Paracetamol and NSAIDs in Cancer Pain Management: Evidence Review and Treatment Considerations

OPINION STATEMENT: Pain is one of the most prevalent and distressing symptoms in cancer, affecting up to 90% of patients and significantly impairing quality of life. Paracetamol (acetaminophen) and non-steroidal anti-inflammatory drugs (NSAIDs) are widely recommended by international guidelines for the management of non-surgical cancer pain, either alone or as adjuvants to opioids. In this paper, the current evidence for their efficacy, tolerability, and safety in this setting is reviewed. Evidence for paracetamol in cancer pain remains limited and of low quality. Small trials and systematic reviews suggest little or no additional analgesic benefit when used alongside strong opioids, and no clear advantage of intravenous over oral paracetamol has been demonstrated. Evidence for NSAIDs is slightly stronger, with studies indicating analgesic benefit both as monotherapy and in combination with opioids, although the quality of evidence is again restricted by small sample sizes, heterogeneity, and outdated trials. Concerns regarding adverse effects, particularly gastrointestinal, renal, and cardiovascular, often limit use, athough short-term use in patients receiving palliative care may be safer than historically perceived. Comparative data between individual NSAIDs, routes of administration, and longer-term use are lacking. Overall, while both paracetamol and NSAIDs are commonly prescribed and theoretically beneficial, high-quality, adequately powered studies in patients with cancer pain are scarce. Further research is needed to evidence their role, especially in opioid-sparing strategies, as well as determining the relative clinical effectiveness and harm of individual NSAIDs in patients with non-surgical cancer pain.