Research shows physicians may be able to use gabapentin to help manage head, neck cancer pain and reduce the need for opioids.
Higher doses of gabapentin given to patients receiving concurrent chemoradiotherapy for squamous cell carcinoma of the head and neck was found to curb the need of opioid use for pain control during radiotherapy (RT), according to a research letter published online May 18 in JAMA Network Open. This could mean that the drug is a good first-line treatment alternative to opioid use and the potential for addiction. Gabapentin was well tolerated by all who received it in the study.
Squamous cell carcinoma is a type of cancer occurring in the squamous cells found in the outer layer of skin and in mucous membranes, which are the tissues that line body cavities. Head and neck squamous cell carcinoma (HNSCC) develops in mouth, nose, and throat.
Sung Jun Ma, M.D., from the Roswell Park Comprehensive Cancer Center in Buffalo, New York, and cohorts, completed a secondary analysis of two clinical trials involving “92 patients receiving concurrent chemoradiotherapy for nonmetastatic squamous cell carcinoma of the head and neck and prophylactic oral gabapentin. The team discovered that “most patients tolerated gabapentin per protocol,” according to their paper.
The authors continue, “The time to first opioid use for additional pain control was greatest in the 3,600-mg cohort in the multivariable competing risks model. The smallest proportion of patients requiring opioids during RT was seen in the 3,600-mg cohort compared with the 900-mg and 2,700-mg cohorts (37.5, 93.1, and 61.3 percent, respectively). Compared with the 3,600-mg cohort, the odds of feeding tube placement were significantly greater during RT in the 2,700-mg cohort; the odds were not significantly greater in the 900-mg cohort.”
They write, “Although gabapentin, 3,600 mg, daily has been adopted as the standard regimen of the Roswell Park Comprehensive Cancer Center, additional studies are warranted to further investigate its role in pain control.”
Turning to gabapentin as a means to control pain might have widespread implications for treating patients undergoing other types of surgeries and procedures, particularly pain related to other types of cancer. However, the authors conclude, “Although gabapentin, 3600 mg, daily has been adopted as the standard regimen of the Roswell Park Comprehensive Cancer Center, additional studies are warranted to further investigate its role in pain control.”
The Centers for Disease Control and Prevention (CDC) has reported, “Over 70% of the 70,630 deaths in 2019 involved an opioid. From 2018 to 2019, there were significant changes in opioid-involved death rates: Opioid-involved death rates increased by over 6%. Prescription opioid-involved death rates decreased by nearly 7%.” Researchers, scientists, members of the medical community and advocates have been busily trying (over the course of the last few years) to come up with ways to fight the crisis. Courts have also been busy prosecuting those who overprescribe and over-distribute deadly opioids. The use of gabapentin to manage pain, in some circumstances, may offer a viable option to help curb the epidemic.