An oral rinse with the antidepressant drug doxepin is effective in relieving oral pain in patients undergoing radiation therapy for head and neck cancer, according to the latest research by Mayo Clinic scientists, presented in Boston at the American Society for Radiation Oncology conference.
Doxepine is an organic chemical compound used as a moderate tricyclic antidepressant. It also has a strong anxiolytic and sedative effect and – which has recently been talked about more often – analgesic. It is used in patients with neurosis, depression, anxiety syndromes and as a premedication before surgical and diagnostic procedures conducted without general anesthesia.
Researchers from the Mayo Clinic Cancer Center in Arizona decided to test its effectiveness (compared to placebo) in relieving severe mouth pain caused by mouth mucositis, and resulting from radiotherapy or chemotherapy in patients with head and neck cancer. The aim of the study was also to evaluate possible side effects of doxepin.
Mucositis and mouth ulcers are common, very painful and debilitating side effects of radiation therapy, explains the study’s lead author, oncologist Dr. Robert Miller. As she adds, they characterize these ailments? myself? redness, swelling? and bleeding wounds on the mucosa of the mouth and tongue. The pain of inflammation is so severe that it makes it difficult to eat, drink or even speak. Patients switch to a liquid diet and some to parenteral (intravenous) nutrition over time.
Moderate inflammation occurs in most patients after chemo- or radiotherapy for head or neck cancer. The risk of acute inflammation increases when chemotherapy is combined with radiotherapy? and with prolonged treatment of cancer.
Until now, such patients were given traditional oncological painkillers and recommended a special diet and dental consultation. However, such drugs have many side effects, ranging from nausea and indigestion, through dizziness and fainting, to kidney or liver failure.
The team of dr. Miller decided to test a different method. He divided 155 patients undergoing radiation therapy for head and neck cancer into groups. One of them was given a doxepin rinse, the other a placebo. Patients were asked to rate their oral pain sensation on a scale of 0 to 10 before starting rinsing, during, and then 15, 30, 60, 120 and 240 minutes after using the rinse.
After the experiment was completed, 64 percent. patients decided to continue treatment with this method. Doxepin turned out to be well tolerated, although some patients reported mild stinging, burning, sleepiness and unpleasant taste side effects.
The results of our research are a great opportunity for patients. They set a new standard of care in the treatment of such ailments, concludes Dr. Miller.
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