Patients planned for chemoradiation to the head and neck are usually advised to expect some pain and soreness during their treatment and that pain relief will be offered as and when it is required. Uncontrolled pain and mucositis affect oral intake and the ability to pursue swallowing exercises, thus compromising long-term functional outcomes. The authors of this paper highlight that while nociceptive pain may be controlled by narcotic analgesics, this may not address neuropathic pain experienced by patients undergoing treatment. Based on their preliminary work on this subject that showed favourable results for early use of gabapentin, they report on the one-year functional outcomes of a small cohort of 26 patients given pre-emptive gabapentin. Patients took gabapentin (2700mg/d) throughout their treatment and were weaned off after they stopped taking other narcotic analgesics. Mean duration for using gabapentin was 42 days.

At one year post-treatment, no patients remained on a gastrostomy feeding tube (mean time to removal was two months), scores on the Functional Oral Intake Scale showed near normal diet texture (mean FOIS = 6.83, SD = 0.39), and only one patient demonstrated aspiration.

Other physiological swallowing parameters on videofluoroscopy were excellent across the group. Patient reported scores on the MD Anderson Dysphagia Inventory (mean MDADI = 82.52) suggested minimal patient perceived problems. While the authors acknowledge the limitation of not having a control group, they highlight that these results indicate that a clinical trial may be warranted. The relative contribution of continued swallowing exercises to positive functional results could not be teased apart in this cohort study, but could be addressed in a prospective trial. Prophylactic gabapentin may be a useful addition to the efforts to manage symptoms and functional morbidities experienced by patients with oropharyngeal tumours.

One-year swallowing outcomes in patients treated with prophylactic gabapentin during radiation-based treatment for oropharyngeal cancer.
Starmer H, Yang W, Gourin CG, et al.
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Roganie Govender

University College London, Head & Neck Academic Centre, UK.

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