Cerchietti Leandro C A, Navigante Alfredo H, Bonomi Marcelo R, Zaderajko Mariel A, Menéndez Pablo R, Pogany Catalina E, Roth Berta M C
Supportive Care Division, Department of Medical Oncology, Angel H. Roffo Cancer Institute, University of Buenos Aires, Buenos Aires, Argentina.
Cancer. 2002 Nov 15;95(10):2230-6. doi: 10.1002/cncr.10938.
Oral mucositis is the dose-limiting toxicity for patients receiving concurrent chemoradiotherapy regimens for tumors of the head and neck area. Currently, the management of established mucositis includes the use of topical anesthetics and systemic analgesics. Based on the clinical evidence of pain alleviation by topical morphine in patients with some inflammatory and painful conditions, a clinical study was undertaken to determine this effect on mucositis-associated pain.
Twenty-six patients with head and neck malignancies treated with concomitant chemoradiotherapy for head and neck carcinoma who had severe painful mucositis (World Health Organization Grade 2 or higher) were enrolled. Patients were randomly assigned to morphine mouthwash (MO; 14 patients) or magic mouthwash (MG), a mixture of equal parts of lidocaine, diphenhydramine, and magnesium aluminum hydroxide (12 patients).
The duration of severe pain was 3.5 days less in the MO group compared with the MG group (P = 0.032). The intensity of oral pain was also significantly lower in the MO group compared with the MG group (P = 0.038). No patient in the MO group required third-step opiates for alleviation of the mouth pain. There was a significant difference in duration of severe functional impairment (P = 0.017). Five patients in the MG group complained of local side effects and only one in the MO group (P = 0.007).
For patients with head and neck carcinomas receiving concomitant chemoradiotherapy, MO is a simple and effective treatment to decrease the severity and duration of pain and the duration of functional impairment.
口腔黏膜炎是头颈部肿瘤患者接受同步放化疗方案时的剂量限制性毒性反应。目前，已确诊的黏膜炎的治疗方法包括使用局部麻醉剂和全身性镇痛药。基于局部应用吗啡可缓解某些炎症和疼痛性疾病患者疼痛的临床证据，开展了一项临床研究以确定其对黏膜炎相关性疼痛的影响。
纳入26例接受头颈部癌同步放化疗且患有严重疼痛性黏膜炎（世界卫生组织2级或更高等级）的头颈部恶性肿瘤患者。患者被随机分为吗啡漱口水组（MO；14例患者）或神奇漱口水组（MG），后者是利多卡因、苯海拉明和氢氧化铝镁等量混合的溶液（12例患者）。
MO组严重疼痛持续时间比MG组少3.5天（P = 0.032）。MO组口腔疼痛强度也显著低于MG组（P = 0.038）。MO组没有患者需要第三步使用阿片类药物来缓解口腔疼痛。严重功能障碍持续时间存在显著差异（P = 0.017）。MG组有5例患者抱怨有局部副作用，而MO组只有1例（P = 0.007）。
对于接受同步放化疗的头颈部癌患者，MO是一种简单有效的治疗方法，可减轻疼痛的严重程度和持续时间以及功能障碍的持续时间。
