Pharmacological Management of Neuropathic Pain after Radiotherapy in Head and Neck Cancer Patients: A Systematic Review

Maria Kouri; Martina Rekatsina; Athina Vadalouca; Ioanna Siafaka; Emmanouil Vardas; Erofili Papadopoulou; Antonella Paladini; Giustino Varrassi

doi:10.3390/jcm11164877

Pharmacological Management of Neuropathic Pain after Radiotherapy in Head and Neck Cancer Patients: A Systematic Review

J Clin Med. 2022 Aug 19;11(16):4877. doi: 10.3390/jcm11164877.

Authors

Maria Kouri^{1

2}, Martina Rekatsina³, Athina Vadalouca⁴, Ioanna Siafaka¹, Emmanouil Vardas², Erofili Papadopoulou², Antonella Paladini⁵, Giustino Varrassi⁶

Affiliations

¹ A' Anesthesiology Clinic, Pain Management and Palliative Care Center, Aretaieio University Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece.
² Dental Oncology Unit, Department of Oral Medicine and Pathology and Hospital Dentistry, Dental School, National and Kapodistrian University of Athens, 11527 Athens, Greece.
³ Department of Anesthesia Pain Therapy and Palliative Care, Aretaieio University Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece.
⁴ Pain Clinic, Athens Medical Center, 15125 Athens, Greece.
⁵ Department of MESVA, University of L'Aquila, 67100 L'Aquila, Italy.
⁶ Paolo Procacci Foundation, 00193 Roma, Italy.

Abstract

Background: Neuropathic pain (NP) in head and neck cancer (HNC) patients represents a treatment challenge. Most studies investigating drugs against NP are conducted in patients suffering with diabetic neuropathy or postherpetic neuralgia, while data are limited in cancer pain management. Additionally, regarding cancer therapy-related NP, most of the studies do not focus on HNC patients. The aim of this review is to identify the studies on systematically administered medication for NP management that included HNC patients under radiotherapy. Methods: A systematic literature search was performed, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, in PubMed, Cochrane Library, Web of Science and ClinicalTrials.gov on 30 October 2021. The medical subject heading (MeSH) terms were (“head and neck cancer” OR “tumor”) AND “neuropathic pain” AND “medication” AND “radiotherapy.” The Cochrane Collaboration tool was used for quality assessment. Results: The search identified 432 articles. Three more articles were identified after searching the reference lists of the retrieved articles. A total of 10 articles met the eligibility inclusion criteria and were included in this review; 6 on gabapentin, 1 on pregabalin, 1 on nortriptyline, 1 on methadone, and 1 on ketamine. Statistically significant results in pain reduction compared to placebo or standard pain medication were found in the studies on pregabalin (p = 0.003), methadone (p = 0.03), ketamine (p = 0.012), and in two out of six gabapentin studies (p < 0.004). Two of the studies (both concerning gabapentin) had no comparison arm. Conclusions: Treatments including pregabalin, methadone, ketamine, and gabapentin were found to provide pain relief against HNC NP. While there is a plethora of pharmacological treatments available for the management of NP, only a few studies have been conducted regarding the pharmacological management of therapy-related NP in HNC patients. More studies should be conducted regarding the pharmacological approaches in HNC therapy-related NP so that specific treatment algorithms can be developed.

Keywords: head–neck cancer; neuropathic pain; pharmacological therapy; radiotherapy.

Publication types

Review

Grants and funding

No funding or sponsorship was received for this study. The authors are grateful to the Paolo Procacci Foundation for its unconditioned support during the publication process.