Page 32 - CPG - Clinical Practice Guidelines - Management of Cancer Pain

Management of Cancer Pain (Second Edition)
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A systematic review of 12 clinical trials comparing nonsteroidal anti-
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opioids and opioids alone in moderate to severe cancer pain showed
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{ Five of seven studies showed a positive impact where three
demonstrated improved analgesia and two showed a reduction
in opioid consumption.
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more frequent in the morphine group and gastric discomfort was
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• Paracetamol added to opioids
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treatment. In contrast, one study reported a slightly greater
reduction in pain score for paracetamol combination [MD of 0.4
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highest paracetamol dose (5 g/day) and had a short follow-up
(96 hours).
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in which increased somnolence was present in patients on
methadone plus paracetamol.
The quality assessment of the primary papers was not well reported.

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found: 26, level I
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alone or in combination with opioids for the three steps of the
WHO cancer pain ladder
• very low-quality evidence that some people with moderate or
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one or two weeks

Another Cochrane systematic review on the effectiveness and safety of
paracetamol in cancer pain revealed: 27, level I
• no convincing evidence of paracetamol being different from
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participants’ satisfaction or preference
• measures of harm (serious AEs and other AEs) were inconsistently
reported and provided no clear evidence of difference between the
groups

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