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The use of paracetamol alone or in combination with morphine in cancer patients is not advocated due to the lack of data supporting or refuting its use.
Pain is a common symptom of cancer. 30% to 50% of cancer patients will experience moderate to severe pain which has a major negative impact on their quality of life. Cochrane review examined the evidence mainly for nonsteroidal anti-inflammatory drugs (NSAIDs) or paracetamol, alone or combined with opioids, for cancer pain. It was withdrawn in 2015 because it was out of date; the date of the last search was 2005.
Paracetamol efficacy assessed for cancer pain in adults and children, and the adverse events reported in clinical trials. Philip J Wiffen et al. searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase from inception to March 2017. Philip J Wiffen et al. examined randomised, double-blind, studies of five days or longer. Paracetamol comparing alone with placebo, or in combination with an opioid and also include Extensive Single-blind studies. Minimum 25 participants treated at the initial randomisation and lasting up to one week; 122 participants were randomised initially, and 95 completed treatment. Paracetamol with strong opioids doses of 60 mg, 70 mg, and 225 mg, taking several hundred mg of oral morphine equivalents daily with some participants. None of the studies reported any of this review primary outcomes: subjects found with at least 50%, and at least 30%, pain reduction from baseline. Participants with Patient Global Impression of Change (PGIC) of much improved or very much improved (or equivalent wording). There was no evidence found that paracetamol being different from placebo with regards to quality of life, participant satisfaction or preferences of rescue medication. Measures of harm were inconsistently reported and provided no clear evidence of a difference (various adverse severe events, and withdrawal due to lack of efficacy). GRADE assessment of evidence quality was very low for all outcomes because studies were at high risk of bias from several sources.
There is no evidence for the first two steps of the three-step WHO cancer pain ladder for the use of paracetamol alone or in combination with opioids to support or refute high-quality. No evidence to found that clear any additional analgesic benefit of paracetamol could be detected in the available studies, given the doses of opioids used.
Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD012637.
Oral paracetamol (acetaminophen) for cancer pain
Philip J Wiffen et. al.
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