Contents:
Background
Non-steroidal anti-inflammatory drugs (NSAIDs) are essential medications for cancer pain management, featuring on the WHO analgesic ladder for mild or moderate pain, with a well-recognised role for metastatic bone pain. The analgesic effect occurs through multiple modes of actions; one proposed mechanism of action is the prevention or reversal of inflammation-induced hyperalgesia locally and in the CNS (1).
The choice of NSAID in the palliative care setting is influenced by factors such as availability, side effect profile, concomitant health conditions, interactions with other medications and co-morbidities, available routes of administration, local guidelines and cost. There is no evidence to suggest any particular NSAID is more beneficial in cancer pain. Whilst the renal risks of different NSAIDs are similar and are not a factor in determining choice, selective COX-2 inhibitors have a lower propensity for gastrointestinal side-effects and complications, with the PCF8 suggesting that celecoxib is now probably the overall NSAID of choice in palliative care (1).
Parecoxib, a prodrug of valdecoxib, is an injectable selective COX-2 inhibiter, licensed in the UK for the short- term treatment of postoperative pain in adults by the intramuscular or intravenous routes (2). A small but growing body of evidence examining its use in the palliative care setting suggests parecoxib to be efficacious and generally well tolerated (3, 4, 5, 6). It may therefore hold a valuable place in the management of cancer pain particularly towards the end of life when oral medication is no longer possible, and the significantly higher GI risk of CSCI ketorolac or diclofenac preclude their use. This is reflected by the inclusion of parecoxib within the Palliative Care Formulary.
Disclaimer
These Guidelines are intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
Whilst SPAGG takes every care to compile accurate information , we cannot guarantee its correctness and completeness, and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.