Prophylactic High-Dose Gabapentin Reduces Opiate Use during Radiation Therapy for Head and Neck Squamous Cell Carcinoma

SIMPLE SUMMARY: Patients undergoing radiotherapy for head and neck cancer often develop painful mouth sores caused by inflammation called oral mucositis. The use of prophylactic gabapentin to reduce pain and opioid use during treatment in this population is controversial. To investigate this further, we evaluated 480 patients with head and neck cancer treated at our institution with high-dose (3600 mg), moderate-dose (200 to 3200 mg), and no gabapentin and examined the rates of opioid use. We found that patients given prophylactic high-dose gabapentin had reduced opioid use and did not require opioids until later in treatment compared with patients taking a moderate dose or no gabapentin. These findings support the use of prophylactic high-dose gabapentin for head and neck cancer patients undergoing radiotherapy to reduce patients’ reliance on opioids for pain relief. ABSTRACT: Background: The role of prophylactic high-dose gabapentin for the management of oral mucositis during radiation therapy for head and neck squamous cell carcinoma (HNSCC) remains controversial. Methods: A retrospective cohort analysis was performed on primary HNSCC patients treated at our institution. Kruskal–Wallis and Fisher’s exact tests were used to compare the patients’ baseline characteristics. Multivariate competing risk and logistic regressions were performed to evaluate time to first opioid use and feeding tube placement. Results: In total, 480 consecutive HNSCC patients were included. Within this cohort, 186 patients received 3600 mg gabapentin, 182 received 300 to 3200 mg gabapentin, and 112 received no gabapentin. The time to first opioid use was greater in the 3600 mg group compared with the no gabapentin group (34.3 vs. 23.9 days, p < 0.001) and to the 300 to 3200 mg group (28.0 days, p < 0.001). The proportion of patients requiring opioids at any point during RT was lower in the 3600 mg gabapentin group compared with the no gabapentin group (31.8% vs. 60.1%, p < 0.001) and with the 300 to 3200 mg group (63.8%, p < 0.001). Conclusions: Prophylactic use of 3600 mg gabapentin was well tolerated, halved overall opioid use, and delayed the time to first opioid use during radiation therapy.