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Non-steroidal anti-inflammatory drugs for pain in hospice/palliative care: an international pharmacovigilance study
  1. Richard McNeill1,
  2. Jason W Boland2,3,
  3. Andrew Wilcock4,5,
  4. Aynharan Sinnarajah6,7 and
  5. David C Currow8
  1. 1Medicine, University of Otago Christchurch, Christchurch, New Zealand
  2. 2Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
  3. 3Palliative Medicine, Care Plus Group and St Andrew’s Hospice, UK
  4. 4Nottingham University Hospitals NHS Trust, Nottingham, UK
  5. 5Faculty of Medicine and Health Sciences, Nottingham University, Nottingham, UK
  6. 6Department of Medicine, Queen's University, Kingston, Ontario, Canada
  7. 7Department of Medicine, Lakeridge Health, Oshawa, Ontario, Canada
  8. 8Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
  1. Correspondence to Professor David C Currow, University of Wollongong, Wollongong, NSW 2522, Australia; dcurrow{at}


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.

  • Pain
  • Hospice care
  • Pharmacology
  • Drug administration

Data availability statement

Data are available upon request.

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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.