An International Journal of Otorhinolaryngology Clinics

Register      Login

VOLUME 2 , ISSUE 1 ( January-April, 2010 ) > List of Articles


Pain Management in Patients with Head and Neck Carcinoma

Aditi Ghei, Sharmila Khot

Keywords : Cancer pain,head and neck cancer

Citation Information : Ghei A, Khot S. Pain Management in Patients with Head and Neck Carcinoma. Int J Otorhinolaryngol Clin 2010; 2 (1):69-75.

DOI: 10.5005/jp-journals-10003-1019

Published Online: 01-12-2010

Copyright Statement:  Copyright © 2010; The Author(s).


Pain is one of the feared effects of advancing cancer and can affect a vast majority of head and neck cancer (HNC) patients. HNC's have a devastating impact on patient's lives as both disease and treatment can affect the ability to speak, swallow and breathe due to involvement of the aerodigestive tract. The etiology of pain in this subgroup of patients could be as a result of direct tumor progression, nerve root compression or as a result of the treatment modalities including surgery radiotherapy and chemotherapy. Pain experienced could be nociceptive or neuropathic. A thorough initial and ongoing assessment of the patient is essential for diagnosis and planning the treatment bearing in mind its modification during treatment. Treatment involves a comprehensive approach which is centred around systematic pharmacotherapy, and supplemented by a range of therapeutic interventions and physical and behavioral approaches. In this article we discuss the incidence, etiology, assessment and treatment of this challenging problem using current modalities.

PDF Share
  1. Pain and the head and neck cancer patient: Changes over treatment. Head Neck Surg 1986;8:169–76.
  2. Pain control in cancer of the head and neck in Thawley SE, Panje WR (Eds): Comprehensive management of Head and Neck Tumors. Philadelphia. PA Saunders. 1987;1:42–68.
  3. The treatment of cancer pain. N Engl J Med 1985;313:84–95.
  4. Pain management in advanced carcinoma of the head and neck. Am J Otolaryngol 1991;12:154–69.
  5. Multiple primary neoplasia of the head and neck and lung: The changing histopathology Cancer1986;57:2193–97.
  6. Analgesic drug therapy in cancer pain: Principles and practice. Med Clin North Am 1987;71:207–32.
  7. The care of patients with severe chronic pain in terminal illness. JAMA 1984;251:1182–88.
  8. Validation of World Health Organisation Guidelines for pain relief in head and neck cancer. A prospective study. Ann Otol Rhinol Laryngol 1993;102:342–48.
  9. Pain control in advanced and recurrent head and neck cancer. Otolaryngol Clin North Am 1980;13:551–60.
  10. Bandolier 2007 [Accessed:26/11/2009] Available from
  11. Merskey and Bogduk, N. IASP Press, Seattle, © 1994;209–14.
  12. Ionic channels and neuropathic pain: Physiopathology and applications. J of cellular physio 2008;215(1):8–15.
  13. In: Lecture notes: Diseases of Ear Nose Throat. Bull P, Clarke R editors (10th ed). Wiley-Blackwell 2007;142–46.
  14. Pain control in head and neck cancer. Current opinion in otolaryngology and head and neck surgery 1998;86:85–89.
  15. Indomethacin and bone pain. Lancet 1974;2:1160.
  16. Clinical pharmacology of opioids for pain. Clin J of Pain 2002;18(suppl):S3–13.
  17. Acute pain management in adults: Operative procedures. Agency for health care policy and research. US department of health and human services 1992.
  18. Opioids and their proper use as analgesics in the management of head and neck cancer patients. Am J of Otolaryngol 2000;21(4):244–54.
  19. The quality of mercy. N Eng J Med 1982;306:98–99.
  20. Addiction rare in patients treated with narcotics. N Eng J Med 1980;302:123.
  21. Palliative Medicine: A Case Based Manual (2nd ed). New York: Oxford University Press; 1998.
  22. Cancer Pain. JAMA 2003;290:2476–79.
  23. Transdermal opioids for cancer pain. Health qual life outcomes 2006;4:24.
  24. Clinical pharmacology of fentanyl buccal tablet for the treatment of breakthrough pain. Expert rev clin pharmacol 2008;1(1):39–47.
  25. Are opioids effective in relieving neuropathic pain? Pain 1999;80:453–62.
  26. Opioids for neuropathic pain. Curr Pain Headache Rep 2005;9:153–60.
  27. Lack of analgesic effect of opioids on neuropathic and idiopathic forms of pain. Pain 1988;33:11–23.
  28. Algorithm for neuropathic pain treatment: An evidence based proposal. Pain 2005;118:289–305.
  29. Gabapentin plus opioid for managing neuropathic cancer pain. J Pain Symptom Manage 2007;34(2):183–89.
  30. Pregabalin pharmacology and its relevance to clinical practice. Epilepsia 2004;45(6):13–18.
  31. Adjuvant analgesics in pain management. In: Doyle D, Hanks GWC, MacDonald N (Eds). Oxford Textbook of Palliative Medicine (2nd ed). New York, NY. Oxford University Press 1998.
  32. Head and neck nerve blocks for cancer pain management. Tech Reg Anesth Pain Manage 1997;1:3–10.
  33. Endoscopic transnasal neurolytic sphenopalatine ganglion block for head and neck cancer pain. J Laryngol and Otol 2001;115(5):385–87.
  34. The recurrence of pain after neurosurgical procedures. Qual of life research 1994;3(1):S43–49.
  35. Continuous intracisternal and high cervical intrathecal bupivacaine analgesia in refractory head and neck pain. Anaesthesiology 1996;84:256–72.
  36. Acupuncture reduces pain and dysfunction in head and neck cancer patients after neck dissection. 31Mar 2008. (Accessed 19 Nov 2009). Available from:
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.