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PAIN MEDICINE

Oral Doxepin Rinse: The Analgesic Effect and Duration of Pain Reduction in Patients with Oral Mucositis Due to Cancer Therapy

Joel B. Epstein, DMD, MSD^*, Joshua D. Epstein, MA, Matthew S. Epstein, BS, Hal Oien, DDS, and Edmond L. Truelove, DDS, MSD^¶

From the *Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, and Chicago Cancer Center, College of Medicine, University of Illinois, Chicago, Illinois; Department of Pharmaceutical Economics and Policy, University of Southern California, Los Angeles, California; Fred Hutchinson Cancer Research Center, Seattle; Private General Dental Practice, Beaverton, Oregon; and ¶Department of Oral Medicine, University of Washington, Seattle, Washington.

Address correspondence and reprint requests to J. Epstein, DMD, Department of Oral Medicine, 801 South Paulina, Chicago, Ill 60612. Address e-mail to jepstein{at}uic.edu.

This research expands on our prior study, in which we assessed pain reduction after topical doxepin rinse in patients with oral mucositis resulting from cancer and cancer therapy. We continued to enroll patients with painful oral mucositis attributable solely to cancer therapy and performed further analysis on the duration of pain reduction. Fifty-one patients with oral mucositis were enrolled. Mucositis was scored and oral pain was assessed with a visual analog scale before doxepin oral rinse (5 mg/mL) and at regular intervals up to 4 h after rinsing. Of those who reported pain reduction, 95% did so within 15 min of rinsing with doxepin. In the total sample, the average patient reported a 70% maximum decrease in pain (P < 0.0001). Recurrence of pain was slow and at the conclusion of the study 19 patients (37%) still reported a reduction from baseline pain. With this censored data we used Cox-proportional hazards to determine what variables best explained longer duration of pain reduction. Our final model determined that more severe baseline pain, worse mucosal erythema score, or a larger relative maximum reduction in pain were all associated with a slower rate of pain recurrence after oral rinsing (all P < 0.01).

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999