Metamizole/dipyrone for the relief of cancer pain: A systematic review and evidence-based recommendations for clinical practice
Background: Dipyrone (metamizole) is one of the most widely used non-opioid analgesics for the treatment of cancer pain. Aim: Because evidence-based recommendations are not yet available, a systematic review was conducted for the German Guideline Program in Oncology to provide recommendations for th...
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| Veröffentlicht in: | Palliative Medicine 2017-01, Vol.31 (1), p.26-34 |
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| creator | Gaertner, Jan Stamer, Ulrike M Remi, Constanze Voltz, Raymond Bausewein, Claudia Sabatowski, Rainer Wirz, Stefan Müller-Mundt, Gabriele Simon, Steffen T Pralong, Anne Nauck, Friedemann Follmann, Markus Radbruch, Lukas Meißner, Winfried |
| description | Background:
Dipyrone (metamizole) is one of the most widely used non-opioid analgesics for the treatment of cancer pain.
Aim:
Because evidence-based recommendations are not yet available, a systematic review was conducted for the German Guideline Program in Oncology to provide recommendations for the use of dipyrone in cancer pain.
Design:
First, a systematic review for clinical trials assessing dipyrone in adult patients with cancer pain was conducted. Endpoints were pain intensity, opioid-sparing effects, safety, and quality of life.
Data sources:
The search was performed in MedLine, Embase (via Ovid), and the Cochrane Library (1948–2013) and additional hand search was conducted. Finally, recommendations were developed and agreed in a formal structured consensus process by 53 representatives of scientific medical societies and 49 experts.
Results:
Of 177 retrieved studies, 4 could be included (3 randomized controlled trials and 1 cohort study, n = 252 patients): dipyrone significantly decreased pain intensity compared to placebo, even if low doses (1.5–2 g/day) were used. Higher doses (3 × 2 g/day) were more effective than low doses (3 × 1 g/day), but equally effective as 60 mg oral morphine/day. Pain reduction of dipyrone and non-steroidal anti-inflammatory drugs did not differ significantly. Compared to placebo, non-steroidal anti-inflammatory drugs, and morphine, the incidence of adverse effects was not increased.
Conclusion:
Dipyrone can be recommended for the treatment of cancer pain as an alternative to other non-opioids either alone or in combination with opioids. It can be preferred over non-steroidal anti-inflammatory drugs due to the presumably favorable side effect profile in long-term use, but comparative studies are not available for long-term use. |
| doi_str_mv | 10.1177/0269216316655746 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1875835865</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_0269216316655746</sage_id><sourcerecordid>1826726817</sourcerecordid><originalsourceid>FETCH-LOGICAL-c440t-c651d8610308accfe75fe3f7ec2ada3922a974d3a2e80c378748d20d7b8e61e43</originalsourceid><addsrcrecordid>eNqNkc1rFEEQxRtRzBq9e5IGL17G9Hf3egvBL4jkEsHbUNtdox1musfu2ch68V-3140hBARPVfB-7xXFI-Q5Z685t_aECbMW3EhujNZWmQdkxZW1HZPsy0Oy2svdXj8iT2q9YoxLZtRjciSsktowtSK_PuECU_yZRzwJcd6VnJAOudDlG9KCY8SB5oF6SB4LnSGmN_SU1l1dcIIl-sZcR_xBIQXatoCN6zZQMTTF52nCFBqXU_2T6seYooeRzgV8s-NT8miAseKzm3lMPr97e3n2oTu_eP_x7PS880qxpfNG8-AMb4858H5AqweUg0UvIIBcCwFrq4IEgY55aZ1VLggW7Mah4ajkMXl1yJ1L_r7FuvRTrB7HERLmbe25s9pJ7Yz-D1QYK4zjtqEv76FXeVtSe6RR2lglBN8HsgPlS6614NDPJU5Qdj1n_b7H_n6PzfLiJni7mTDcGv4W14DuAFT4ineu_ivwNyFOpYc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1856742215</pqid></control><display><type>article</type><title>Metamizole/dipyrone for the relief of cancer pain: A systematic review and evidence-based recommendations for clinical practice</title><source>Applied Social Sciences Index & Abstracts (ASSIA)</source><source>MEDLINE</source><source>SAGE Complete</source><creator>Gaertner, Jan ; Stamer, Ulrike M ; Remi, Constanze ; Voltz, Raymond ; Bausewein, Claudia ; Sabatowski, Rainer ; Wirz, Stefan ; Müller-Mundt, Gabriele ; Simon, Steffen T ; Pralong, Anne ; Nauck, Friedemann ; Follmann, Markus ; Radbruch, Lukas ; Meißner, Winfried</creator><creatorcontrib>Gaertner, Jan ; Stamer, Ulrike M ; Remi, Constanze ; Voltz, Raymond ; Bausewein, Claudia ; Sabatowski, Rainer ; Wirz, Stefan ; Müller-Mundt, Gabriele ; Simon, Steffen T ; Pralong, Anne ; Nauck, Friedemann ; Follmann, Markus ; Radbruch, Lukas ; Meißner, Winfried</creatorcontrib><description>Background:
Dipyrone (metamizole) is one of the most widely used non-opioid analgesics for the treatment of cancer pain.
