The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding), by inconsistency (variability in results), and by imprecise results (few patients and outcome events).
A Cochrane review [Abstract] 1 included 11 studies lasting one week or longer, with a total of 949 subjects with mostly moderate or severe cancer pain. None had a placebo only control; 8 compared different NSAIDs, 3 an NSAID with opioid or opioid combination, and 1 both. None compared an NSAID plus opioid with the same dose of opioid alone. It was not possible to compare NSAIDs as a group with another treatment, or one NSAID with another NSAID. Results for all NSAIDs are reported as a randomized cohort. With NSAID, initially moderate or severe pain was reduced to no worse than mild pain after 1 or 2 weeks in 4 studies (n=415), with a range of estimates between 26% and 51% in individual studies.Adverse event and withdrawal reporting was inconsistent. Two serious adverse events were reported with NSAIDs, and 22 deaths, but these were not clearly related to any pain treatment. Common adverse events were thirst/dry mouth (15%), loss of appetite (14%), somnolence (11%), and dyspepsia (11%). Withdrawals were common, mostly because of lack of efficacy (24%) or adverse events (5%).
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