Efficacy and Safety of Celecoxib Combined with Gabapentin for Head and Facial Pain in Nasopharyngeal Carcinoma: A Retrospective Cohort Study
Background Head and facial pain caused by local invasion in nasopharyngeal carcinoma (NPC) is notoriously severe and traditionally managed with opioids, which carry substantial dependence and tolerability risks. Because this tumor-related pain intrinsically involves both neuropathic and inflammatory pathways, we retrospectively evaluated a novel opioid-sparing analgesic strategy combining celecoxib and gabapentin. Methods This exploratory retrospective cohort analysis included 60 newly diagnosed NPC patients experiencing severe head and facial pain secondary to cranial nerve or skull base invasion. Patients received either opioid monotherapy (extended-release oxycodone, n=30) or a combined regimen of celecoxib and gabapentin (n=30). The primary endpoint was the absolute reduction in Numeric Rating Scale (NRS) scores at 48 hours. Secondary endpoints included sleep quality improvement, assessed via the Insomnia Severity Index (ISI), and adverse events. Longitudinal data were rigorously analyzed using Generalized Estimating Equations (GEE) to account for repeated measures and adjust for baseline clinical covariates. Results Baseline clinical characteristics were broadly comparable between the cohorts, with no statistically significant differences in premedication NRS scores (6.5 in both groups) or ISI scores (16.5 vs 19.5, P = 0.118); however, the combined group had a numerically higher baseline ISI score, and all ISI comparisons were therefore based on change-from-baseline scores. The GEE longitudinal analysis revealed a significant treatment-by-time interaction for pain relief. At the 48-hour primary endpoint, the combined regimen demonstrated a significantly greater absolute reduction in NRS scores compared to the opioid group (Estimated Mean Difference [MD], 2.15; 95% CI, 1.45 to 2.85; P < 0.001). Furthermore, the combined therapy yielded a profoundly larger improvement in sleep architecture (ISI reduction MD, 9.85; 95% CI, 7.50 to 12.20; P < 0.001). Safety profiles analyzed via Fisher’s exact test confirmed the combined group had a significantly lower incidence of nausea and vomiting (0.0% vs 20.0%, P = 0.024); no significant between-group differences were observed for other adverse events including constipation, dizziness, and somnolence. Conclusion Combining celecoxib and gabapentin appears to offer an effective, opioid-sparing alternative for managing complex tumor-related pain in NPC, and was associated with greater pain reduction over the 48-hour observation period, accelerated sleep recovery, and significantly better gastrointestinal tolerability compared to conventional opioid therapy in this retrospective cohort. These findings are hypothesis-generating and warrant prospective validation.