Aim:
Because evidence-based recommendations are not yet available, a systematic review was conducted for the German Guideline Program in Oncology to provide recommendations for the use of dipyrone in cancer pain.
Design:
First, a systematic review for clinical trials assessing dipyrone in adult patients with cancer pain was conducted. Endpoints were pain intensity, opioid-sparing effects, safety, and quality of life.
Data sources:
The search was performed in MedLine, Embase (via Ovid), and the Cochrane Library (1948–2013) and additional hand search was conducted. Finally, recommendations were developed and agreed in a formal structured consensus process by 53 representatives of scientific medical societies and 49 experts.
Results:
Of 177 retrieved studies, 4 could be included (3 randomized controlled trials and 1 cohort study, n = 252 patients): dipyrone significantly decreased pain intensity compared to placebo, even if low doses (1.5–2 g/day) were used. Higher doses (3 × 2 g/day) were more effective than low doses (3 × 1 g/day), but equally effective as 60 mg oral morphine/day. Pain reduction of dipyrone and non-steroidal anti-inflammatory drugs did not differ significantly. Compared to placebo, non-steroidal anti-inflammatory drugs, and morphine, the incidence of adverse effects was not increased.
Conclusion:
Dipyrone can be recommended for the treatment of cancer pain as an alternative to other non-opioids either alone or in combination with opioids. It can be preferred over non-steroidal anti-inflammatory drugs due to the presumably favorable side effect profile in long-term use, but comparative studies are not available for long-term use.</description><identifier>ISSN: 0269-2163</identifier><identifier>EISSN: 1477-030X</identifier><identifier>DOI: 10.1177/0269216316655746</identifier><identifier>PMID: 27435604</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Analgesics ; Anti-Inflammatory Agents, Non-Steroidal - adverse effects ; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use ; Cancer ; Cancer Pain - drug therapy ; Clinical medicine ; Clinical practice guidelines ; Clinical research ; Clinical trials ; Clinical Trials as Topic ; Cohort analysis ; Comparative studies ; Dipyrone - adverse effects ; Dipyrone - therapeutic use ; Dosage ; Drug dosages ; Evidence-Based Medicine ; Experts ; Humans ; Morphine ; Narcotics ; Oncology ; Opioids ; Pain ; Pain Management - methods ; Palliative Care - methods ; Quality of Life ; Relief ; Safety ; Side effects ; Systematic review</subject><ispartof>Palliative Medicine, 2017-01, Vol.31 (1), p.26-34</ispartof><rights>The Author(s) 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c440t-c651d8610308accfe75fe3f7ec2ada3922a974d3a2e80c378748d20d7b8e61e43</citedby><cites>FETCH-LOGICAL-c440t-c651d8610308accfe75fe3f7ec2ada3922a974d3a2e80c378748d20d7b8e61e43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0269216316655746$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0269216316655746$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>313,314,776,780,788,21798,27899,27901,27902,30976,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27435604$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gaertner, Jan</creatorcontrib><creatorcontrib>Stamer, Ulrike M</creatorcontrib><creatorcontrib>Remi, Constanze</creatorcontrib><creatorcontrib>Voltz, Raymond</creatorcontrib><creatorcontrib>Bausewein, Claudia</creatorcontrib><creatorcontrib>Sabatowski, Rainer</creatorcontrib><creatorcontrib>Wirz, Stefan</creatorcontrib><creatorcontrib>Müller-Mundt, Gabriele</creatorcontrib><creatorcontrib>Simon, Steffen T</creatorcontrib><creatorcontrib>Pralong, Anne</creatorcontrib><creatorcontrib>Nauck, Friedemann</creatorcontrib><creatorcontrib>Follmann, Markus</creatorcontrib><creatorcontrib>Radbruch, Lukas</creatorcontrib><creatorcontrib>Meißner, Winfried</creatorcontrib><title>Metamizole/dipyrone for the relief of cancer pain: A systematic review and evidence-based recommendations for clinical practice</title><title>Palliative Medicine</title><addtitle>Palliat Med</addtitle><description>Background:
