***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Patients who receive radiotherapy for head and neck cancer are likely to develop painful mucositis . The pain is characterized by a burning or stinging sensation similar to neuropathic pain sensations . The purpose of the present study was to compare the analgesic effect of a tricyclic antidepressant ( TC ) , commonly used in the treatment of neuropathic pain , with the effect of opioids on radiation-induced mucositis pain . Forty-three patients receiving 66 - 68 Gy external radiation according to the DAHANCA guidelines ( the Danish Head and Neck Cancer Study Group ) were r and omized to either morphine or TC when mucositis pain was insufficiently managed with weak analgesics . Patients with insufficient pain control in either treatment arm received supplementary medication from the opposite treatment arm . Pain was evaluated weekly using a VAS scale and the McGill Pain Question naire . The degree of mucositis and the degree of depression were measured at the same time intervals . Twenty-two patients entered the opioid arm and 21 the TC arm . Two patients in each arm were non-evaluable . VAS pain scores were significantly reduced in the opioid treatment arm one week after r and omization ( p = 0.01 ) . Eight patients in the TC arm were managed with TC alone , but for 11 patients it was necessary to add morphine . The 20 evaluable patients in the morphine arm required no additional treatment . There were no significant differences in side effects between the two groups . Higher pain scores in the TC arm , but not in the opioid arm , were significantly correlated with higher BDI scores . Some head and neck cancer patients with radiation-induced nucositis pain may have sufficient pain control on TC alone . This might be useful in patients with relative counter-indications to opioid treatment Benzydamine hydrochloride rinse reduced pain associated with radiation mucositis when it was used during the course of radiation therapy . Fewer patients using benzydamine rinse required systemic analgesics . All patients using benzydamine tolerated the rinse well and continued with regular rinsing throughout the course of radiation therapy . Benzydamine hydrochloride is currently undergoing clinical trials in the United States for application for approval from the Food and Drug Administration Purpose The purpose of the study is to compare the efficacy of benzydamine HCl with sodium bicarbonate in the prevention of concurrent chemoradiation-induced oral mucositis in head and neck cancer patients . Methods Sixty locally advanced head and neck cancer patients treated with high-dose radiotherapy concurrently with platinum-based chemotherapy  were r and omly assigned to receive either benzydamine HCl or sodium bicarbonate from the first day of treatment to 2 weeks after the completion of treatment . The total score for mucositis , based on the Oral Mucositis Assessment Scale ( OMAS ) , was used for the assessment , conducted weekly during the treatment period and at the fourth week of the follow-up . Pain score , all prescribed medications , and tube feeding needs were also recorded and compared . Results The median of total OMAS score was statistically significant lower in patients who received benzydamine HCl during concurrent chemo-radiotherapy ( CCRT ) than in those who received sodium bicarbonate , ( p value < 0.001 ) . There was no difference in median pain score , ( p value = 0.52 ) . Nineteen percent of patients in sodium bicarbonate arm needed oral antifungal agents whereas none in the benzydamine HCl arm required such medications , ( p value = 0.06 ) . Tube feeding needs and the compliance of CCRT were not different between the two study arms . Conclusions For patients undergoing high-dose radiotherapy concurrently with platinum-based chemotherapy , using benzydamine HCl mouthwash as a preventive approach was superior to basic oral care using sodium bicarbonate mouthwash in terms of reducing the severity of oral mucositis and encouraging trend for the less need of oral antifungal drugs Benzydamine HCl is a new nonsteroidal analgesic and anti-inflammatory compound which is not chemically related to local anesthetics such as procaine and xylocaine . A double-blind , r and omized clinical investigation was carried out to determine the analgesic and anti-inflammatory effectiveness of benzydamine HCl in patients with radiation-induced mucositis of the oropharynx . Of the 67 patients in the study , 37 were on benzydamine and 30 on placebo .  