Nonsteroidal anti-inflammatory drugs as adjuvant analgesics in cancer patients

Jenkins, Catherine; Bruera, Éduardo

doi:10.1191/026921699666671383

Cited by 35 publications

(32 citation statements)

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“…Commonly used adjuvant analgesics are a diverse group of medications which include corticosteroids, antidepressants, and anticonvulsants [3][4][5][6]. Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used as adjuvants to opioids, even though they are primarily analgesics [7,8].…”

Section: Introductionmentioning

confidence: 99%

Use of non-opioid analgesics as adjuvants to opioid analgesia for cancer pain management in an inpatient palliative unit: does this improve pain control and reduce opioid requirements?

Shinde

Gordon

Sharma

et al. 2014

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Background Cancer pain is complex, and despite the introduction of the WHO cancer pain ladder, few studies have looked at the prevalence of adjuvant medication use in an inpatient palliative medicine unit. In this study, we evaluate the use of adjuvant pain medications in patients admitted to an inpatient palliative care unit and whether their use affects pain scores or opiate dosing. Methods In this retrospective observational study, patients admitted to the inpatient palliative care unit over a 3-month period with a diagnosis of cancer on opioid therapy were selected. Data pertaining to demographics, diagnosis, oral morphine dose equivalent of the opioid at the time of discharge, adjuvant analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), and pain scores as reported by nurses and physicians were collected. Results Seventy-seven patients were eligible over a 3-month period, out of which 65 (84 %) were taking an adjuvant medication. The most commonly prescribed adjuvant was gabapentin (70 %). Fifty-seven percent were taking more than one adjuvant. There were more women in the group receiving adjuvants (57 vs. 17%, p=0.010). Those without adjuvants compared with those on adjuvants did not have worse pain scores on discharge as reported by physicians (0.8±0.8 vs. 1.0±0.7, p=0.58) or nurses (2.0±2.7 vs. 2.1±2.6, p=0.86). There was no difference in morphine equivalent doses of the opioid in both groups (median (min, max); 112 (58, 504) vs. 200 (30, 5,040)) at the time of discharge; 75-80 % of patients had improvement in pain scores as measured by a two-point reduction in numerical rating scale (NRS). Discussion This study shows that adjuvant medications are commonly used for treating pain in patients with cancer. More than half of study population were on two adjuvants or an adjuvant plus NSAID along with an opioid. We did not demonstrate any benefit in terms of improved pain scores or opioid doses with adjuvants, but this could reflect confounding variables and physician choice. Larger prospective studies are needed to define the opioid-sparing effects of adjuvants. Conclusion Adjuvant agents are used in over 80 % of those treated for cancer pain.

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Section: Introductionmentioning

confidence: 99%

Use of non-opioid analgesics as adjuvants to opioid analgesia for cancer pain management in an inpatient palliative unit: does this improve pain control and reduce opioid requirements?

Shinde

Gordon

Sharma

et al. 2014

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“…However, patients with a VAS-pain score ≥4 (42% on admission on step 3 of WHO analgesic ladder) reported higher values for other associated symptoms (activity 5.4, nausea 2.3 and drowsiness 3.8) than did patients with VAS-pain scores of 0 (4.2, 0.7 and 3.0, respectively), and antiemetics were also prescribed more 38 frequently in this group (47% vs 25%, respectively). Thus, NSAIDs are probably underprescribed in Sweden (38.2 DDD/1,000 inhabitants/day), possibly due to the fear of possible side effects of NSAIDs, as recently reviewed by Jenkins and Bruera [11]. Surprisingly, only 10 of the 124 (8%) patients were receiving medication with NSAID.…”

Section: Discussionmentioning

confidence: 99%

Pain and pain alleviation in hospital-based home care: demographic, biological and treatment factors

Heedman

Strang

2003

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The aim of this study was to contrast two opposed groups, namely palliative cancer patients who were suffering significant pain (VAS≥4) and palliative cancer patients with no pain (VAS = 0) in hospital-based home care and, retrospectively, to study possible differences in relation to demographic, biological and treatment factors. The ESAS (Edmonton Symptom Assessment Scale) was used to assess 191 palliative cancer patients on admission and after 1 week of home care. Fifty-two (27%) had pain (mean 5.5±1.7) and 72 (38%) had no pain on admission [the middle group (n=67) had VAS 1-3]. Activity was more severely affected (5.4 vs 4.2, p<0.01) and nausea less well controlled in patients with pain (2.3 vs 0.7, P<0.0001). Pain was associated with the diagnosis of prostate cancer (P<0.01) and the presence of skeletal metastases (P<0.001), whereas painfree patients, with or without analgesics, more often had colorectal cancer (P<0.01) or melanoma (P<0.05).The medication profiles differed between the two groups: 22 (42%) of the 52 patients with pain were on step 3 of the WHO analgesic ladder and 24 of 51 (47%) were receiving antiemetics, whereas 42 (58%) of the 72 patients with no current pain had no analgesic prescribed and only 25% of them had antiemetics prescribed, indicating biological differences. If pain was present on admission a pain analysis was formally documented in 23 (44%) of the 52 cases and the medication was changed in 27 of the 52 (52%). The patients improved after 1 week (5.4±1.6 vs 3.9±2.3, P<0.001), and the improvement was significant even when a pain analysis was not documented or when medication was not changed. In conclusion, the results of this study indicate biological differences in pain alleviation and the need for a more structured way of working.