Dipyrone (metamizole) is one of the most widely used non-opioid analgesics for the treatment of cancer pain.
Aim:
Because evidence-based recommendations are not yet available, a systematic review was conducted for the German Guideline Program in Oncology to provide recommendations for the use of dipyrone in cancer pain.
Design:
First, a systematic review for clinical trials assessing dipyrone in adult patients with cancer pain was conducted. Endpoints were pain intensity, opioid-sparing effects, safety, and quality of life.
Data sources:
The search was performed in MedLine, Embase (via Ovid), and the Cochrane Library (1948–2013) and additional hand search was conducted. Finally, recommendations were developed and agreed in a formal structured consensus process by 53 representatives of scientific medical societies and 49 experts.
Results:
Of 177 retrieved studies, 4 could be included (3 randomized controlled trials and 1 cohort study, n = 252 patients): dipyrone significantly decreased pain intensity compared to placebo, even if low doses (1.5–2 g/day) were used. Higher doses (3 × 2 g/day) were more effective than low doses (3 × 1 g/day), but equally effective as 60 mg oral morphine/day. Pain reduction of dipyrone and non-steroidal anti-inflammatory drugs did not differ significantly. Compared to placebo, non-steroidal anti-inflammatory drugs, and morphine, the incidence of adverse effects was not increased.
Conclusion:
Dipyrone can be recommended for the treatment of cancer pain as an alternative to other non-opioids either alone or in combination with opioids. It can be preferred over non-steroidal anti-inflammatory drugs due to the presumably favorable side effect profile in long-term use, but comparative studies are not available for long-term use.</description><subject>Analgesics</subject><subject>Anti-Inflammatory Agents, Non-Steroidal - adverse effects</subject><subject>Anti-Inflammatory Agents, Non-Steroidal - therapeutic use</subject><subject>Cancer</subject><subject>Cancer Pain - drug therapy</subject><subject>Clinical medicine</subject><subject>Clinical practice guidelines</subject><subject>Clinical research</subject><subject>Clinical trials</subject><subject>Clinical Trials as Topic</subject><subject>Cohort analysis</subject><subject>Comparative studies</subject><subject>Dipyrone - adverse effects</subject><subject>Dipyrone - therapeutic use</subject><subject>Dosage</subject><subject>Drug dosages</subject><subject>Evidence-Based Medicine</subject><subject>Experts</subject><subject>Humans</subject><subject>Morphine</subject><subject>Narcotics</subject><subject>Oncology</subject><subject>Opioids</subject><subject>Pain</subject><subject>Pain Management - methods</subject><subject>Palliative Care - methods</subject><subject>Quality of Life</subject><subject>Relief</subject><subject>Safety</subject><subject>Side effects</subject><subject>Systematic