Top Line: Does multimodal analgesia provide better pain control than opioids alone in patients receiving head and neck cancer radiation?
The Study: Pain from radiation induced mucositis is common during and after radiation for HNSCC. In this randomized trial, 49 patients experiencing moderate to severe pain (≥4 out of 10) during curative intent radiation or chemoradiation for HNSCC were randomized to an opioid-based pain regimen or a multimodal analgesia regimen. Multimodal analgesia consisted of pregabalin twice daily titrated in increments of 50mg per dose to a max of 300mg BID, acetaminophen 1000mg three times per day, and naproxen 250-500mg twice per day plus a PPI. Opioids could be used in the MMA arm if pain was poorly controlled. The primary endpoint of mean pain score reported during the last week of RT was deemed non-inferior with MMA. However, MMA had significantly lower mean pain score in the 6 weeks following RT. The median weekly opioid requirement was nearly halved with MMA (51 mg v 99 mg oral morphine equivalent dose).
TBL: In this small randomized trial, a regimen of mixed analgesia agents resulted in pain control that was noninferior to opioids at the end of RT and superior 6 weeks after RT in patients with HNSCC. | Zayed, Radiother Oncol 2025
The Study: Pain from radiation induced mucositis is common during and after radiation for HNSCC. In this randomized trial, 49 patients experiencing moderate to severe pain (≥4 out of 10) during curative intent radiation or chemoradiation for HNSCC were randomized to an opioid-based pain regimen or a multimodal analgesia regimen. Multimodal analgesia consisted of pregabalin twice daily titrated in increments of 50mg per dose to a max of 300mg BID, acetaminophen 1000mg three times per day, and naproxen 250-500mg twice per day plus a PPI. Opioids could be used in the MMA arm if pain was poorly controlled. The primary endpoint of mean pain score reported during the last week of RT was deemed non-inferior with MMA. However, MMA had significantly lower mean pain score in the 6 weeks following RT. The median weekly opioid requirement was nearly halved with MMA (51 mg v 99 mg oral morphine equivalent dose).
TBL: In this small randomized trial, a regimen of mixed analgesia agents resulted in pain control that was noninferior to opioids at the end of RT and superior 6 weeks after RT in patients with HNSCC. | Zayed, Radiother Oncol 2025