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The usefulness of NSAIDs alone or in combination with opioids in cancer pain cannot be established as there was a lack of high-quality evidence supporting or refuting its use in adults with cancer pain.
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 It was withdrawn in 2015 because it was out of date; the date of the last search was 2005.
NSAIDs efficacy assessed for cancer pain in adults and children, and the adverse events reported in clinical trials. Sheena Derry et al. searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase from inception to March 2017. Sheena Derry, et al. examined randomised, double-blind, studies of five days or longer. Minimum 25 participants treated at the initial randomisation and lasting up to one week. Eleven studies included, 949 participants for lasting one week or more extended; randomised initially, mostly moderate or severe pain to completed treatment or not. To evaluate eight studies, which were double-blind, two single-blind, and one open-label and only had control no placebo. Eight studies compared different NSAIDs, three an NSAID with the opioid or opioid combination, and one both NSAID plus opioid with the same dose of opioid alone not compared. 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). NSAIDs are reported as a randomised cohort and judged as very low-quality evidence for all outcomes. Any studies were not reported our primary outcomes of participants with pain reduction of at least 50%, and at least 30%, Global Patient Impression of Change (PGIC) of much improved or very much improved (or equivalent wording) from baseline. Initially moderate or severe pain was reduced with NSAID. The estimates ranges between 26% and 51% in individual studies with mild pain in four studies (415 participants in total) after one or two weeks. Adverse event and withdrawal were reported as inconstant. Some serious adverse events were reported with NSAIDs and 22 deaths, and not related to any pain treatment. Frequent adverse events were thirst/dry mouth (15%), loss of appetite (14%), somnolence (11%), and dyspepsia (11%). Withdrawals were frequent, mostly because of lack of efficacy (24%) or adverse events (5%).
GRADE assessment of evidence quality was very low for all outcomes because studies were at high risk of bias from several sources.
No evidence was found to support or refute for high-quality to use of NSAIDs alone or in combination with opioids for the three steps of the three-step WHO cancer pain ladder. Some of the people with moderate or severe cancer pain can obtain substantial levels of benefit within one or two weeks with very low-quality evidence.
Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD012638
Oral nonsteroidal anti-inflammatory drugs (NSAIDs) for cancer pain in adults
Sheena Derry et. al.
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