review</subject><issn>0269-2163</issn><issn>1477-030X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><recordid>eNqNkc1rFEEQxRtRzBq9e5IGL17G9Hf3egvBL4jkEsHbUNtdox1musfu2ch68V-3140hBARPVfB-7xXFI-Q5Z685t_aECbMW3EhujNZWmQdkxZW1HZPsy0Oy2svdXj8iT2q9YoxLZtRjciSsktowtSK_PuECU_yZRzwJcd6VnJAOudDlG9KCY8SB5oF6SB4LnSGmN_SU1l1dcIIl-sZcR_xBIQXatoCN6zZQMTTF52nCFBqXU_2T6seYooeRzgV8s-NT8miAseKzm3lMPr97e3n2oTu_eP_x7PS880qxpfNG8-AMb4858H5AqweUg0UvIIBcCwFrq4IEgY55aZ1VLggW7Mah4ajkMXl1yJ1L_r7FuvRTrB7HERLmbe25s9pJ7Yz-D1QYK4zjtqEv76FXeVtSe6RR2lglBN8HsgPlS6614NDPJU5Qdj1n_b7H_n6PzfLiJni7mTDcGv4W14DuAFT4ineu_ivwNyFOpYc</recordid><startdate>201701</startdate><enddate>201701</enddate><creator>Gaertner, Jan</creator><creator>Stamer, Ulrike M</creator><creator>Remi, Constanze</creator><creator>Voltz, Raymond</creator><creator>Bausewein, Claudia</creator><creator>Sabatowski, Rainer</creator><creator>Wirz, Stefan</creator><creator>Müller-Mundt, Gabriele</creator><creator>Simon, Steffen T</creator><creator>Pralong, Anne</creator><creator>Nauck, Friedemann</creator><creator>Follmann, Markus</creator><creator>Radbruch, Lukas</creator><creator>Meißner, Winfried</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>201701</creationdate><title>Metamizole/dipyrone for the relief of cancer pain: A systematic review and evidence-based recommendations for clinical practice</title><author>Gaertner, Jan ; Stamer, Ulrike M ; Remi, Constanze ; Voltz, Raymond ; Bausewein, Claudia ; Sabatowski, Rainer ; Wirz, Stefan ; Müller-Mundt, Gabriele ; Simon, Steffen T ; Pralong, Anne ; Nauck, Friedemann ; Follmann, Markus ; Radbruch, Lukas ; Meißner, Winfried</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c440t-c651d8610308accfe75fe3f7ec2ada3922a974d3a2e80c378748d20d7b8e61e43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Analgesics</topic><topic>Anti-Inflammatory Agents, Non-Steroidal - adverse effects</topic><topic>Anti-Inflammatory Agents, Non-Steroidal - therapeutic use</topic><topic>Cancer</topic><topic>Cancer Pain - drug therapy</topic><topic>Clinical medicine</topic><topic>Clinical practice guidelines</topic><topic>Clinical research</topic><topic>Clinical trials</topic><topic>Clinical Trials as Topic</topic><topic>Cohort analysis</topic><topic>Comparative studies</topic><topic>Dipyrone - adverse effects</topic><topic>Dipyrone - therapeutic use</topic><topic>Dosage</topic><topic>Drug dosages</topic><topic>Evidence-Based Medicine</topic><topic>Experts</topic><topic>Humans</topic><topic>Morphine</topic><topic>Narcotics</topic><topic>Oncology</topic><topic>Opioids</topic><topic>Pain</topic><topic>Pain Management - methods</topic><topic>Palliative Care - methods</topic><topic>Quality of Life</topic><topic>Relief</topic><topic>Safety</topic><topic>Side effects</topic><topic>Systematic review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gaertner, Jan</creatorcontrib><creatorcontrib>Stamer, Ulrike M</creatorcontrib><creatorcontrib>Remi, Constanze</creatorcontrib><creatorcontrib>Voltz, Raymond</creatorcontrib><creatorcontrib>Bausewein, Claudia</creatorcontrib><creatorcontrib>Sabatowski, Rainer</creatorcontrib><creatorcontrib>Wirz, Stefan</creatorcontrib><creatorcontrib>Müller-Mundt, Gabriele</creatorcontrib><creatorcontrib>Simon, Steffen T</creatorcontrib><creatorcontrib>Pralong, Anne</creatorcontrib><creatorcontrib>Nauck, Friedemann</creatorcontrib><creatorcontrib>Follmann, Markus</creatorcontrib><creatorcontrib>Radbruch, Lukas</creatorcontrib><creatorcontrib>Meißner, Winfried</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Palliative Medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gaertner, Jan</au><au>Stamer, Ulrike M</au><au>Remi, Constanze</au><au>Voltz, Raymond</au><au>Bausewein, Claudia</au><au>Sabatowski, Rainer</au><au>Wirz, Stefan</au><au>Müller-Mundt, Gabriele</au><au>Simon, Steffen