Nonsteroidal anti-inflammatory drugs as adjuvant analgesics in cancer patients

The role of nonsteroidal anti-inflammatory drugs (NSAIDs) is examined in th e control of cancer pain with a particular focus on their use as adjuvants to opioids in advanced cancer pain. These agents have both a peripheral eff ect on inflammation and a role in attenuating central pain pathways. The po ssibility of obtaining the benefits of NSAIDs with fewer side-effects by us ing COX-2-specific agents is discussed. The gastrointestinal, renal, haemos tatic, cognitive and hypersensitivity side-effects of NSAIDs are reviewed a nd their potential impact assessed. The evidence for the efficacy of NSAIDs as single agents for cancer pain is reviewed together with the nine papers which have reported the effects of NSAIDs as adjuvants to opioids in cance r pain. Ail of these papers reported positive results of NSAIDs, but, in th e absence of any randomized, double-blind controlled trials, where NSAIDs w ere used as adjuvants on a long-term basis alongside optimal opioid use, de finite conclusions cannot be reached. Guidelines for the safe use of NSAIDs are suggested. Finally, suggestions for future research are made.