QP2: Challenges Treating Severe Oral Mucositis Pain in Patients at High Risk for Aspiration
Abstract
QP2: Challenges Treating Severe Oral Mucositis Pain in Patients at High Risk for Aspiration Annabelle Hood, Bridget Scullion and Hilary McGuire Background: Mucositis is one of the most common adverse reactions encountered in patients receiving chemotherapy and radiation therapies, particularly in the head and neck region. It is associated with painful ulcers, odynodysphagia, altered taste, dehydration and can affect the ability to tolerate additional therapies, nutritional status, and overall quality of life. Onset and severity of mucositis is correlated with the degree of and recovery of neutropenia, however therapeutic interventions are directed at treating the pain caused by mucositis, including topical lidocaine, Magic Mouthwash (contains a combination of an anticholinergic ± antacid ± topical anesthetic), opioid agonists, and doxepin mouthwash. High grade mucositis increases aspiration risk, therefore limiting use of topical liquid preparations. Additionally, systemic opioids further increase the risk of aspiration due to sedation and promotion of muscle relaxation. The challenging nature of treating pain related to mucositis is highlighted through a patient case of a 63 y/o male with acute myeloid leukemia with extramedullary relapse post allogenic stem cell transplant complicated by graft versus host disease status post treatment with decitabine and ipilimumab admitted to the hospital for worsening pleural and pericardial effusions. He received salvage chemotherapy…
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