Opioids for oral mucositis-related pain: a narrative review

Background and Objective: Oral mucositis (OM), a common toxicity of chemotherapy and head-and-neck radiation in cancer patients, can cause severe pain that commonly results in difficulty chewing, swallowing, and speaking. If not adequately controlled, OM-related pain can lead to therapy discontinuation. Although extensive research has focused on the prophylaxis, treatment, and histology of OM, OM-related pain remains a clinical challenge. We aimed to investigate any available guidelines in the use of opiates to treat pain associated to this pathology. This narrative review summarizes the current literature on opiate analgesia for managing OM-related pain in cancer patients. Methods: We performed a comprehensive literature search using the terms “oral mucositis”, “pain”, and “opioids” which yielded 160 articles. After we screened these articles for English-language articles describing studies in adult patients and removed duplicate articles, we had 117 articles available for review. Key Content and Findings: In addition to oral hygiene maintenance, current strategies for managing OM-related pain in cancer patients include the use of oral rinses, topical anesthetics, prophylactic antimicrobials, and systemic analgesics such as opioids, which are commonly the default option and delivered intravenously. Conclusions: Current treatment options for OM-related pain often include the use of opioid analgesics. However, evidence for the selection of systemic analgesics to treat OM-related pain is limited.