ABSTRACT
Coadjuvants for cancer pain are medications that, when added to opioids, can potentially decrease narcotic request and opioid-related side effects. Our goal was to review not only the evidence that supports the effectiveness, but also the mechanisms of action of these drugs. We performed a qualitative review using the PubMed database applying the clinical queries tool to identify therapeutic clinical trials or systematic reviews evaluating cancer pain--oral or transdermal--analgesia. We excluded studies using anti-inflammatories, steroids or narcotics as primary analgesia and studies focused on perioperative cancer pain. We supplemented the information describing the mechanisms of action and suggested dosage schemes. We found a qualitative systematic review evaluating ketamine, and randomized trials supporting the use of amitriptyline, gabapentin and transdermal nitroglycerin. We also found some negative trials using gabapentin and lamotrigine for neuropathic pain secondary to chemotherapy. Weak evidence supports intravenous magnesium and lidocaine for breakthrough cancer pain. Further primary research based on clinical trials is required to support some adjuvant analgesics for cancer pain.
Subject(s)
Analgesics/administration & dosage , Neoplasms/complications , Pain/drug therapy , Anticonvulsants/administration & dosage , Drug Therapy, Combination , Humans , Pain/etiology , PubMedABSTRACT
Los coadyuvantes en cáncer son medicamentos que adicionados a la terapia opioide pueden disminuir el requerimiento de ésta y los efectos adversos relacionados con su uso. El objetivo de este artículo es revisar no solo la evidencia, sino también los mecanismos de acción y esquemas de tratamiento de estas drogas. Realizamos una revisión cualitativa de la literatura utilizando la herramienta de preguntas clínicas de PubMed, seleccionando los ensayos clínicos y las revisiones sistemáticas que evaluaran analgesia oral o transdérmica en cáncer. Excluimos los artículos que analizaron la efectividad primaria de opioides, antiinflamatorios y esteroides, además de intervenciones perioperatorias. Suplementamos la información con revisión de los mecanismos de acción de estos medicamentos y esquemas de dosificación. Identificamos una revisión sistemática que evaluaba ketamina y ensayos clínicos que apoyan el uso de gabapentina, amitriptilina y nitroglicerina transdérmica. Encontramos, además, ensayos negativos de gabapentina y lamotrigina en dolor por quimioterapia. Evidencia muy débil soporta el uso de magnesio y lidocaína intravenosa en crisis dolorosas. Se requieren más estudios para justificar el uso de algunos coadyuvantes en dolor por cáncer.
Coadjuvants for cancer pain are medications that, when added to opioids, can potentially decrease narcotic request and opioid-related side effects. Our goal was to review not only the evidence that supports the effectiveness, but also the mechanisms of action of these drugs. We performed a qualitative review using the PubMed database applying the clinical queries tool to identify therapeutic clinical trials or systematic reviews evaluating cancer pain--oral or transdermal--analgesia. We excluded studies using anti-inflammatories, steroids or narcotics as primary analgesia and studies focused on perioperative cancer pain. We supplemented the information describing the mechanisms of action and suggested dosage schemes. We found a qualitative systematic review evaluating ketamine, and randomized trials supporting the use of amitriptyline, gabapentin and transdermal nitroglycerin. We also found some negative trials using gabapentin and lamotrigine for neuropathic pain secondary to chemotherapy. Weak evidence supports intravenous magnesium and lidocaine for breakthrough cancer pain. Further primary research based on clinical trials is required to support some adjuvant analgesics for cancer pain.