Gaertner Jan, Stamer Ulrike M, Remi Constanze, Voltz Raymond, Bausewein Claudia, Sabatowski Rainer, Wirz Stefan, Müller-Mundt Gabriele, Simon Steffen T, Pralong Anne, Nauck Friedemann, Follmann Markus, Radbruch Lukas, Meißner Winfried
1 Clinic for Palliative Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
2 Department of Anesthesiology and Pain Medicine, Inselspital, University of Bern, Bern, Switzerland.
Palliat Med. 2017 Jan;31(1):26-34. doi: 10.1177/0269216316655746. Epub 2016 Jul 20.
Dipyrone (metamizole) is one of the most widely used non-opioid analgesics for the treatment of cancer pain.
Because evidence-based recommendations are not yet available, a systematic review was conducted for the German Guideline Program in Oncology to provide recommendations for the use of dipyrone in cancer pain.
First, a systematic review for clinical trials assessing dipyrone in adult patients with cancer pain was conducted. Endpoints were pain intensity, opioid-sparing effects, safety, and quality of life.
The search was performed in MedLine, Embase (via Ovid), and the Cochrane Library (1948-2013) and additional hand search was conducted. Finally, recommendations were developed and agreed in a formal structured consensus process by 53 representatives of scientific medical societies and 49 experts.
Of 177 retrieved studies, 4 could be included (3 randomized controlled trials and 1 cohort study, n = 252 patients): dipyrone significantly decreased pain intensity compared to placebo, even if low doses (1.5-2 g/day) were used. Higher doses (3 × 2 g/day) were more effective than low doses (3 × 1 g/day), but equally effective as 60 mg oral morphine/day. Pain reduction of dipyrone and non-steroidal anti-inflammatory drugs did not differ significantly. Compared to placebo, non-steroidal anti-inflammatory drugs, and morphine, the incidence of adverse effects was not increased.
Dipyrone can be recommended for the treatment of cancer pain as an alternative to other non-opioids either alone or in combination with opioids. It can be preferred over non-steroidal anti-inflammatory drugs due to the presumably favorable side effect profile in long-term use, but comparative studies are not available for long-term use.
安乃近是治疗癌痛最广泛使用的非阿片类镇痛药之一。
由于尚无循证推荐意见，因此为德国肿瘤学指南项目开展了一项系统评价，以提供安乃近用于癌痛治疗的推荐意见。
首先，对评估安乃近用于成年癌痛患者的临床试验进行系统评价。观察指标为疼痛强度、阿片类药物节省效应、安全性和生活质量。
检索了MedLine、Embase（通过Ovid）和Cochrane图书馆（1948 - 2013年），并进行了额外的手工检索。最后，由53名科学医学协会代表和49名专家在正式的结构化共识过程中制定并商定了推荐意见。
在检索到的177项研究中，4项可纳入（3项随机对照试验和1项队列研究，n = 252例患者）：与安慰剂相比，即使使用低剂量（1.5 - 2克/天），安乃近也能显著降低疼痛强度。高剂量（3×2克/天）比低剂量（3×1克/天）更有效，但与60毫克口服吗啡/天效果相当。安乃近与非甾体抗炎药的疼痛缓解效果无显著差异。与安慰剂、非甾体抗炎药和吗啡相比，不良反应发生率未增加。
安乃近可推荐用于癌痛治疗，可单独使用或与阿片类药物联合使用，作为其他非阿片类药物的替代药物。由于长期使用可能具有较好的副作用谱，它可能优于非甾体抗炎药，但长期使用的比较研究尚不可得。
