Methylene Blue for the Treatment of Intractable Pain From Oral Mucositis Related to Cancer Treatment: An Uncontrolled Cohort

Authors: Carlos J. Roldan MD1,2, Matthew Chung MD1, Lei Feng MS3, and Eduardo Bruera MD4
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  • 1 Department of Pain Medicine, The University of Texas MD Anderson Cancer Center;
  • | 2 McGovern Medical School at The University of Texas Health Science Center at Houston; and
  • | 3 Department of Biostatistics, and
  • | 4 Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Background: Oral mucositis is a complication of cancer therapy, causing severe pain that affects oral functioning, nutrition, and quality of life, as well as therapy nonadherence or dose-limiting toxicity. Anecdotal experience has suggested that methylene blue (MB) oral rinse may be an effective and safe treatment of this oral pain. Methods: To evaluate the efficacy and safety of MB oral rinse for the treatment of oral pain due to mucositis in patients with cancer, we retrospectively evaluated patients who experienced refractory pain despite conventional therapy. Results: We identified 281 patients who received MB oral rinse. Most were receiving treatment for leukemia (n=85; 30.3%) and head and neck squamous cell carcinoma (n=84; 29.9%). The most common treatments were radiation therapy alone (n=108; 38.4%) and chemoradiation (n=86; 30.6%). Median duration of symptoms was 14 days. Mean (SD) numeric rating scale pain scores were 7.7 (1.83; median, 8) before MB oral rinse and 2.51 (2.76; median, 2) after MB oral rinse (P<.0001). Most patients achieved pain control within the first 3 doses. The effectiveness of MB oral rinse was independent of patient age, sex, cancer type, cancer stage, MB dilution, and pain duration or baseline pain scores. The lowest response to treatment was reported in individuals with esophageal mucositis. Few patients experienced adverse effects of MB oral rinse (n=13; 4.6%); 10 had a transient burning sensation, 2 had transient blue discoloration of the teeth and mouth, and 1 had increased pain. Conclusions: MB oral rinse is an effective and safe treatment for refractory pain from oral mucositis related to cancer treatment.

Submitted July 21, 2020; accepted for publication September 3, 2020. Published online January 4, 2021.

Author contributions: Study concept: Roldan, Bruera. Data curation: Roldan, Chung. Investigation: Roldan. Methodology: Roldan. Project administration: Roldan. Supervision: Roldan. Formal analysis: Feng. Writing—original draft: Roldan. Writing—review and editing: All authors.

Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Correspondence: Carlos J. Roldan, MD, Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Unit 409, 1515 Holcombe Boulevard, Houston, TX 77030. Email: croldan@mdanderson.org
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