Pain control in oral and neck carcinoma patients treated with chemoradiation are a challenge to manage, achieving a pain control and avoiding the complication of pain killers is as more important as pain control. In this study locally advanced squamous cell carcinoma treated with concurrent chemo radiation involving inj cisplatin for all patients and few patients were given inj nimotuzumab along with inj cisplatin. Controlling pain for moderate- severe level with tramadol without antiemetics is not tolerated by most of the patients, adding a drug for a drug induced complication (emesis) is a burden for patients, hence drug with least complication is always better.
Three groups (40 patients in each group) of locally advanced oral and neck squamous cell carcinoma treated with concurrent chemoradiation (with inj.cispaltin +/- inj.nimotuzumab) were taken. For pain control Group-A had tapentadol 50mg twice daily if pain persisted dose were increased up 200mg with 6 hours interval, Group-B had tramadol plus paracetamol with antiemetics, Group-C had tramadol plus paracetamol without antiemetics. On 3rd and 4th weeks of treatment patients had grade III and grade IV severe pain and pain score was assessed with facial expression as per WHO criteria.
In group-A, of 40 patients 36 (90%) had good pain relief with pain score0-1 of which 31 patients showed pain relief with 50mg twice daily and 4 had dose escalation of 50mg four times daily, 1 patient showed skin allergy with good pain control, 4 patients were switched to tab. morphine 10gm every 4th hour. In group-B, 35 (87.5%) patients had good pain relief with pain score 0-1, but 5 patients did not tolerate due to emesis, sedation in spite of good pain relief, 5 patients were switched to tab. morphine 10mg every 4th hourly. In group-C only 7 (17.5%)patients tolerated with pain relief, rest did not tolerate emesis and sedation and were given symptomatic care.
Tapentadol statistically had similar pain control as that of tramadol with paracetamol, but was superiorly tolerated by the patients without emesis.
CBCC-Oncology Services, Saveetha University Chennai
Has not received any funding
The author has declared no conflicts of interest.