From the Guidelines
Lidocaine is an effective treatment for oral sores (mucositis) caused by chemotherapy, and it can be used as a 2% viscous solution or oral gel. For relief, you can use 2% viscous lidocaine solution by swishing 1-2 teaspoons (5-10 ml) in your mouth for about one minute, then spitting it out, as suggested by the U.K. guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 2016 1. This can be done every 3-4 hours as needed for pain. Alternatively, you may use lidocaine oral gel (2%) applied directly to sores with a clean finger or cotton swab. Some oncologists prescribe "magic mouthwash," a compound containing lidocaine mixed with other soothing ingredients. Be careful not to swallow large amounts of lidocaine as it can cause numbness in your throat, potentially leading to choking. Also, avoid eating or drinking for 30-60 minutes after application to prevent accidental biting of numbed areas. Lidocaine works by temporarily blocking nerve signals in the mouth tissues, reducing pain sensation.
The management of oral and gastrointestinal mucosal injury guidelines by ESMO also suggest the use of other treatments for oral mucositis, such as oral cryotherapy, low-level laser therapy, and morphine mouthwash 1. However, the most recent and highest quality study recommends the use of lidocaine for the treatment of oral sores caused by chemotherapy. If your pain is severe or persistent, consult your oncologist as they may recommend different concentrations or alternative treatments. Always use lidocaine products as prescribed and inform your healthcare provider if you experience any unusual side effects.
Some key points to consider when using lidocaine for oral sores include:
- Using the correct concentration (2% viscous solution or oral gel)
- Avoiding swallowing large amounts of lidocaine
- Avoiding eating or drinking for 30-60 minutes after application
- Informing your healthcare provider of any unusual side effects
- Considering alternative treatments if pain is severe or persistent.
From the Research
Lidocaine for Oral Sores from Chemotherapy
- Lidocaine is often used as an ingredient in "magic mouthwash" to treat oral mucositis caused by chemotherapy 2.
- However, studies have shown that "magic mouthwash" containing lidocaine, diphenhydramine hydrochloride, and aluminum hydroxide suspension is not effective in treating oral mucositis 3, 4.
- The effectiveness of lidocaine alone in treating oral mucositis is not well-established, and more research is needed to determine its efficacy.
- Other agents, such as aloe vera, have shown promise in preventing and treating oral mucositis caused by chemotherapy 5, 6.
Alternative Treatments for Oral Mucositis
- Aloe vera mouthwash has been shown to be effective in preventing and treating oral mucositis in patients undergoing chemotherapy 5, 6.
- Other agents, such as allopurinol, immunoglobulin, and human placental extract, have also shown promise in treating oral mucositis, but more research is needed to confirm their effectiveness 3, 4.
- Patient-controlled analgesia (PCA) and pharmacokinetically based analgesia (PKPCA) have been compared to continuous infusion methods for controlling pain, but no significant differences were found 3, 4.