Use of topical lidocaine, diphenhydramine hydrochloride, nystatin, and gabapentin swish in treatment for post-radiation neuropathy and oral mucositis.

The pain caused by cancer treatment-related oral mucositis is often described as the most excruciating symptom (1). Frequently, it leads to reduced ingestion, malnutrition, and sometimes postponement or withdrawal of the therapy (1). For health care providers, adequate pain treatment is a major challenge. Treatments that have varying degrees of success include antibiotics, antifungal, antivirals, opioids, benzydamine oral rinse, and palifermin (2,3). Topical pain management is invariably administered in most patients due to its favorable risk-benefit profile and adjuvant role (2,3). However, topical treatment of mucositis pain today is based on empiricism and not on scientific evidence (2,3). We report the use of a novel topical mixture of lidocaine, diphenhydramine hydrochloride, nystatin, and gabapentin along with a course of oral opioids for radiation-induced intractable oral pain.