Publications about Phenytoin and Cancer Pain
Shah and Sharma, Pain (1990), 3270 investigated the effects of phenytoin for pain relief in patients with head and neck cancer. Sixty patients received 100 mg PHT 3 to 4 times a day and pain relief was evaluated by scoring good relief (greater than 60%), fair (30-59%), and poor (less than 30%).
Phenytoin produced good pain relief, especially shooting pain, in 37.1% of the patients and fair relief in 42. 9%. Duration of pain relief was approximately 3 to 4 hours. The authors also noted PHT’s usefulness in reducing hyperesthesia over post surgical scars.
3270. Shah, S. and Sharma, K., Use of phenytoin in head and neck cancer pain, Sixth World Congress on Pain, Adelaide, Australia, 1-6, April 1990, Pain, Suppl 5: S357, 1990.
Bhatia, Antiseptic (1991), 3271 assessed the effect of oral phenytoin (200-400 mg/day) on pain relief in fifty patients with proven malignancy of the head and neck. Phenytoin was beneficial in forty-five (90%) of the patients. Improvements in mood, pain tolerance and analgesic efficacy, particularly in spasmodic and throbbing pain, were remarkable.
No adverse effects
No additional anti-pain therapy was required for these terminal cancer patients from a remote, rural area of India. And also, no adverse effects were noted. The author concludes that symptom control with PHT alone in terminal cancer patients having mild to moderate pain can be sufficient. Narcotic drugs may not be required. Importantly, as the author points out, phenytoin is safe, inexpensive and available.
3271. Bhatia, M.T., Simplified approach for relief of terminal cancer pain with phenytoin sodium, Antiseptic, 88(1): 18-22, 1991.
Bhatia, Journal of the Indian Medical Association (1991), 3272 studied the analgesic efficacy of 200-400 mg phenytoin as a sole treatment for the control of pain in cancer patients in rural India. Of the total of eighty patients, thirty-nine had carcinoma of the cervix; seventeen, breast carcinoma; and twenty-four, cancer of the head and neck.
Patients experienced spasmodic throbbing, burning, sharp or cutting type pain that was assessed by an objective numerical questionnaire. Phenytoin relieved 80% of the pain and related symptoms in thirty-eight patients (47%). Twenty-three patients (29%) had pain and symptom control between 60-80%. Thirteen patients (16%) had symptom control between 40-60%. Phenytoin also improved mood and sense of well-being in seventy-two of the eighty patients.
Terminal cancer pain
3272. Bhatia, M.T., Anticonvulsant alone in the relief of cancer pain, J. Indian Med. Assoc., 90(11): 301-2, 1992.
Bhatia, Personal Communication (1992), 3273 presents, in tabular form, data on 30 patients treated with combined aspirin and Dilantin for terminal cancer pain. For each patient, the sex, age, type of cancer, and individual dosage and frequency of administration of aspirin and Dilantin are listed. The relief of pain, provided by the combined therapy, for each cancer patient is given.
3273. Bhatia, M.T., Combination of dilantin with aspirin in relief of terminal cancer pain, Personal Communication, 1-3, 1992.
Yajnik, Singh, Singh and Kumar, Journal of Pain and Symptom Management (1992), 3274evaluated the efficacy of phenytoin (PHT), buprenorphine (Bu), and Bu + PHT for the relief of cancer pain of various etiologies. A randomized, double-blind one-month study of three groups, each comprised of twenty-five patients, was conducted. PHT (100 mg po twice daily) provided > 50% pain relief to eighteen patients (72%) and > 75% relief to four patients (16%). Bu (0.2 mg sublingually twice daily) gave twenty-one patients (84%) > 50% relief, and fifteen patients (60%) > 75% relief.
Eight Bu-treated patients had serious side effects, while none of the phenytoin-treated patients experienced problems. Combined therapy (PHT, 50 mg po + Bu 0.2 mg SL twice daily) provided > 50% pain relief to twenty-two patients (88%) and > 75% to eighteen (72%). Only one patient experienced a serious side effect.
Phenytoin has moderate pain relieving properties
This study suggests that phenytoin has mild to moderate pain relieving properties of its own and can significantly enhance buprenorphine analgesia. The authors state that further clinical trials of PHT in the relief of cancer pain are warranted.
3274. Yajnik, S., Singh, G.P., Singh, G., and Kumar, M., Phenytoin as co-analgesic in cancer pain, J. Pain Symp. Manage., 7(4): 209-213, 1992.
Chang, Journal of Pain and Symptom Management (1997), 3275 report the use of intravenous and oral phenytoin to control rapidly progressive severe pelvic and lower extremity pain in a 58-year-old woman with metastatic fibrosarcoma. Morphine alone,(10 mg/hr or 120 mg every 4 hours, up to 540 mg/day), intravenous and oral, failed to relieve the pain or produced unacceptable side effects.
A 500 mg loading dose of intravenous phenytoin produced near complete relief of her pain within an hour. She was discharged on phenytoin (199 mg twice a day), desipramine (25 mg daily), lorazepam (0.5 mg twice a day), and morphine (120 mg every 4 hr) with good pain control. Cessation of the phenytoin led to pain recurrence and so the phenytoin was continued for 9 mos, until her death.
3275. Chang, V.T., Intravenous phenytoin in the management of crescendo pelvic cancer-related pain, J. Pain Symp. Manage., 13(4):238-240, 1997.
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