Efficacy of controlled-release oxycodone for reducing pain due to oral mucositis in nasopharyngeal carcinoma patients treated with concurrent chemoradiotherapy: a prospective clinical trial

Abstract

Background Pain due to oral mucositis (OM) is a major problem during concurrent chemoradiotherapy (CCRT) in nasopharyngeal carcinoma (NPC) patients. Methods We enrolled 56 NPC patients receiving CCRT and allocated them into two groups: moderate pain group ( n = 27) and a severe pain group ( n = 29) according to the degree of pain reported (moderate = numerical rating scale (NRS) score 4–6 or severe = NRS score 7–10) at initiation of controlled-release oxycodone (CRO) treatment. Results Total dose of CRO was significantly higher in severe pain patients than in moderate pain patients (791.60 ± 332.449 mg vs. 587.27 ± 194.940 mg; P = 0.015). Moderate pain patients had significantly better quality of life ( P = 0.037), lower weight loss ( P = 0.030) and more active CCRT response (90.9% vs. 64.0%; P = 0.041). Although 24-h pain control rate was comparable in the two groups (85.2% vs. 86.2%; P = 0.508), the moderate pain group score eventually stabilized at ~ 2 vs. 3 in the severe pain group ( P < 0.001); the titration time to reach bearable pain (NRS ≤ 3) was also significantly shorter in moderate pain patients (2.45 ± 0.60 days vs. 3.60 ± 1.98 days; P = 0.012). Incidence of adverse events was comparable in both groups. Conclusions The study findings suggest that early introduction of low-dose CRO at the moderate pain stage could help reduce the total dose required, provide better pain control, improve quality of life, and enhance CCRT response.

Sarcopenia is associated with higher toxicity and poor prognosis of nasopharyngeal carcinoma

“…Extra toxicity can also lead to a poor quality of life. 8 Therefore, identifying the patient or tumor characteristics associated with toxicity and survival can potentially help personalize treatment regimens and improve the quality of care in patients with NPC. Depletion of skeletal muscle mass, termed sarcopenia, is common in head and neck cancer (HNC), and is related to increased treatment-related toxicity and decreased survival in HNC patients who receive comprehensive treatment of surgery/chemotherapy and/or radiotherapy.…”

The Effects of Early Nutritional Intervention on Oral Mucositis and Nutritional Status of Patients With Head and Neck Cancer Treated With Radiotherapy

“…According to the evidence-based clinical practice guidelines on mucositis published by the mucositis research group of the Multinational Association of support Care in Cancer/International Society of Oral Oncology (MASCC/ISOO), morphine mouthwash and doxepin mouthwash are recommended for HNC patients undergoing RT ( 33 , 56 , 57 ). Studies have also shown that introduction of low-dose controlled-release oxycodone in the early stage of moderate pain in patients with RT and chemotherapy for nasopharyngeal cancer can help to reduce total dose, provide better pain control, reduce weight loss, and improve quality of life ( 58 – 60 ). Anti-inflammatory therapy is also a common clinical treatment.…”

Pain management after ambulatory surgery: a prospective, multicenter, randomized, double-blinded parallel controlled trial comparing nalbuphine and tramadol

“…Written informed consent was obtained from all subjects participating in the trial. The trial was registered prior to patient enrollment at chictr.org.cn (ChiCTR-IOR-16010032, Principal investigator: Qulian Guo, Date of registration: 2016- [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26].…”

“…The pain intensity was measured using the VAS. A decrease in VAS score of more than 25% compared with the baseline was used as an indicator of analgesic efficacy [15]. The VAS score was also compared between groups E and C at all timepoints to determine any differences in the efficacy and duration of the analgesic effects.…”