PAIN MANAGEMENT IN THE DRESSINGS OF RADIODERMATITIS IN THE HEAD AND NECK REGION
A. Lombardo, E. Fontana, S. Iannarino, F. Stivala, A. Mariotto, M. Urso, G. Riva, S. Valzan, M. Miletta, M. Paleologo | A.O.U. City of Health and Science of Turin, Molinette Hospital
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BACKGROUND
Radiodermatitis in patients undergoing radiotherapy after major head and neck oncologic surgery represents a significant issue that negatively affects the quality of care. This complication, particularly in advanced stages, can cause a high degree of pain. Inadequate treatments, carried out without any rationale, worsen the patient’s clinical condition, with negative repercussions on pain, emotional well-being, and healing. In order to improve outcomes for pain perceived by patients with grade 2–3 radiodermatitis (Radiation Therapy Oncology Group – RTOG scale) during dressing changes, an observational study was conducted.
METHODS
From January 1, 2020, to October 1, 2024, an observational study was conducted on 30 patients (24 men and 6 women, aged between 33 and 75) with grade 3 radiodermatitis of the head and neck region, as assessed by the Radiation Therapy Oncology Group (RTOG) scale. Pain was assessed using a validated scale, the Numerical Rating Scale (NRS), with a range from 0 to 10, where zero corresponds to no pain and 10 to the maximum imaginable pain. For a thorough evaluation, all phases of the dressing procedure were considered: removal, cleansing, debridement, care of the perilesional skin, dressing application, closure, and fixation. The results were entered into Microsoft Excel, and for each phase of the dressing procedure, the mean and standard deviation (SD) were calculated.
RESULTS
- Removal: mean pain 6, SD ± 2
- Cleansing: mean pain 6, SD ± 2
- Debridement: mean pain 8, SD ± 2
- Dressing and Fixation: mean pain 4, SD ± 2.
CONCLUSIONS
In light of the results, the need for better pain control during dressing changes was evident. For this purpose, a multidisciplinary team was established, consisting of a wound care specialist, pain management anesthesiologist, otolaryngologist, and nurses trained in hypnotic communication. They developed an appropriate therapeutic scheme based on hypnotic communication and, subsequently, the following:
- Local application of 5% lidocaine cream +:
- For painful radiodermatitis (NRS > 3): intravenous acetaminophen 1000 mg
- Before debridement: tramadol 50 mg in 100 ml of normal saline, administered over 15 minutes.
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