Nonsteroidal anti-inflammatory drugs and pain in cancer patients: a systematic review and reappraisal of the evidence

Abstract

Background: Emerging data highlights the potential role of cyclooxygenase (COX) inhibitors in the primary prevention of malignancy, reducing metastatic spread and improving overall mortality. Despite nonsteroidal anti-inflammatory drugs (NSAIDs) forming a key component of the WHO analgesic ladder, their use in cancer pain management remains relatively low. This review re-appraises the current evidence regarding the efficacy of COX inhibitors as analgesics in cancer pain, providing a succinct resource to aid clinicians' decision making when determining treatment strategies. Methods: Medline® and Embase® databases were searched for publications up to November 2018. Randomised controlled trials (RCTs) and double-blind controlled studies considering the use of NSAIDs for management of cancerrelated pain in adults were included. Animal studies, case reports, and retrospective observational data were excluded. Results: Thirty studies investigating the use of NSAIDs in cancer pain management were identified. There is a lack of high-quality evidence regarding the analgesic efficacy of NSAIDs in cancer pain, with short study durations and heterogeneity in outcome measures limiting the ability to draw meaningful conclusions. Conclusions: Despite the renewed interest in these cost-effective, well-established medications in cancer treatment outcomes, there is a paucity of data from the past 15 yr regarding their efficacy in cancer pain management. However, when analgesic strategies in the cancer population are being formulated, it is important that the potential benefits of this class of drug are considered. Further work investigating the role of NSAIDs in cancer pain management is undoubtedly warranted.

Non-steroidal anti-inflammatory drugs (NSAIDs) and organ damage: A current perspective

“…In addition, a 10-year population cohort study (aspirin user is age-sex matched to non-user with a ratio of 1:2) in Honk Kong depicted significant reduction of different cancers (liver, stomach, colorectum, lung, oesophagus, pancreas, leukaemia), except breast cancer, in long-term aspirin users compared with those who have not been prescribed aspirin [65]. Other systemic reviews and cohort studies are also in agreement with this observation [66][67]. Apart from cancer, NSAIDs have been also repurposed for other clinical complications which include diflunisal-induced osteoprotection against staphylococcal osteomyelitis [68], mefenamic acid-mediated protection against schistosomiasis [69], aspirin and ibuprofen-mediated cryptococcal cell death [70], oxyphenbutazone-induced sensitization of Mycobacterium tuberculosis to host-derived factors and exogenous antimycobacterial compounds [71] and piroxicam-induced dipeptidyl peptidase-4 inhibition as an alternative strategy for regulating glucose metabolism in diabetes mellitus [72].…”

COVID-19 and Cancer Comorbidity: Therapeutic Opportunities and Challenges

“…However, the lack of effect of these therapies due to tumor cell plasticity, and other growth factors activating pathways like those triggered by IL6, raises doubt about the efficacy of IL-6 inhibitors. Furthermore, IL inhibitors protect patients with chronic inflammatory disorders, like asthma, from COVID-19 as anti-inflammatory drugs help cancer pain management 125 , 126 . COVID-19 patients who had severe eosinophilic asthma and underwent treatment with monoclonal antibodies against IL-5, including reslizumab and benralizumab, showed less severe symptoms of COVID-19 127 , 128 .…”

Approaches and best practices for managing cancer pain within the constraints of the COVID-19 pandemic in India

“…[ 21 ] Adjuvant analgesics such as steroids, anticonvulsants, antidepressants, antispasmodics, and bisphosphonates are required alone or in combination to manage complex cancer pain syndromes. [ 27 28 ] Their use reduces the overall opioid requirement[ 29 30 ] [ Table 2 ].…”