Opioid-sparing effects of ketorolac in palliative care patients receiving opioids for chronic cancer-related pain: A systematic literature review.

Butcher, B; Hutchings, E; Fazekas, B; Clark, K; Rowett, D; Currow, D

Opioid-sparing effects of ketorolac in palliative care patients receiving opioids for chronic cancer-related pain: A systematic literature review.

Butcher, B Hutchings, E Fazekas, B Clark, K Rowett, D Currow, D

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Publisher:: SAGE Publications
Publication Type:: Journal Article
Citation:: Palliative Medicine, 2022, 36, (1), pp. 71-80
Issue Date:: 2022-01-01

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Field	Value	Language
dc.contributor.author	Butcher, B
dc.contributor.author	Hutchings, E
dc.contributor.author	Fazekas, B
dc.contributor.author	Clark, K
dc.contributor.author	Rowett, D
dc.contributor.author	Currow, D https://orcid.org/0000-0003-1988-1250
dc.date.accessioned	2022-10-06T05:16:53Z
dc.date.available	2022-10-06T05:16:53Z
dc.date.issued	2022-01-01
dc.identifier.citation	Palliative Medicine, 2022, 36, (1), pp. 71-80
dc.identifier.issn	0269-2163
dc.identifier.issn	1477-030X
dc.identifier.uri	http://hdl.handle.net/10453/162363
dc.description.abstract	BACKGROUND: Standard of care in treatment of cancer-related pain involves opioids in combination with non-steroidal anti-inflammatory drugs (NSAID). Ketorolac, a NSAID, has demonstrated opioid-sparing effects in other clinical settings. AIM: This systematic literature review investigated ketorolac's opioid-sparing effects in patients receiving opioids for chronic, cancer-related pain. DESIGN: The primary outcome was total daily dose of opioids. Secondary outcomes included frequency of opioid use, use and frequency of 'rescue' medication and adverse events. Outcomes were described, and meta-analysed where possible. PROSPERO registration CRD42019130894. DATA SOURCES: Articles included original research, from any study phase or methodology, published in English in a peer-reviewed journal or conference between 1990 and 2020; included subjects >18 years; had chronic cancer-related pain and described the use of opioid-sparing effect of ketorolac. RESULTS: Nine articles were included. While there was significant heterogeneity, ketorolac may have an opioid-sparing effect, with significant reductions in total daily dose of morphine observed in a single randomised controlled trial (SMD -4.30 mg, 95% CI -5.36 to -3.25), but the changes in the before and after studies were not statistically significant -0.46 mg (95% CI -1.14 to 0.22). Ketorolac was associated with greater likelihood of complete pain relief, but the data were heterogeneous. Insufficient data were available to analyse frequency of opioid use, or rescue medication requirements. CONCLUSIONS: Given the heterogeneity of the data, adequately powered, randomised controlled trials are required to establish any opioid-sparing effect of ketorolac. For patients not responding to conventional pain management, ketorolac may have a role in treatment augmentation.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	SAGE Publications
dc.relation.ispartof	Palliative Medicine
dc.relation.isbasedon	10.1177/02692163211045310
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1117 Public Health and Health Services, 1199 Other Medical and Health Sciences
dc.subject.classification	Gerontology
dc.subject.mesh	Analgesics, Opioid
dc.subject.mesh	Anti-Inflammatory Agents, Non-Steroidal
dc.subject.mesh	Cancer Pain
dc.subject.mesh	Humans
dc.subject.mesh	Ketorolac
dc.subject.mesh	Neoplasms
dc.subject.mesh	Pain, Postoperative
dc.subject.mesh	Palliative Care
dc.subject.mesh	Randomized Controlled Trials as Topic
dc.subject.mesh	Humans
dc.subject.mesh	Neoplasms
dc.subject.mesh	Pain, Postoperative
dc.subject.mesh	Ketorolac
dc.subject.mesh	Analgesics, Opioid
dc.subject.mesh	Anti-Inflammatory Agents, Non-Steroidal
dc.subject.mesh	Palliative Care
dc.subject.mesh	Randomized Controlled Trials as Topic
dc.subject.mesh	Cancer Pain
dc.title	Opioid-sparing effects of ketorolac in palliative care patients receiving opioids for chronic cancer-related pain: A systematic literature review.
dc.type	Journal Article
utslib.citation.volume	36
utslib.location.activity	England
utslib.for	1117 Public Health and Health Services
utslib.for	1199 Other Medical and Health Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
utslib.copyright.status	closed_access	*
pubs.consider-herdc	false
dc.date.updated	2022-10-06T05:16:52Z
pubs.issue	1
pubs.publication-status	Published
pubs.volume	36
utslib.citation.issue	1

Abstract:

BACKGROUND: Standard of care in treatment of cancer-related pain involves opioids in combination with non-steroidal anti-inflammatory drugs (NSAID). Ketorolac, a NSAID, has demonstrated opioid-sparing effects in other clinical settings. AIM: This systematic literature review investigated ketorolac's opioid-sparing effects in patients receiving opioids for chronic, cancer-related pain. DESIGN: The primary outcome was total daily dose of opioids. Secondary outcomes included frequency of opioid use, use and frequency of 'rescue' medication and adverse events. Outcomes were described, and meta-analysed where possible. PROSPERO registration CRD42019130894. DATA SOURCES: Articles included original research, from any study phase or methodology, published in English in a peer-reviewed journal or conference between 1990 and 2020; included subjects >18 years; had chronic cancer-related pain and described the use of opioid-sparing effect of ketorolac. RESULTS: Nine articles were included. While there was significant heterogeneity, ketorolac may have an opioid-sparing effect, with significant reductions in total daily dose of morphine observed in a single randomised controlled trial (SMD -4.30 mg, 95% CI -5.36 to -3.25), but the changes in the before and after studies were not statistically significant -0.46 mg (95% CI -1.14 to 0.22). Ketorolac was associated with greater likelihood of complete pain relief, but the data were heterogeneous. Insufficient data were available to analyse frequency of opioid use, or rescue medication requirements. CONCLUSIONS: Given the heterogeneity of the data, adequately powered, randomised controlled trials are required to establish any opioid-sparing effect of ketorolac. For patients not responding to conventional pain management, ketorolac may have a role in treatment augmentation.

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http://hdl.handle.net/10453/162363