scholarly journals Oral nonsteroidal anti-inflammatory drugs (NSAIDs) for cancer pain in adults

2017 ◽  
Author(s):  
Sheena Derry ◽  
Philip J Wiffen ◽  
R Andrew Moore ◽  
Ewan D McNicol ◽  
Rae F Bell ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

scholarly journals Non-steroidal anti-inflammatory drugs (NSAIDs) for chronic non-cancer pain in children and adolescents

2017 ◽  
Author(s):  
Christopher Eccleston ◽  
Tess E Cooper ◽  
Emma Fisher ◽  
Brian Anderson ◽  
Nick MR Wilkinson
Keyword(s):  
Cancer Pain ◽  
Children And Adolescents ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

scholarly journals Metamizole/dipyrone for the relief of cancer pain: A systematic review and evidence-based recommendations for clinical practice

2016 ◽  
Vol 31 (1) ◽  
pp. 26-34 ◽  
Author(s):  
Jan Gaertner ◽  
Ulrike M Stamer ◽  
Constanze Remi ◽  
Raymond Voltz ◽  
Claudia Bausewein ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cancer Pain ◽  
Pain Intensity ◽  
Oral Morphine ◽  
Cochrane Library ◽  
Evidence Based ◽  
Low Doses ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Background: Dipyrone (metamizole) is one of the most widely used non-opioid analgesics for the treatment of cancer pain. Aim: Because evidence-based recommendations are not yet available, a systematic review was conducted for the German Guideline Program in Oncology to provide recommendations for the use of dipyrone in cancer pain. Design: First, a systematic review for clinical trials assessing dipyrone in adult patients with cancer pain was conducted. Endpoints were pain intensity, opioid-sparing effects, safety, and quality of life. Data sources: The search was performed in MedLine, Embase (via Ovid), and the Cochrane Library (1948–2013) and additional hand search was conducted. Finally, recommendations were developed and agreed in a formal structured consensus process by 53 representatives of scientific medical societies and 49 experts. Results: Of 177 retrieved studies, 4 could be included (3 randomized controlled trials and 1 cohort study, n = 252 patients): dipyrone significantly decreased pain intensity compared to placebo, even if low doses (1.5–2 g/day) were used. Higher doses (3 × 2 g/day) were more effective than low doses (3 × 1 g/day), but equally effective as 60 mg oral morphine/day. Pain reduction of dipyrone and non-steroidal anti-inflammatory drugs did not differ significantly. Compared to placebo, non-steroidal anti-inflammatory drugs, and morphine, the incidence of adverse effects was not increased. Conclusion: Dipyrone can be recommended for the treatment of cancer pain as an alternative to other non-opioids either alone or in combination with opioids. It can be preferred over non-steroidal anti-inflammatory drugs due to the presumably favorable side effect profile in long-term use, but comparative studies are not available for long-term use.

Designing a clinical trial of non-steroidal anti-inflammatory drugs for cancer pain: a survey of UK palliative care physicians

2020 ◽  
pp. bmjspcare-2020-002792
Author(s):  
Andrew J Page ◽  
Matthew R Mulvey ◽  
Michael I Bennett
Keyword(s):  
Palliative Care ◽  
Cancer Pain ◽  
Palliative Medicine ◽  
Bone Pain ◽  
Controlled Trial ◽  
Perceived Efficacy ◽  
Inflammatory Drugs ◽  
Cox 2 ◽  
Anti Inflammatory ◽  
Cox 2 Inhibitors

