With nearly all patients who undergo treatment for cancer of the head and neck experiencing oral mucositis, 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 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 by Hermann et al in Cancer, show that gabapentin is an effective alternative to standard pain-control drugs and that many patients with head and neck cancer had their pain and symptoms managed without any narcotics.

Methods

Anurag K. Singh, MD

Anurag K. Singh, MD, Professor of Oncology and Director of Radiation Research at Roswell Park Comprehensive Cancer Center, 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 at 2,700 mg daily, progressing successively to hydrocodone/acetaminophen and fentanyl when needed, or to a regimen of low‐dose gabapentin at 900 mg daily, progressing to methadone when needed. Patients were undergoing definitive chemoradiation; the primary endpoints were safety and toxicity, while secondary endpoints included pain, opioid requirement, and quality of life.

Results

The researchers reported two key findings: 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,” said Dr. Singh. “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. 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.”

Dr. Singh and team have another clinical study underway 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 cancer.

Disclosure: This research benefitted from shared resources supported by Roswell Park’s Cancer Center Support Grant from the National Cancer Institute. For full disclosures of the study authors, visit acsjournals.onlinelibrary.wiley.com.