Mirabile, A., Airoldi, M., Ripamonti, C., Bolner, A., Murphy, B., Russi, E., . . . Bossi, P. (2016). Pain management in head and neck cancer patients undergoing chemo-radiotherapy: Clinical practical recommendations. Critical Reviews in Oncology/Hematology, 99, 100–106.
DOI Link
Purpose & Patient Population
PURPOSE: To provide consensus recommendations for pain management in the setting of patients with head and neck cancer-induced oral mucositis
TYPES OF PATIENTS ADDRESSED: Patients with head and neck cancer undergoing chemotherapy and/or radiation therapy
Type of Resource/Evidence-Based Process
RESOURCE TYPE: Evidence-based guideline
PROCESS OF DEVELOPMENT: 37 experts met and appointed a four-person facilitator board who formed a systematic review of literature on pain in patients with head and neck cancer undergoing chemo-radiation treatment. On the basis of the systematic review, facilitators drafted key statements. These were provided to panel members and rated using a Delphi appropriateness method. After panel discussion and final statements reaching consensus, external specialists in medical oncology and supportive cancer care reviewed the statements.
DATABASES USED: MEDLINE
INCLUSION CRITERIA: Any study design; consensus guideline; abstracts presented at annual meetings of the American Society of Clinical Oncology (ASCO) and of the European Society of Medical Oncology (ESMO)
Phase of Care and Clinical Applications
PHASE OF CARE: Active antitumor treatment
APPLICATIONS: Palliative care
Results Provided in the Reference
Guidelines & Recommendations
The consensus document provides overall statements regarding the importance of pain management, assessment for pain, and the need to have patients continue swallowing efforts to minimize atrophy and fibrosis. Specific recommendations regarding pain-related interventions are:
- Basic oral care will reduce severity of oral mucositis and associated pain.
- An opioid-based systemic pain control program is usually needed.
- Topical coating agents and anesthetics may reduce mucosal sensitivity, but with short duration.
- Topical capsaicin should not be used.
- A transmucosal opioid is a rational approach to odynophagia, which should be viewed as incidental breakthrough pain.
Limitations
No quality rating of evidence used is discussed, and numerous consensus statements are not supported by evidence or any references.
Nursing Implications
This guideline is a mix of consensus-based and evidence-based recommendations. Nurses should be aware of the need for patients to continue trying to swallow to avoid disuse muscle atrophy and fibrosis from treatment. This guideline suggests that pain on swallowing be managed as breakthrough pain, and that transmucosal opioids would be an appropriate approach for management.