Researchers tested a new way to help end-of-life cancer patients who struggle to swallow. They used a numbing medication called bupivacaine as a nasal spray and found it might reduce the thick mucus that makes swallowing difficult. By studying how the treatment changed genes in throat cells, scientists discovered the spray appears to work by reducing mucus production for about 30 minutes at a time. This small pilot study suggests the approach is worth testing on more patients to confirm whether it really helps people eat and drink more comfortably during their final days.
The Quick Take
- What they studied: Whether a numbing spray applied inside the nose could help cancer patients who have trouble swallowing by reducing thick mucus in their throat
- Who participated: End-of-life cancer patients in palliative care (comfort-focused care) who were experiencing swallowing difficulties. The exact number of participants was not specified in the study
- Key finding: The nasal bupivacaine spray appeared to change how genes work in throat cells, specifically reducing genes related to mucus production. This effect lasted about 30 minutes per dose and seemed to help patients eat and drink more easily
- What it means for you: If you or a loved one is struggling to swallow at the end of life, this research suggests a simple nasal spray might offer temporary relief. However, this is very early research, and larger studies are needed before doctors can widely recommend it. Talk with your healthcare team about whether this might be appropriate
The Research Details
This was a pilot study, which means it was a small, early-stage test to see if a new idea is worth studying more carefully. Researchers gave cancer patients in palliative care a nasal spray containing bupivacaine, a numbing medication commonly used by dentists and surgeons. They collected samples from patients’ throats before and after treatment using simple swabs. They then analyzed these samples using advanced genetic testing to see which genes were turned on or off after the treatment. This approach allowed them to understand how the spray might be working at a molecular level, not just whether patients felt better.
Understanding exactly how a treatment works at the genetic level helps scientists design better studies and predict whether it will work for more people. By looking at gene expression patterns, researchers can identify the specific biological pathways affected by the treatment, which makes future research more targeted and efficient. This type of detailed analysis is especially important for palliative care, where even small improvements in comfort can significantly impact quality of life
This is a pilot study, which is the earliest stage of research. The sample size was not specified, suggesting it was very small. The study was conducted at a single medical center. While the genetic analysis is sophisticated, the lack of a control group (patients who didn’t receive the spray) means we cannot be completely certain the changes were caused by the treatment. These limitations are normal for pilot studies and indicate the need for larger, more rigorous follow-up research
What the Results Show
The nasal bupivacaine spray appeared to change the activity of genes in throat cells, particularly those involved in producing mucus. The researchers found that certain genes related to mucin (the protein that makes mucus thick and sticky) showed reduced activity after treatment. These changes in gene expression suggest the spray works by reducing mucus production in the throat, which would explain why patients reported being able to swallow more easily. The relief appeared to last approximately 30 minutes per dose, after which the effect wore off.
The study also examined broader patterns of gene activity to understand which biological pathways were affected. The analysis suggested that the treatment influenced multiple interconnected genes and processes beyond just mucus production, though the exact significance of these secondary changes requires further investigation. Importantly, the researchers noted that patients tolerated the treatment well, with no serious adverse effects reported during the pilot phase
Current standard treatments for swallowing difficulty in end-of-life patients include feeding tubes, IV fluids, and nutritional supplements, but these approaches don’t directly address the underlying problem of thick mucus blocking the throat. This research suggests a different approach—using a numbing spray to reduce mucus production itself. While other medications exist that can thin mucus, this appears to be the first study examining how intranasal bupivacaine specifically affects the genes controlling mucus production. The findings align with what we know about how bupivacaine works in other parts of the body
This was a very small pilot study with an unspecified number of participants and no control group for comparison. The study was conducted at only one medical center, so results may not apply to all patients or settings. The genetic analysis shows associations but cannot prove that the spray directly caused the gene changes—other factors could have contributed. The 30-minute duration of relief is relatively short, meaning patients would need multiple doses throughout the day. Finally, this research was conducted only in cancer patients with end-of-life care needs, so it’s unclear whether the treatment would work for people with swallowing difficulties from other causes
The Bottom Line
This research is too early to recommend bupivacaine nasal spray as a standard treatment. However, it provides enough promising evidence to justify larger, more rigorous clinical trials. If you are a palliative care patient or family member dealing with severe swallowing difficulties, discuss this research with your healthcare team—they may be able to tell you if clinical trials are available in your area. Do not attempt to use this treatment without medical supervision
This research is most relevant to: end-of-life cancer patients experiencing swallowing difficulties, palliative care specialists and oncologists, patients’ families seeking comfort-focused care options, and researchers studying new treatments for dysphagia. This research is NOT yet applicable to people with swallowing difficulties from other causes (like stroke or Parkinson’s disease) and should not be used outside of supervised medical settings
Based on this pilot study, relief from swallowing difficulty appears to occur within minutes of applying the nasal spray and lasts approximately 30 minutes. If larger clinical trials confirm these findings, it could take 2-5 years before the treatment becomes widely available. Patients should not expect permanent improvement—this appears to be a temporary relief measure that would need to be repeated as needed
Want to Apply This Research?
- If using this treatment under medical supervision, track: time of each nasal spray application, duration of relief (how long until swallowing became difficult again), amount of food and water consumed during relief periods, and any side effects or discomfort. Record this in a simple log with date, time, and notes
- Work with your healthcare team to establish a dosing schedule that maximizes your ability to eat and drink at preferred meal times. For example, if relief lasts 30 minutes, apply the spray 5-10 minutes before meals. Use the app to set reminders for doses and track which times of day work best for you
- Over weeks of use, review your app data to identify patterns: Do certain times of day work better? Are you able to consume more nutrition overall? Is the relief duration consistent or changing? Share this data with your palliative care team to optimize your treatment plan and adjust dosing if needed
This research describes a pilot study in very early stages of development. Bupivacaine nasal spray for swallowing difficulty is not yet an approved medical treatment and should only be used under direct medical supervision as part of a clinical study or with explicit physician approval. This information is for educational purposes only and should not replace professional medical advice. Always consult with your healthcare provider before starting any new treatment, especially if you have underlying health conditions or take other medications. Results from this small pilot study may not apply to all patients or situations.