For Cancer Pain, What Rx Is Best?

NSAIDs, opiates may be equally effective for malignant pleural effusion surgery

/ Author:  / Reviewed by: Jennifer Gershman, PharmD, CPh

(RxWiki News) For patients struggling with cancer-related pain, what pain relievers are best? The answer may not be so black and white.

A new UK study found no significant differences in pain management between NSAIDs and opiates for patients with malignant pleural effusion (MPE) undergoing pleurodesis treatment. NSAIDs were tied to more rescue medicine (additional medication needed for uncontrolled pain), however.

MPE is a cancer-related condition that causes excess fluid to collect around the lungs. Pleurodesis is a surgical procedure that prevents this buildup.

NSAIDs are typically avoided in MPE treatment because they are thought to reduce the effectiveness of pleurodesis. Smaller chest tubes also may be less painful than larger tubes during pleurodesis, but the effectiveness of these devices has not yet been proven.

To investigate, a team of researchers led by Najib M. Rahman, DPhil, a specialist in respiratory medicine at the University of Oxford in England, looked at nearly 300 MPE patients who underwent pleurodesis between 2007 and 2013.

These patients were randomly assigned to one of four groups: a larger chest tube (24F) and opiates, a larger chest tube and NSAIDs, a smaller (12F) chest tube and opiates, or a smaller chest tube and NSAIDs.

Dr. Rahman and team found that the use of NSAIDs, compared with opiates, resulted in no significant differences in pain management in these patients. NSAIDs also resulted in similar rates of pleurodesis effectiveness after three months.

The smaller chest tubes were also tied to a significant reduction in pain compared to the larger tubes.

This study was published Dec. 22 in the journal JAMA.

The UK Medical Research Council funded this research.

Study author Jonathan Miles received fees from GlaxoSmithKline, AstraZeneca and Pfizer, among other pharmaceutical companies.

Review Date: 
December 21, 2015
Last Updated:
December 24, 2015