scholarly journals Nonopioid Drugs in the Treatment of Cancer Pain

2014 ◽  
Vol 32 (16) ◽  
pp. 1677-1690 ◽  
Author(s):  
Janette Vardy ◽  
Meera Agar
Keyword(s):  
Cancer Pain ◽  
Cord Compression ◽  
Primary Objective ◽  
Limited Evidence ◽  
Who Analgesic Ladder ◽  
Sequential Approach ◽  
Analgesic Agents ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Strong Opioids

The WHO analgesic ladder for the treatment of cancer pain provides a three-step sequential approach for analgesic administration based on pain severity that has global applicability. Nonopioids were recommended for mild pain, with the addition of mild opioids for moderate pain and strong opioids for severe pain. Here, we review the evidence for the use of nonopioid analgesic agents in patients with cancer and describe the mode of action of the main drug classes. Evidence supports the use of anti-inflammatory drugs such as acetaminophen/paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) for mild cancer pain. Adding an NSAID to an opioid for stronger cancer pain is efficacious, but the risk of long-term adverse effects has not been quantified. There is limited evidence to support using acetaminophen with stronger opioids. Corticosteroids have a specific role in spinal cord compression and brain metastases, where improved analgesia is a secondary benefit. There is limited evidence for adding corticosteroids to stronger opioids when pain control is the primary objective. Systematic reviews suggest a role for antidepressant and anticonvulsant medications for neuropathic pain, but there are methodologic issues with the available studies. Bisphosphonates improve pain in patients with bony metastases in some tumor types. Denosumab may delay worsening of pain compared with bisphosphonates. Larger studies of longer duration are required to address outstanding questions concerning the use of nonopioid analgesia for stronger cancer pain.

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

Management of lung cancer-related pain

2011 ◽  
Vol 152 (30) ◽  
pp. 1184-1191 ◽  
Author(s):  
Károly Tagányi
Keyword(s):  
Lung Cancer ◽  
Surgical Therapy ◽  
Interventional Procedures ◽  
Advanced Lung Cancer ◽  
Moderate Pain ◽  
Who Analgesic Ladder ◽  
Mild Pain ◽  
Analgesic Ladder ◽  
Inflammatory Drugs ◽  
Strong Opioids

Pain occurs in seventy-four percent of patients suffering from advanced lung cancer, and eighty-two percent of patients feels that the applied treatment of pain was inefficient. The management of cancer-related pain is based on the WHO analgesic ladder. The ladder has three steps. Step one involves the use of nonsteroidal anti-inflammatory drugs for mild pain, step two mild opioids for moderate pain and step three strong opioids for the treatment of heavy pain. This management – in case of emergency – is supplemented by interventional procedures (nerve blockades, surgery). The most effective pain-killing intervention is the all-round oncological and surgical therapy. The different treatments (oncological, radiological, surgical, drug and interventional) are applied in combination with each other. The paper is dealt with the possibility offered by the drug and interventional treatments. Orv. Hetil., 2011, 152, 1184–1191.

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

Synthesis of new ibuprofen hybrid conjugates as potential anti-inflammatory and analgesic agents

2020 ◽  
Vol 12 (15) ◽  
pp. 1369-1386
Author(s):  
Siva S Panda ◽  
Adel S Girgis ◽  
Hitesh H Honkanadavar ◽  
Riham F George ◽  
Aladdin M Srour
Keyword(s):  
Writhing Test ◽  
Rat Paw Edema ◽  
Analgesic Agents ◽  
Inflammatory Drugs ◽  
Cox 2 ◽  
Anti Inflammatory ◽  
Rat Paw ◽  
Inhibition Studies

Background: A new set of hybrid conjugates derived from 2-(4-isobutylphenyl)propanoic acid (ibuprofen) is synthesized to overcome the drawbacks of the current non-steroidal anti-inflammatory drugs. Results & methodology: Synthesized conjugates were screened for their anti-inflammatory, analgesic and ulcerogenic properties. Few conjugates were found to have significant anti-inflammatory properties in the carrageenan-induced rat paw edema test, while a fair number of conjugates showed promising peripheral analgesic activity in the acetic acid-induced writhing test as well as central analgesic properties in the in vivo hot plate technique. The newly synthesized conjugates did not display any ulcerogenic liability. Conclusion: In vitro, COX-1 and COX-2 enzyme inhibition studies raveled compound 7e is more selective toward COX-2 compared with ibuprofen.

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.

New small molecule analgesics

2021 ◽  
Vol 28 ◽  
Author(s):  
Sergey S. Laev ◽  
Nariman F. Salakhutdinov
Keyword(s):  
Pain Management ◽  
Small Molecule ◽  
Opioid Analgesics ◽  
Analgesic Drugs ◽  
Analgesic Effects ◽  
Design And Synthesis ◽  
Analgesic Agents ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
New Perspective

: Pain is a symptom of ninety percent of human diseases, and pain management is a very important medicinal problem. Various modulators of the pain response have been detected and analgesic effects are obtained by increasing inhibition or decreasing excitation in the nervous system. Various known analgesic drugs are commonly used to relieve the pain; however, this problem is still not fully resolved by currently available treatments. Available analgesic drugs (non-steroidal anti-inflammatory drugs, opioids, and analgesic adjuvants) are not too effective and are severely limited by adverse effects, for example, opioid addiction. Therefore, developing effective pain management is a difficult but necessary task. Thus, there is an urgent need for further development of the design and synthesis of new analgesic agents. The aim of this review is to present recent progress in search of new small molecule analgesics. The structures and effects of new perspective analgesic agents (anti-inflammatory agents, opioid analgesics, adjuvant agents for pain management and natural compounds) are presented and discussed. The review covers the literature published in 2015-2020 years and includes 173 references.

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