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“…Con mucha frecuencia en el control sintomático deben emplearse fármacos gastrolesivos como los corticoides (16)(17)(18) y antiinflamatorios no esteroideos (AINE) (19) solos o en combinación, a dosis altas y durante periodos largos de tiempo (20). La incidencia anual de perforaciones gastroduodenales y sangrados en tomadores crónicos de AINE se sitúa entre el 1-4%, con una prevalencia en torno al 20-30% (21,22).…”

Section: Ulcus Péptico: (Porcentaje De Acuerdo 60%)unclassified

Herramientas para la evaluación multidimensional de uso para médicos de cuidados paliativos: Proyecto ICO tool-kit

et al. 2011

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ORIGINAL RESUMENIntroducción: el paciente y su familia presentan una serie de necesidades físicas, emocionales, sociales y espirituales que requieren ser evaluadas. Estas necesidades han de quedar registradas ya que han de permitir la fijación de objetivos asistenciales, la revisión de los resultados y su reevaluación posterior. La evaluación de estas necesidades con instrumentos comunes facilita la transmisión de la información entre los distintos profesionales sanitarios implicados en el proceso de atención.Objetivo: consensuar distintos instrumentos para una evaluación multidimensional en el paciente oncológico avanzado que deberían incluirse en cualquier valoración médica de equipo de cuidados paliativos de la red asistencial del Institut Català d'Oncologia.Material y método: técnica de consenso entre los distintos participantes mediante grupo de discusión. Acuerdo interobservador en grupo de discusión basado en la valoración tanto de la bibliografía existente sobre los instrumentos analizados, como de la experiencia práctica diaria de los miembros de los equipos en su empleo. El equipo de trabajo estuvo formado por una muestra representativa de los 3 centros participantes y constituida por 5 médicos, 4 psico-oncólogos y 4 trabajadores sociales. Todos con experiencia en cuidados paliativos y dedicación completa. De los distintos instrumentos analizados, se empleó para su valoración tanto la bibliografía existente de los mismos, así como la experiencia práctica de los equipos con su empleo. Se obtenía una puntuación y un grado de acuerdo que sirvió para la elección de los instrumentos que se consideraban más útiles y formarían parte del kit de evaluación.Resultado y conclusiones: tras discusión y análisis de los resultados, se seleccionaron los instrumentos que se consideraron más adecuados para la evaluación. Se definió un conjunto de instrumentos para la evaluación de las 3 dimensiones exploradas: física (antecedentes, estado funcional, dependencia, listado de síntomas y supervivencia), emocional (sínto-mas emocionales, incluyendo espiritualidad y cuidados al final de la vida) y social mostrando el porcentaje de acuerdo alcanzado para cada una de ellas. Pal 2010; Vol. 17, pp. 348-359 PALABRAS CLAVE: Cuidados paliativos. Evaluación. Neoplasias. Med ABSTRACTIntroduction: both Patients and their families have physical, emotional, social and spiritual needs to be assessed. Such needs have to be recorded so as to allow the setting of therapeutic objectives, the outcomes review and their further reassessment. Needs' assessment undergone with common tools, facilitates information transmission among the wide range of professionals involved in the care process.Objective: to build up a consensus on instruments for multidimensional assessment in advanced cancer patients to be included/used in any medical evaluation made from the palliative care team of the Catalan Institute of Oncology.Materials and methods: consensus among the participants through group discussion. The group consisted of a representative sample of...

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Nonsteroidal anti-inflammatory drugs as adjuvant analgesics in cancer patients

Cited by 35 publications

References 68 publications

Use of non-opioid analgesics as adjuvants to opioid analgesia for cancer pain management in an inpatient palliative unit: does this improve pain control and reduce opioid requirements?

Use of non-opioid analgesics as adjuvants to opioid analgesia for cancer pain management in an inpatient palliative unit: does this improve pain control and reduce opioid requirements?

Pain and pain alleviation in hospital-based home care: demographic, biological and treatment factors

Herramientas para la evaluación multidimensional de uso para médicos de cuidados paliativos: Proyecto ICO tool-kit

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