Patients developed radiation mucositis , hyperemia , and throat pain when the total radiation dose reached above 2,000 rad over 2 weeks ( 200 rad per fraction , five treatments per week ) . Analysis of the data showed that benzydamine HC1 used as a rinse/gargle provided a statistically significant and clinical ly meaningful alleviation of the symptoms of oropharyngeal mucositis . There was also significant improvement in terms of reduction in hyperemia and mucositis in benzydamine group . No systemic side effects associated with benzydamine medication were noted . In view of the relative ineffectiveness of systemic analgesics and topical anesthetics for these conditions , benzydamine HCl promises to be a useful addition to the therapeutic armamentarium PURPOSE To determine if addition of the ulcer-coating polysaccharide sucralfate could improve symptomatic relief of radiation mucositis over a popular combination of antacid , diphenhydramine , and viscous lidocaine alone . METHODS AND MATERIAL S A double-blind study was conducted in which nurses and pharmacists coded patient groups and distributed medication in a manner blinded to both the patients and physicians . Eligible patients receiving radiation to the head and neck and /or chest sites that included the esophagus were r and omized to a st and ard combination of antacid , diphenhydramine , and viscous lidocaine vs. the same solution plus sucralfate .  Eligible patients were those receiving > 40 Gy at 1.8 Gy/fraction , one fraction/day , five fractions/week . Participating patients were stratified between chest , small field head and neck , and large field head and neck . The patients subjective evaluation of throat soreness and relief with medication was elicited as well as physician observations and smears for C and idiasis screening . Medication was prescribed when the patient became symptomatic and concomitant use of other locally effective non study agents was not allowed . The ability to eat various consistency of foods was grade d 0 - 5 , with 5 indicating no compromise of ability to ingest a food compared to baseline . Statistical analysis included mean + SD for food and soreness scores , paired t-test , and two-way analyses of variance to evaluate effects of site and treatment group on the changes in scores . RESULTS Over 2 years , 111 patients were entered . Because some withdrew and others did not require medication , results are presented for evaluable patients in each category . Mild adverse effects from the medication solution ( usually mouth discomfort ) were reported by < 10 % of patients in each treatment group among 106 patients evaluable for toxicity . There was a comparable incidence of mild-moderate mucositis for the two treatment groups . Severe mucositis was noted in two patients of the st and ard medication group and none among patients receiving sucralfate . The groups were comparable for indicators including degree of soreness , dietary changes , and objective measures or mucosal irritation or infection . For the head and neck patients there was a significant worsening in soreness and in the ability to eat in both treatment groups , whereas patients treated to the chest had less nutritional change . Multivariate analysis including control for confounding factors did not detect treatment effects for any of the response measures . No patient had occult fungal infection detected by oral pathology evaluation of routine mucosal scrapings . CONCLUSIONS A trend ( that was not statistically significant ) of less severe radiation mucositis was noted for patients receiving sucralfate in addition to the combination of viscous lidocaine , diphenhydramine , and antacid for nonulcerative radiation mucositis A variety of mouthwashes are frequently used in the management of irradiation-induced mucositis . Benzydamine has recently been introduced for alleviating this condition . Its efficacy as a mouthwash was compared with chlorhexidine in two groups of patients receiving radiotherapy for oral carcinoma .  