 OCT 2002
Copyright © 2002 American Cancer Society
Volume 95, Issue 10, pages 2230–2236, 15 November 2002
How to Cite
Cerchietti, L. C. A., Navigante, A. H., Bonomi, M. R., Zaderajko, M. A., Menéndez, P. R., Pogany, C. E. and Roth, B. M. C. (2002), Effect of topical morphine for mucositis-associated pain following concomitant chemoradiotherapy for head and neck carcinoma. Cancer, 95: 2230–2236. doi: 10.1002/cncr.10938
- Issue online: 31 OCT 2002
- Version of Record online: 31 OCT 2002
- Manuscript Accepted: 12 JUN 2002
- Manuscript Revised: 30 APR 2002
- Manuscript Received: 29 OCT 2001
- topical morphine;
- head and neck carcinoma
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.
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).
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).
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. Cancer 2002;95:2230–6. © 2002 American Cancer Society.