Vayne-Bossert, P., Escher, M., de Vautibault, C., Dulguerov, P., Allal, A., Desmeules, J., . . . Pautex, S. (2010). Effect of topical morphine (mouthwash) on oral pain due to chemotherapy- and/or radiotherapy-induced mucositis: A randomized double-blinded study. Journal of Palliative Medicine, 13(2), 125–128.

To determine if a mouthwash containing morphine decreases oral pain associated with chemotherapy- or radiotherapy-induced mucositis

Subjects were randomized to two groups. One used 2% morphine solution. The other used a placebo, a quinine solution. Both groups used the specified solution six times daily, holding the solution in the mouth for 2 minutes at each application. After three days patients crossed over to the alternate treatment. Patients kept daily diaries and rated oral pain before and one hour after the mouthwash. The study lasted six days.

• The sample was composed of 11 patients.
• Mean patient age was 55.1 years (SD = 3 years).
• The report did not state the percentages of males and females in the sample.
• The report did not state key disease characteristics.
• All patients were receiving either chemotherapy or radiotherapy. Most patients used acetaminophen and NSAIDs for pain; three patients used opiods.
   

• Multisite
• Clinical
• Switzerland
   

Phase of care: active treatment

Randomized double-blind crossover study

The study used a 10 cm visual analog scale (VAS), to rate pain.

ANOVA suggested a difference over time between placebo and morphine, but authors noted no significant differences in pain between mouthwashes on the same or different days. Not all patients adhered to prescribed frequency of use. Authors noted no adverse events.

Study results did not support the use of morphine mouthwash as a treatment for the pain of oral mucositis.

• The study had a small sample size, with fewer than 30 patients.
• The study had a risk of bias resulting from sample characteristics.
• Other possible study limitations were short duration; low pain levels, given the medications used; and lack of information about rescue medication. The study did not consider how many subjects may have been receiving multiple treatments, a factor that might have affected mucositis. The frequency of mouthwash use, to achieve effective pain relief, is unknown.

This study was too small to demonstrate the effects of a morphine-containing mouthwash on mucositis-associated oral pain.