Abstract

8032 Background: Adjuvant analgesic treatments have primary indications for uses other than the treatment of pain but demonstrate analgesic activity in some conditions. Although there is high level evidence to support the use of adjuvant analgesics in the chronic pain setting (eg antidepressants and anticonvulsants for benign neuropathic pain) the evidence relevant to the cancer pain setting has never been reviewed. Methods: This study examined the literature assessing adjuvant analgesic treatments specifically for publications restricted to patients with cancer pain, where pain relief was the primary outcome. Relevant studies were identified following searches of MEDLINE, EMBASE and the Cochrane Library (including up to December 2003). An appropriate level of evidence (NHMRC Australia designation) was applied for each treatment. Results: Significant variation in the extent and quality of research was noted across treatments. Level I or II evidence existed to support analgesic efficacy for NSAIDs, intravenous bisphosphonates and radiation treatment for painful bone metastases. Treatments employed for relief of cancer-related neuropathic pain were associated with a low evidence for analgesic efficacy, including anticonvulsants (Level III), systemic local anaesthetics (Level III), ketamine (Level II) and antidepressants (no evidence). Conclusions: Recruitment of patients with cancer-related pain to studies assessing adjuvant analgesic treatments is difficult, but clearly there is an important need for further clinical trials in this area. No significant financial relationships to disclose.

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