Are NSAIDS enough for cancer pain?

Non-steroidal anti-inflammatory drugs (NSAIDs) are effective in managing cancer pain with few side effects, according to a new review of a number of studies.

The majority of studies demonstrate little difference in effectiveness among various NSAIDs — such as aspirin, naproxen (Aleve), or ibuprofen (Motrin, Advil) — or paracetamol (acetaminophen, Tylenol). The research to date also shows only marginal benefits at best from the common practice of adding a narcotic opioid to the NSAID regimen.

Ewan McNicol of the New England Medical Center and coauthors reviewed 42 trials involving 3,084 patients. The various papers compare NSAIDs with placebo; one NSAID with another; or NSAIDs and opioids, alone or in combination, with NSAID/opioid combinations.

For short-term management of mild pain, the data “strongly suggest that the use of NSAID alone is … adequate for this purpose,” conclude the authors. For mild to moderate pain, “It may be advisable for a patient to increase to a maximum acceptable dose of their NSAID … before the addition of, or replacement with, an opioid.”

More definitive conclusions could not be drawn because the studies differ in the medications and dosages, routes of administration, types of cancer, baseline pain severity, types of pain, and outcome measures. Study length also varies widely, ranging from six hours to six weeks.

The reviewers call for additional research on the advantages and disadvantages of NSAIDs only versus NSAIDs plus opioids. Studies are also needed to ensure long-term safety and effectiveness of NSAIDs — with and without opioids — in treating chronic cancer pain, the authors say.

http://www.cochrane.org