New Treatment Could Ease Oral Cancer Pain

Oral mucositis from head and neck cancer treatment eased with doxepin oral rinse

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Patients with cancer already have treatment and healing to deal with, so ways to ease their excess pain are always being explored. A new study reveals promise of one new method to ease such pain.

This new study focused on patients with cancer of the head and neck who were experiencing pain in the mouth and throat.

The study showed that using an oral rinse form of an antidepressant medication with pain-killing properties helped ease the patients' pain.

"Talk to your doctor before changing use of any prescribed medication."

According to the authors of this study, which was led by Robert C. Miller, MD, of the Department of Radiation Oncology at the Mayo Clinic in Rochester, Minnesota, patients receiving radiation therapy for cancers of the head and neck (which can include mouth and throat cancer) often experience sores and a painful swelling in the mouth called oral mucositis.

Dr. Miller and team explained that oral mucositis can hinder eating and drinking, leading to issues with nutrition, dehydration and weight loss that can be serious and require hospitalization and the use of intravenous (IV) fluids or feeding tubes.

These researchers wanted to test the effectiveness of an oral rinse form of doxepin (brand name Deptran), an antidepressant with pain-killing properties, at treating oral mucositis in these patients.

To do so, Dr. Miller and team identified 155 adult patients currently receiving radiotherapy for a head and neck cancer at 25 different centers across the US between December 17, 2010 and May 17, 2012. The patients all had mouth and throat pain that was rated as at least a four on a scale of zero to 10, with zero representing no pain and 10 representing the worst oral pain.

The patients were randomly separated into two groups, one of which received doxepin oral rinse and the other of which received a placebo (an inactive medication replacement) on day one of the study. One the next day, the patients then received the other treatment. The patients' pain was measured for several hours after the treatments were given.

Dr. Miller and team found that the patients experienced a greater pain reduction after using doxepin than after using the placebo.

On average, the pain scores 30 minutes after using the rinse dropped two points on the 0-10 pain scale after doxepin, compared with drop of only one point after the placebo. The researchers noted that significant differences in pain scores were also seen at one, two and four hours after receiving the rinse.

The doxepin treatment was associated with more adverse effects like a stinging or burning, unpleasant taste in the mouth and drowsiness. However, more patients (77.3 percent) expressed the desire to continue receiving treatment after taking doxepin than they did after taking the placebo (51.5 percent) during the first phase of the study.

The study authors called these findings "modest but significant" in terms of mouth and throat pain score reductions.

"A doxepin rinse diminishes [oral mucositis] pain," Dr. Miller and team concluded. "Further studies are warranted to determine its role in the management of [oral mucositis]."

This study included a relatively small number of participants over a short period of time. Further research involving more patients, a long-term time frame and more exploration into possible side effects is needed.

This study was published online April 14 by the Journal of Clinical Oncology.

Dr. Miller reported receiving research funding from pharmaceutical company Pfizer. The study was supported by grants from a variety of organizations, including the National Cancer Institute and the National Institutes of Health.

Review Date: 
April 14, 2014
Last Updated:
April 15, 2014