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Meta-Analysis
. 2018 Dec;9(7):1235-1254.
doi: 10.1002/jcsm.12352. Epub 2018 Oct 29.

Systematic Review and Meta-Analysis on Non-Opioid Analgesics in Palliative Medicine

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Free PMC article
Meta-Analysis

Systematic Review and Meta-Analysis on Non-Opioid Analgesics in Palliative Medicine

Robert H Schüchen et al. J Cachexia Sarcopenia Muscle. .
Free PMC article

Abstract

Non-opioid analgesics are widely used for pain relief in palliative medicine. However, there is a lack of evidence-based recommendations addressing the efficacy, tolerability, and safety of non-opioids in this field. A comprehensive systematic review and meta-analysis on current evidence can provide a basis for sound recommendations in clinical practice. A database search for controlled trials on the use of non-opioids in adult palliative patients was performed in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, and EMBASE from inception to 18 February 2018. Endpoints were pain intensity, opioid-sparing effects, safety, and quality of life. Studies with similar patients, interventions, and outcomes were included in the meta-analyses. Our systematic search was able to only identify studies dealing with cancer pain. Of 5991 retrieved studies, 43 could be included (n = 2925 patients). There was no convincing evidence for satisfactory pain relief by acetaminophen alone or in combination with strong opioids. We found substantial evidence of moderate quality for a satisfactory pain relief in cancer by non-steroidal anti-inflammatory drugs (NSAIDs), flupirtine, and dipyrone compared with placebo or other analgesics. There was no evidence for a superiority of one specific non-opioid. There was moderate quality of evidence for a similar pain reduction by NSAIDs in the usual dosage range compared with up to 15 mg of morphine or opioids of equianalgesic potency. The combination of NSAID and step III opioids showed a beneficial effect, without a decreased tolerability. There is scarce evidence concerning the combination of NSAIDs with weak opioids. There are no randomized-controlled studies on the use of non-opioids in a wide range of end-stage diseases except for cancer. Non-steroidal anti-inflammatory drugs, flupirtine, and dipyrone can be recommended for the treatment of cancer pain either alone or in combination with strong opioids. The use of acetaminophen in the palliative setting cannot be recommended. Studies are not available for long-term use. There is a lack of evidence regarding pain treatment by non-opioids in specific cancer entities.

Keywords: Cancer; Meta-analysis; NSAID; Non-opioid analgesics; Pain relief; Palliation; Systematic review.

Figures

Figure 1
Figure 1
Flow chart selection process.
Figure 2
Figure 2
Analysis 1.1. Non‐opioids vs. opioids: withdrawals due to inadequate pain relief. CI, confidence interval; NSAIDs, non‐steroidal anti‐inflammatory drugs.
Figure 3
Figure 3
Analysis 1.2. Non‐opioids vs. opioids: withdrawals due to adverse events. CI, confidence interval; NSAIDs, non‐steroidal anti‐inflammatory drugs.
Figure 4
Figure 4
Analysis 1.3. Non‐opioids vs. opioids: number of patients with adverse events. CI, confidence interval; NSAIDs, non‐steroidal anti‐inflammatory drugs.
Figure 5
Figure 5
Non‐steroidal anti‐inflammatory drugs high dosage vs. low dosage: withdrawals due to inadequate pain relief. CI, confidence interval.
Figure 6
Figure 6
Non‐steroidal anti‐inflammatory drugs high dosage vs. low dosage: number of patients with adverse events. CI, confidence interval.
Figure 7
Figure 7
Opioids step III + NSAID vs. opioids step III + placebo: withdrawals due to inadequate pain relief. CI, confidence interval; NSAIDs, non‐steroidal anti‐inflammatory drugs.
Figure 8
Figure 8
Opioids step III + NSAID vs. opioids step III + placebo: withdrawals due to adverse events. CI, confidence interval; NSAIDs, non‐steroidal anti‐inflammatory drugs.
Figure 9
Figure 9
Opioids step III + NSAID vs. opioids step III + placebo: number of persons with adverse event. CI, confidence interval; NSAIDs, non‐steroidal anti‐inflammatory drugs.

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References

    1. Connor S, Sepulveda C. The Global Atlas of Palliative Care at the End of Life. 2014.
    1. Bruera E, Kim HN. Cancer pain. JAMA 2003;290:2476–2479. - PubMed
    1. van den Beuken‐van Everdingen MHJ, Hochstenbach LMJ, Joosten EAJ, Tjan‐Heijnen VCG, Janssen DJA. Update on prevalence of pain in patients with cancer: systematic review and meta‐analysis. J Pain Symptom Manage 2016;51:1070–1090.e9. - PubMed
    1. Dalal S, Tanco KC, Bruera E. State of art of managing pain in patients with cancer. Cancer J Sudbury Mass 2013;19:379–389. - PubMed
    1. Eisenberg E, Berkey CS, Carr DB, Mosteller F, Chalmers TC. Efficacy and safety of nonsteroidal antiinflammatory drugs for cancer pain: a meta‐analysis. J Clin Oncol Off J Am Soc Clin Oncol 1994;12:2756–2765. - PubMed

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