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Is pain part of a systemic syndrome in head and neck cancer?

  • Paolo BossiEmail author
  • Massimo Ghiani
  • Angela Argenone
  • Roberta Depenni
Review Article

Abstract

Head and neck cancers (HNC) represent 5% of all malignancies worldwide with about 180,000 cancer deaths per year. Patients with HNC are characterized by a systemic inflammatory state, generally associated with worse outcomes. Treatment-related toxicity is common among HNC patients and causes systemic consequences such as fatigue or cognitive dysfunction. The therapeutic treatments of HNC involve the release in circulation of inflammatory systemic mediators, whose effects trigger a vicious circle that may lead to functional and behavioral alterations. The areas of the head and neck are highly sensitive to pain. Literature data confirm that in HNC patients, pain is one of the most distressing symptoms across all the phases of treatment. Pain is associated with worse general conditions, depression, fatigue, impaired cognitive functions, and lower survival rate. The treatment of advanced HNC cases is multimodal and requires a multidisciplinary psycho-socio-pharmacological approach mediated by a team of experts. The pharmacological approach in management of HNC patients with pain is fundamental and involves the use of opioids, NSAIDs, steroids, or other drugs. Opioids in pain management therapy in patients with HNC could allow the pain level to be adequately monitored, thus improving quality of life. The integration of opioid and non-opioid therapy as well as non-pharmacological interventions is essential for the rehabilitation of physical, social, and psychological functions and to achieve pain control in patients with HNC. Opioid treatment is the mainstay for pain control, being used both for background and breakthrough cancer pain (BTcP) episodes. Fentanyl, easily absorbed and generally well tolerated, appears to be a possible choice due to its versatility. Non-pharmacological interventions, such as tailored yoga, physical exercise, and acupuncture, may have a role in pain management in patients with HNC.

Keywords

Head and neck cancer Pain Pain management Multidisciplinary approach Opioids 

Notes

Acknowledgments

The authors acknowledge Annarita Chieti, PhD, of Sanitanova S.r.l., who is responsible for the medical writing and editorial assistance.

Compliance with ethical standards

Conflict of interest

Paolo Bossi is a part of advisory boards of/consultant for Angelini, Roche, Merck, Kyowa Kirin, Astrazeneca, MSD, BMS, SunPharma, and Sanofi. Other authors have nothing to declare.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Medical OncologyASST Spedali Civili BresciaBresciaItaly
  2. 2.Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
  3. 3.Oncology DepartmentA. Businco HospitalCagliariItaly
  4. 4.Radiation Oncology DepartmentIstituto Nazionale Tumori-IRCCS-G. Pascale FoundationNaplesItaly
  5. 5.Oncology and Haematology DepartmentUniversity Hospital of Modena and Reggio EmiliaModenaItaly

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