Anurag Singh

Alternative Pain-Control Strategy Reduces Need for Opioids in Patients with Head and Neck Cancer

Highlights
  • Most patients treated for head and neck cancer experience painful mouth sores
  • Team tested how well gabapentin controlled pain, at both low and high doses
  • Both gabapentin and methadone can be more effective than standard approaches

BUFFALO, N.Y. — With nearly all patients who undergo treatment for cancers of the head and neck experiencing oral mucositis, or painful mouth sores, effective pain control is one of the main goals of physicians and care teams. Looking to provide more effective relief for patients while also reducing the need for opioid painkillers, a team from Roswell Park Comprehensive Cancer Center explored whether gabapentin, a drug used to relieve nerve pain and treat seizures, could be an effective alternative to narcotics in managing treatment-related symptoms for these patients. Their results, published in the journal Cancer, show that gabapentin is an effective alternative to standard pain-control drugs and that many patients with head and neck cancers had their pain and symptoms managed without any narcotics.

Anurag K. Singh, MD, Professor of Oncology and Director of Radiation Research at Roswell Park, led the study, in which 60 patients with squamous cell carcinoma of the head and neck were randomly assigned to one of two treatment arms: high‐dose gabapentin (2,700 mg daily), progressing successively to hydrocodone-acetaminophen and fentanyl when needed, or to a regimen of low‐dose gabapentin (900 mg daily), progressing to methadone when needed.

The researchers, who include first author Gregory Hermann, MD, MPH, a resident physician in radiation medicine at Roswell Park, report two key findings: that high‐dose prophylactic gabapentin increased the percentage of patients who required no opioid during treatment — from 7% among those receiving the low-dose regimen to 42% in the high-dose arm — and that methadone may improve quality of life compared to a regimen of short‐acting opioids such as hydrocodone and fentanyl, a synthetic opioid.

“We learned some important things here,” says Dr. Singh, the study’s senior author. “This was a pilot study, but our results were so striking that we have already changed our practice at Roswell Park. We’re now going to high-dose gabapentin as our first intervention for patients dealing with the effects of treatment for head-and-neck cancer. And for those whose pain progresses on gabapentin, we now know that methadone — an inexpensive, widely available narcotic — is more effective, less likely to impair quality of life and less likely to lead to addiction than other opioids.”

The study represents the latest evidence from Roswell Park demonstrating safe and effective alternatives that can significantly reduce the need for opioids in clinical care. Last year, Roswell Park implemented new pain-management guidelines for patients undergoing surgery based on research led by Emese Zsiros, MD, PhD, showing that patients recovered well after surgery when prescribed few or no opioids.

Dr. Singh and team have another clinical study underway (NCT03574792) that seeks to determine whether incorporating venlafaxine hydrochloride, a drug commonly prescribed to treat depression, into pain management may further reduce the need for narcotics in patients treated for head and neck cancers.

The study in Cancer is available https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/cncr.32676. This research benefitted from shared resources supported by Roswell Park’s Cancer Center Support Grant from the National Cancer Institute (project no. P30CA016056).

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