T</au><au>Pralong, Anne</au><au>Nauck, Friedemann</au><au>Follmann, Markus</au><au>Radbruch, Lukas</au><au>Meißner, Winfried</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Metamizole/dipyrone for the relief of cancer pain: A systematic review and evidence-based recommendations for clinical practice</atitle><jtitle>Palliative Medicine</jtitle><addtitle>Palliat Med</addtitle><date>2017-01</date><risdate>2017</risdate><volume>31</volume><issue>1</issue><spage>26</spage><epage>34</epage><pages>26-34</pages><issn>0269-2163</issn><eissn>1477-030X</eissn><abstract>Background:
Dipyrone (metamizole) is one of the most widely used non-opioid analgesics for the treatment of cancer pain.
Aim:
Because evidence-based recommendations are not yet available, a systematic review was conducted for the German Guideline Program in Oncology to provide recommendations for the use of dipyrone in cancer pain.
Design:
First, a systematic review for clinical trials assessing dipyrone in adult patients with cancer pain was conducted. Endpoints were pain intensity, opioid-sparing effects, safety, and quality of life.
Data sources:
The search was performed in MedLine, Embase (via Ovid), and the Cochrane Library (1948–2013) and additional hand search was conducted. Finally, recommendations were developed and agreed in a formal structured consensus process by 53 representatives of scientific medical societies and 49 experts.
Results:
Of 177 retrieved studies, 4 could be included (3 randomized controlled trials and 1 cohort study, n = 252 patients): dipyrone significantly decreased pain intensity compared to placebo, even if low doses (1.5–2 g/day) were used. Higher doses (3 × 2 g/day) were more effective than low doses (3 × 1 g/day), but equally effective as 60 mg oral morphine/day. Pain reduction of dipyrone and non-steroidal anti-inflammatory drugs did not differ significantly. Compared to placebo, non-steroidal anti-inflammatory drugs, and morphine, the incidence of adverse effects was not increased.
Conclusion:
Dipyrone can be recommended for the treatment of cancer pain as an alternative to other non-opioids either alone or in combination with opioids. It can be preferred over non-steroidal anti-inflammatory drugs due to the presumably favorable side effect profile in long-term use, but comparative studies are not available for long-term use.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>27435604</pmid><doi>10.1177/0269216316655746</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0269-2163 |
| ispartof | Palliative Medicine, 2017-01, Vol.31 (1), p.26-34 |
| issn | 0269-2163 1477-030X |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1875835865 |
| source | Applied Social Sciences Index & Abstracts (ASSIA); MEDLINE; SAGE Complete |
| subjects | Analgesics Anti-Inflammatory Agents, Non-Steroidal - adverse effects Anti-Inflammatory Agents, Non-Steroidal - therapeutic use Cancer Cancer Pain - drug therapy Clinical medicine Clinical practice guidelines Clinical research Clinical trials Clinical Trials as Topic Cohort analysis Comparative studies Dipyrone - adverse effects Dipyrone - therapeutic use Dosage Drug dosages Evidence-Based Medicine Experts Humans Morphine Narcotics Oncology Opioids Pain Pain Management - methods Palliative Care - methods Quality of Life Relief Safety Side effects Systematic review |
| title | Metamizole/dipyrone for the relief of cancer pain: A systematic review and evidence-based recommendations for clinical practice |
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