Pain Medicine Department, The Royal Marsden Hospital, London, UK; Signalling and Cancer Metabolism, Division of Cancer Biology, The Institute of Cancer Research, London, UK.
Anaesthesia and Perioperative Medicine, The Royal Marsden Hospital, London, UK; Perioperative and Critical Care Outcomes Group, Division of Cancer Biology, The Institute of Cancer Research, London, UK.
Br J Anaesth. 2019 Aug;123(2):e412-e423. doi: 10.1016/j.bja.2019.02.028. Epub 2019 May 20.
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.
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 cancer-related pain in adults were included. Animal studies, case reports, and retrospective observational data were excluded.
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.
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.
新出现的数据强调了环氧化酶（COX）抑制剂在恶性肿瘤一级预防中的潜在作用，可减少转移扩散并提高总体生存率。尽管非甾体类抗炎药（NSAIDs）是世界卫生组织（WHO）镇痛阶梯治疗的关键组成部分，但在癌症疼痛管理中的应用仍然相对较少。本综述重新评估了 COX 抑制剂作为癌症疼痛治疗的镇痛药的现有证据，为临床医生制定治疗策略时提供了一个简洁的资源，以辅助其决策。
检索了截至 2018 年 11 月的 Medline®和 Embase®数据库，以查找有关 NSAIDs 治疗成人癌症相关疼痛的出版物。纳入了随机对照试验（RCT）和双盲对照研究。排除了动物研究、病例报告和回顾性观察数据。
共确定了 30 项研究 NSAIDs 治疗癌症疼痛管理的研究。尽管人们对 NSAIDs 在癌症治疗结果中的这种成本效益好且成熟的药物重新产生了兴趣，但由于研究持续时间短且结局测量指标存在异质性，限制了得出有意义结论的能力，因此关于 NSAIDs 在癌症疼痛管理中的镇痛疗效的高质量证据有限。
尽管过去 15 年来，人们对 NSAIDs 在癌症治疗结果中的作用的兴趣日益浓厚，但在癌症疼痛管理中，关于此类药物疗效的数据却很少。然而，在制定癌症患者的镇痛策略时，必须考虑此类药物的潜在益处。进一步研究 NSAIDs 在癌症疼痛管理中的作用无疑是必要的。