ObjectivesInsufficient quality evidence exists to support or refute the use of non-steroidal anti-inflammatory drugs (NSAIDs) in the management of cancer pain. We aimed to determine the most clinically pragmatic design of a future randominsed controlled trial (RCT), based on how NSAIDs are currently used and perceived efficacy.MethodsAn online survey was distributed to members of the Association for Palliative Medicine of Great Britain and Ireland examining NSAID use, indications and perceived efficacy, as well as duration of respondents’ experience in palliative medicine.Results23% of 968 members responded. A placebo-controlled trial of NSAIDs as a strong opioid adjunct in cancer-related bone pain was considered the most clinically pragmatic design. Concerning current practice, oral administration was the preferential route (79.4%), dosed regularly (79.5%). Selective cyclooxygenase-2 (COX-2) inhibitors and non-selective COX-2 inhibitors were considered similarly effective by 45% in cancer pain; ibuprofen being the first line oral NSAID of choice (42.6%). Treatment efficacy is generally determined within 1 week (94.3%). On a Likert scale, most physicians consider NSAIDs improve cancer pain either ‘sometimes’ (57.7%) or ‘often’ (40%). Years of specialist palliative care experience did not affect perception of efficacy (p=0.353).ConclusionsA randomised controlled trial of NSAIDs as opioid adjuncts for cancer-related bone pain would be the most pragmatic design supported by palliative care clinicians to benefit clinical practice.

scholarly journals Analgesic Effects of Nonsteroidal Anti-inflammatory Drugs in Cancer Pain Due to Somatic or Visceral Mechanisms

1999 ◽  
Vol 17 (5) ◽  
pp. 351-356 ◽  
Author(s):  
Sebastiano Mercadante ◽  
Alessandra Casuccio ◽  
Antonio Agnello ◽  
Salvatore Pumo ◽  
Jafar Kargar ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Analgesic Effects ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

scholarly journals Comparative Efficacy of Therapeutics for Chronic Cancer Pain: A Bayesian Network Meta-Analysis

2019 ◽  
Vol 37 (20) ◽  
pp. 1742-1752 ◽  
Author(s):  
Rongzhong Huang ◽  
Lihong Jiang ◽  
Yu Cao ◽  
Hongli Liu ◽  
Minsheng Ping ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Pain Intensity ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Secondary Outcome ◽  
Chronic Cancer Pain ◽  
Published Evidence ◽  
Nonopioid Analgesics ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

PURPOSE Opioids are the primary choice for managing chronic cancer pain. However, many nonopioid therapies are currently prescribed for chronic cancer pain with little published evidence comparing their efficacy. METHODS Electronic databases were searched for randomized controlled trials (RCTs) comparing any systemic pharmaceutical intervention and/or combination thereof in treating chronic cancer pain. The primary outcome was global efficacy reported as an odds ratio (OR). The secondary outcome was change in pain intensity reported as a standardized mean difference (SMD). RESULTS We included 81 RCTs consisting of 10,003 patients investigating 11 medication classes. Most RCTs (80%) displayed low risk of bias. The top-ranking classes for global efficacy were nonopioid analgesics (network OR, 0.30; 95% credibility interval [CrI], 0.13 to 0.67), nonsteroidal anti-inflammatory drugs (network OR, 0.44; 95% CrI, 0.22 to 0.90), and opioids (network OR, 0.49; 95% CrI, 0.27 to 0.86), whereas the top-ranked interventions were lidocaine (network OR, 0.04; 95% CrI, 0.01 to 0.18; surface under the cumulative ranking curve analysis [SUCRA] score, 98.1), codeine plus aspirin (network OR, 0.22; 95% CrI, 0.08 to 0.63; SUCRA score, 81.1), and pregabalin (network OR, 0.29; 95% CrI, 0.08 to 0.92; SUCRA score, 73.8). In terms of reducing pain intensity, we found that no class was superior to placebo, whereas the following top-ranked interventions were superior to placebo: ziconotide (network SMD, −24.98; 95% CrI, −32.62 to −17.35; SUCRA score, 99.8), dezocine (network SMD, −13.56; 95% CrI, −23.37 to −3.69; SUCRA score, 93.5), and diclofenac (network SMD, −11.22; 95% CrI, −15.91 to −5.80; SUCRA score, 92.9). CONCLUSION There are significant differences in efficacy among current regimens for chronic cancer pain. Our evidence suggests that certain nonopioid analgesics and nonsteroidal anti-inflammatory drugs can serve as effectively as opioids in managing chronic cancer pain.