Mucositis and pain were recorded over a 6 week period and oral carriage of C and ida species , coliforms and Staphylococcus aureus was assessed using an oral rinse technique . There was no significant difference in the mucositis scores , overall pain scores or the yeast and bacterial species isolated between the two treatment groups . However , 58 % ( 7 out of 12 ) and 92 % ( 12 out of 13 ) patients reported oral discomfort when rinsing the mouth with chlorhexidine and benzydamine , respectively . In both groups , the most common coliform isolated was Klebsiella pneumoniae and the carriage of yeasts was significantly greater than that of coliforms . These results indicate that , although the individual patient acceptance of chlorhexidine is better than benzydamine , there is little difference between the two mouthwashes both in controlling pain and mucositis or in the oral carriage of the micro-organisms studied OBJECTIVE Radiation-induced mucositis ( RIM ) in chemoradiotherapy ( CRT ) for head and neck cancer ( HNC ) causes severe pain and worsens CRT compliance , QOL and outcome . Following retrospective reports , we conducted a r and omized trial of the safety and efficacy of gabapentin for RIM-associated pain during CRT . METHODS HNC patients ( pts ) receiving CRT were r and omized to st and ard pain control ( SPC ) with acetaminophen and opioids , or SPC plus gabapentin ( SPC+G ) . Gabapentin was maintained at 900mg/day for 4 weeks after CRT . Primary endpoint was maximum visual analogue scale ( VAS ) score during CRT , and secondary endpoints were total opioid dose , changes in QOL ( EORTC QLQ-C30 and QLQ-HN 35 ) from baseline to 4 weeks after CRT , and adverse events . RESULTS Twenty-two eligible Stage III or IV pts were r and omly assigned to SPC or SPC+G ( n=11 each ) . Twelve were treated in a locally advanced setting and 10 in a postoperative setting . Median maximum VAS scores , median total dose of opioids at maximum VAS and total dose of opioids at 4 weeks after CRT tended to be higher in the SPC+G arm ( 47 in SPC vs. 74 in SPC+G , p=0.517 ; 215 mg vs. 745.3 mg , p=0.880 ; and 1260 mg vs. 1537.5 mg , p=0.9438 , respectively ) , without significance . QOL analysis showed significantly worse scores in the SPC+G arm for weight gain ( p=0.005 ) . Adverse events related to gabapentin were manageable . CONCLUSIONS This pilot study is the first prospect i ve r and omized trial of gabapentin for RIM-related pain . Gabapentin had no apparent beneficial effect . Further research into agents for RIM-related pain is warranted Radiotherapy of head and neck malignancies is accompanied by oral discomforts , such as epithelitis , pain and functional impairment . This can lead to chronic sequalae with subjective distress such as loss of taste and xerostomia and pronounced decrease in quality of life . Thus , the need to reduce the mucosal damage following radiotherapy is obvious . Therefore , we investigated the possible ability of sucralfate , an aluminium hydroxide complex of sulphated sucrose used in the treatment of gastric ulcer , in preventing oral discomfort in patients treated with curative intent for malignancies in the head and neck region . The study was double-blind , placebo-controlled and r and omized and included 50 consecutive patients . The study demonstrated that the proportion of patients with severe mucosal reactions was significantly lower in the sucralfate group than in the placebo group Benzydamine was evaluated in patients with head and neck carcinoma for treatment of radiation‐induced oral mucositis , a frequent complication of radiation therapy ( RT ) for which there is no predictable therapy or preventive treatment currently available PURPOSE Painful oral mucositis ( OM ) is a significant toxicity during radiotherapy for head and neck cancers . The aim of this r and omized , double-blind , placebo-controlled trial was to test the efficacy of doxepin hydrochloride in the reduction of radiotherapy-induced OM pain . PATIENTS AND METHODS In all , 155 patients were r and omly allocated to a doxepin oral rinse or a placebo for the treatment of radiotherapy-related OM pain . Patients received a single dose of doxepin or placebo on day 1 and then crossed over to receive the opposite agent on a subsequent day . Pain question naires were administered at baseline and at 5 , 15 , 30 , 60 , 120 , and 240 minutes . Patients were then given the option to continue doxepin . The primary end point was pain reduction as measured by the area under the curve ( AUC ) of the pain scale using data from day 1 . RESULTS Primary end point analysis revealed that the AUC for mouth and throat pain reduction was greater for doxepin ( -9.1 ) than for placebo ( -4.7 ; P < .001 ) . Crossover analysis of patients completing both phases confirmed that patients experienced greater mouth and throat pain reduction with doxepin ( intrapatient changes of 4.1 for doxepin-placebo arm and -2.8 for placebo-doxepin arm ; P < .001 ) . Doxepin was associated with more stinging or burning , un 
    Output:
    
Non-opioid interventions , including topical doxepin , amitriptyline , diclofenac and benzydamine , were found to provide relief of pain due to mucositis , and when effective may allow for reduction in the use of opioids in pain management