What strategies do you employ to mitigate mucositis related pain during the treatment of head and neck cancer?

The bottom line is there is no magic bullet that works well.

I start Glutamine a week before and throughout the duration of the treatment. It seems to delay the onset.

I use custom made mouth pieces to reduce dental scatter if possible--that will reduce mucositis

I start with over the counter analgesics (acetaminophen, tylenol) first and then move to short acting narcotics on as needed basis. If that's not sufficient or they're needing it too frequently, i use long-acting. Usually I use oxycodo...

In my practice, I usually start with NSAIDs and/or MMW with lidocaine (our formulation also has a low-to-intermediate potency corticosteroid in it), then short-acting opioids. Once taking short-acting opioids around-the-clock as Rx'ed, prescribe a long-acting opioid. In oropharynx or larynx primary, most of the mucosal irritation is in the pharynx, and when instructing patients on how to take MMW, I always tell them to ingest the dose with a straw, so as to bypass the oral cavity and avoid the n...

Best first step is to minimize mucositis with your radiation plan. At time of simulation, make sure any metal from dentures, bridges, appliances, etc are removed. In cases of BoT, have the patient extend his neck as much as possible to remove the oral cavity from entry/exit to the beam. Metal crowns or implants should be covered with a mouth piece to absorb scatter as much as possible.

Be sure to contour the oral cavity and pharyngeal constrictors, eg. I try and keep this dose (while of course c...

Drs. Karam and Hadziahmetovic, thank you so much for your very thorough answers! These are extremely helpful. As a small addition, I want to mention a recent report on the potential benefit of methylene blue mouth rinse for patients with severe RT-related oral mucositis (Roldan et al, Pain Pract 2017). The authors describe a series of 5 patients with intractable mucositis, refractory to systemic opiates, who received 0.05% methylene blue as mouth rinse for 3 weeks. Pain relief and overall satisf...

Best exploration of backscatter from dental amalgam I've recently seen. Amelioration technique is investigated too.

They have a non-exhaustive compendium of mucositis-related literature over on Wikibooks; I've seen a kajillion of these in the past so make this a kajillion and one. The methylene blue data would be a good addition.

Some people remain convinced that amifostine helps prevent muscosits. Many others do not. In my experience if forced to say whether it does or not, I'd say "Yes," but the...