Nonsteroidal Anti-Inflammatory Drugs, Alone or Combined With Opioids, for Cancer Pain

2004 ◽  
Vol 22 (10) ◽  
pp. 1975-1992 ◽  
Author(s):  
Ewan McNicol ◽  
Scott Strassels ◽  
Leonidas Goudas ◽  
Joseph Lau ◽  
Daniel Carr
Keyword(s):  
Side Effects ◽  
Cancer Pain ◽  
Limited Data ◽  
Inclusion Criteria ◽  
Clinical Difference ◽  
Significant Difference ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Meta Analyses ◽  
Dose Dependent

Purpose To assess the safety and efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs), alone or combined with opioids, for the treatment of cancer pain. Patients and Methods Forty-two trials involving 3,084 patients met inclusion criteria: eight compared NSAID with placebo; 13 compared one NSAID with another; 23 compared NSAID with opioid, NSAID or opioid versus NSAID plus opioid combinations, or NSAID plus opioid combinations versus NSAID plus opioid combinations; and nine studies assessed the effect of increasing NSAID dose. Results Sixteen studies lasted 1 week or longer and 11 evaluated a single dose. Seven of eight trials demonstrated superior efficacy of single doses of NSAID compared with placebo. Only four of 13 studies reported increased efficacy of one NSAID compared with another; four other studies found that one NSAID had fewer side effects than one or more others. Thirteen of 14 studies found no difference, or minimal clinical difference, when comparing an NSAID plus opioid combination versus either drug alone. Comparisons between various NSAID plus opioid combinations were inconclusive. Four studies demonstrated increased efficacy with increased NSAID dose, without dose-dependent increases in side effects. Conclusion Heterogeneity of study methods and outcomes precluded meta-analyses. Short duration of studies undermines generalization of findings on efficacy and safety. On the basis of limited data, NSAIDs appear to be more effective than placebo for cancer pain; clear evidence to support superior safety or efficacy of one NSAID compared with another is lacking; and trials of combinations of an NSAID with an opioid have disclosed either no significant difference, or at most a slight but statistically significant advantage, compared with either single entity.

The role of paracetamol and nonsteroidal anti-inflammatory drugs in addition to WHO Step III opioids in the control of pain in advanced cancer. A systematic review of the literature

2011 ◽  
Vol 26 (4) ◽  
pp. 305-312 ◽  
Author(s):  
Maria Nabal ◽  
Silvia Librada ◽  
Maria Josè Redondo ◽  
Alessandra Pigni ◽  
Cinzia Brunelli ◽  
...  
Keyword(s):  
Literature Review ◽  
Cancer Pain ◽  
Systematic Literature Review ◽  
Cochrane Review ◽  
Cochrane Central Register ◽  
Dose Requirement ◽  
Opioid Dose ◽  
Number Of Patients ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol are used widely in the management of mild to moderate cancer pain and are frequently combined with opioids in the treatment of moderate to severe pain. Aim: To perform a systematic literature review of the evidence of the efficacy and toxicity of NSAIDs or paracetamol added to WHO Step III opioid treatment for cancer pain. Design and data sources: A systematic literature review of MedLine, EMBASE and Cochrane Central register of controlled trials database was carried out using both text words and MeSH/EMTREE terms. Results: Seven eligible papers were retrieved from the new search and five from the Cochrane review. Five of seven studies showed an additive effect of NSAIDs when combined with opioids either by improving analgesia (three studies) or by reducing the opioid dose (two studies). Paracetamol was only marginally effective in one of five trials. The study designs were not adequate to assess differences in side effects between the opioids alone and opioids in combination with NSAIDs or paracetamol. Conclusions: The evidence from the available clinical trials is of limited amount and quality, but it weakly supports the proposal that the addition of an NSAIDs to WHO Step III opioids can improve analgesia or reduce opioid dose requirement. There is insufficient evidence to support the use of paracetamol in combination with Step III opioids. Data on the toxicity of NSAIDs in this indication are insufficient owing to the small number of patients and the short duration of treatment reported in the studies.

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