Objectives To describe the current, real-world use of non-steroidal anti-inflammatory drugs for pain and the associated benefits and harms.
Methods A prospective, multicentre, consecutive cohort pharmacovigilance study conducted at 14 sites across Australia, Aotearoa/New Zealand and the UK including hospital, hospice inpatient and outpatient services. Pain scores and harms were graded using the National Cancer Institute Common Terminology Criteria for Adverse Events at baseline, 2 days and 14 days. Ad-hoc safety reporting continued until day 28.
Results Data were collected from 92 patients between March 2018 and October 2021. Most patients had cancer (91%) and were coprescribed opioids (90%). At 14 days, 88% of patients had benefit from non-steroidal anti-inflammatory drugs and 22% had harm. The most common harms were nausea (8%), vomiting (3%), acute kidney injury (3%) and non-gastrointestinal bleeding (3%); only 2% were severe and no patients ceased their non-steroidal anti-inflammatory drugs due to toxicity. Overall, 65% had benefit without harm and 3% had harm without benefit.
Conclusions Most patients benefited from non-steroidal anti-inflammatory drugs with only one in five patients experiencing tolerable harm. This suggests that short-term use of non-steroidal anti-inflammatory drugs in patients receiving palliative care is safer than previously thought and may be underused.
- Hospice care
- Drug administration
Data availability statement
Data are available upon request.
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Contributors RMcN: concept design for this RAPID study, study design, data analysis, data interpretation, initial drafting, guarantor. JWB: study design, data interpretation, critical draft revision. AW: study design, data interpretation, critical draft revision. AS: study design, data interpretation, critical draft revision. DCC: concept design of the RAPID program, study design, data interpretation, critical draft revision. RMcN is the acting guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.