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The results of the current study support the use of gabapentin as both an effective and well-tolerated treatment for pain related to radiation-induced mucositis in patients with head and neck malignancies who are treated with concurrent chemoradiation. Gabapentin-based pain management of acute mucositis is effective and associated with 1) less weight loss, radiotherapy treatment interruptions, lower oxycodone dose during treatment despite a higher proportion of patients treated to higher doses with hyperfractionated RT (Table2, Figure1) Gabapentin appears promising in reducing the need for narcotic pain medication for patients with head and neck malignancies treated with IMRT and should be further evaluated prospectively in controlled clinical trials. Both S., Quon H. Gabapentin for the treatment of pain related to radiation-induced mucositis in patients with head and neck tumors treated with intensity-modulated radiation therapy. Head Neck. 2010;32:173–177. doi: 10.1002/hed.21165. Presently there are no systematic reviews of the specific use of gabapentin for neuropathic pain in radiation induced oral mucositis. A total of eleven references were obtained. Three retrospective studies were included in this review. Some non-opioid pain medications, such as gabapentin (Neurontin), pregabalin (Lyrica) and duloxetine (Cymbalta), are specific for nerve pain. Pain from radiation Gabapentin’s efficacy in the treatment of neuropathic pain makes it a plausible candidate for managing pain secondary to radiation treatment, which can be the result of radiation-induced inflammation, mucositis, or direct nerve injury. Gabapentin appears to be promising in reducing the need for high total doses of opioids and avoiding unplanned treatment interruptions for patients with head and neck malignancies treated with concurrent chemoradiotherapy and should be further evaluated prospectively in controlled clinical trials. Patients undergoing radiotherapy for head and neck cancer often develop painful mouth sores caused by inflammation called oral mucositis. The use of prophylactic gabapentin to reduce pain and opioid use during treatment in this population is controversial. Nevertheless, prophylactic gabapentin with 3600 mg daily was well tolerated and eliminated the need for opioids during RT in 62.5% of patients. Although gabapentin, 3600 mg, daily has been adopted as the standard regimen of the Roswell Park Comprehensive Cancer Center, additional studies are warranted to further investigate its role in pain For radiation-induced cutaneous fibrosis, deep-friction massage, therapy, and orthotics have been proposed as possible treatments. 5,6 Gabapentin, pregabalin, duloxetine, and tricyclic Radiotherapy is a mainstay of treatment for cancer-related pain. However, radiotherapy itself can lead to treatment-related symptoms including mucositis, esophagitis, cystitis, proctitis, and desquamation. Pain experienced during radiotherapy can affect eating, drinking, talking, sleep, and treatment adherence. This retrospective study evaluates the efficacy of gabapentin for the treatment of pain related to radiation induced mucositis, in patients with head and neck cancers, treated with radiation therapy (RT). As time and treatment progress, patients undergoing definitive radiation therapy require additional oral pain medications, such as tramadol, buprenorphine, gabapentin, and amantadine. OTM buprenorphine (80–120 mcg/kg Q 12–24 H) or transdermal fentanyl liquid (2.7 mg/kg, one application) can be used to further alleviate pain when NSAIDs and Perineural fibrosis and ischemia, subsequently developing myelin destruction and axonal injury, are attributed to the main mechanism of radiation-induced neuropathic pain, such as radiation-induced brachial plexopathy after radiotherapy for breast carcinoma. 1, 9 In addition, radiation treatment may produce various types of postradiation Heath Skinner, MD, Associate Professor of Radiation Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, who was not involved in the study, stated that gabapentin potentially provided a needed adjunct to current pain control strategies. Most patients tolerated gabapentin well, but those who received the highest dose of gabapentin were significantly less likely to require opioids during radiation therapy—93.1% of patients receiving 900 mg gabapentin required opioids to manage oral mucositis pain, compared to only 37.5% of patients in the 3,600 mg cohort. By week 7, the median pain score in the treatment group was below the 0.25 quantile of the control group. Conclusion: Prophylactic use of gabapentin during chemoradiation for HNC patients resulted in a decrease in pain, neurosensory symptoms, and general systemic symptoms. Bar Ad V, Weinstein G, Dutta PR, et al. Gabapentin for the treatment of pain related to radiation-induced mucositis in patients with head and neck tumors treated with intensity-modulated radiation therapy. Head Neck 2010;32:173-7. [Google Scholar] 26.
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