Takase, H., Sakata, T., Yamano, T., Sueta, T., Nomoto, S., & Nakagawa, T. (2011). Advantage of early induction of opioid to control pain induced by irradiation in head and neck cancer patients. Auris, Nasus, Larynx, 38(4), 495–500.

To determine whether early induction of low-dose opioid for the treatment of mild pain improves dietary and caloric intake and reduces weight loss among patients with head and neck cancer

The low-dose opioid this study used was controlled-release oxycodone (CRO). The intial dose was 10 mg and the dose was titrated upward as needed. Because all patients agreed to use an opioid at some point, patients were classified into two groups, mild and moderate (referring to pain), according to when the opioid was introduced.

• The sample was composed of 43 patients, 23 in the mild-pain group and 20 in the moderate-pain group.
• In the mild group, mean patient age was 63.6 years. In the moderate group, mean patient age was 63.7 years.
• In the mild group, 2 patients were female and 21 patients were male. In the moderate group, 2 patients were female and 18 were male.
• All patients had head and ceck cancers and were receiving radiation therapy from 40 Gy to a high of 60 Gy. (Not all patients received the highest dose.)

• Single site
• Inpatient
• Department of Otorhinolaryngology, Fukuoka University Hospital, Fukuoka, Japan

Prospective descriptive study

• Visual analog scale (VAS) (0 = no pain, 100 = unbearable pain), to measure pain
• Caloric intake – caloric intake rate (Caloric intake rate was calculated by dividing the caloric intake by the basal energy expenditure [BEE]. Caloric intake was estimated from inpatient dietary forms and from what patients actually ate.)
• Weight loss
• Duration of time on a regular diet before the switch to a softer or liquid diet

• VAS pain scores were significantly lower in the mild group than in the moderate group, at 25–50 Gy.
• The amount of oxycodone used for pain was significantly lower in the mild group than in the moderate group.
• Patients in the mild group maintained a regular diet for a significantly longer period than did patients in the moderate group.
• Caloric intake was significantly higher in the mild group, at more than 20 Gy.
• Weight loss was significantly lower in the mild group, at more than 20 Gy.
• The incidence of side effects was equal in both groups. Constipation and nausea were the most frequent side effects, followed by sleepiness, diarrhea, vomiting, itching, and dysuria.

Results indicated that the introduction of opioids for mild pain during radiotherapy controls the level of pain and increases the food intake of head and neck cancer patients. For such patients, use of opioids, beginning when pain is mild, may help to ensure a better dietary intake during radiotherapy.

• The study had a small sample, with fewer than 100 patients.
• Researchers took almost four years to gather data.
• The validity of the caloric-intake measures, based on what patients may have eaten, is questionable.

For the population of patients with head and neck cancer, maintaining food intake is a challenge, so this study is relevant. The intervention uses a standard pain control agent; the point at issue is the advisability of early intervention (early in terms of the World Health Organization ladder). The patient population pertinent to the study is very specific; the study is not generalizable.