![]() She experienced decreased stomatodynia and odynophagia and was able to decrease the dose of her systemic opiate analgesics. Ketamine oral rinse was described in a case report of a 32-year-old female with radiation-induced mucositis pain refractory to compounded topical solutions (containing lidocaine, diphenhydramine, nystatin, and magnesium hydroxide/aluminum hydroxide), transdermal fentanyl, and intravenous hydromorphone. Ketamine also has the modest anti-inflammatory properties which could be beneficial in mucositis pain relief. Peripheral administration of ketamine was shown to have antinociceptive efficacy similar to that of systemic administration, likely mediated by NMDA antagonism. Local administration of ketamine to the limbs of patients with complex regional pain syndrome has been shown to cause a reduction in allodynia in a double-blind placebo controlled study. Ketamine is FDA approved for induction and maintenance of general anesthesia but has also been used for procedural sedation, refractory severe pain, and acute respiratory failure in children. Ketamine also appears to selectively interrupt association pathways in the brain producing somatesthetic sensory blockade. Ketamine works by selectively depressing the thalamoneocortical system, non-competitively blocking N-methyl-D-aspartate (NMDA) receptors, and having intrinsic sympathomimetic activity. Ketamine is a sedative hypnotic with anesthetic and analgesic properties and with reported benefit when used topically. Other agents that have been investigated with variable responses are oral capsaicin, oral sulfasalazine, and growth factor mouthwashes. ![]() Data supporting these management options are limited. Current standard of care focuses on palliation and includes systemic opiate analgesics for moderate to severe mucositis pain, topical anesthetics and mucosal coating agents for moderate pain, and bland rinses for mild pain. One marketed agent is a recombinant human keratinocyte growth factor, palifermin, and despite its approval to reduce the incidence and duration of oral mucositis, it has seen limited utility due to questionable clinical benefit and high acquisition costs. ![]() Unfortunately, few available options have proven useful. Īs a result, many agents and strategies have been investigated to alleviate this pain, to prevent the incidence of mucositis, or to decrease the severity of mucositis. Mucositis also has the potential to impact the effectiveness of cancer treatment as it is a dose-limiting toxicity resulting in cessation or reduction of treatment in 35% of patients receiving chemotherapy. ![]() ![]() Pain from oral mucositis has been reported as one of the most debilitating side effect by patients receiving HCT. Mucositis and associated pain are consistently reported as extremely distressing for patients and may involve erythema, inflammation, bleeding, and ulceration. Oral mucositis occurs in approximately 40% of patients receiving standard dose chemotherapy, 80% of patients receiving radiation therapy to the head and neck, and up to 100% of patients undergoing a hematopoietic cell transplant (HCT). Mucositis has significant quality of life and clinical consequences for patients undergoing antineoplastic cytotoxic therapies. ![]()
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