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Cancer pain management: Use of acetaminophen and nonsteroidal antiinflammatory drugs

Russell K Portenoy, MD
Ebtesam Ahmed, PharmD, MS
Yair Y Keilson, MD
Section Editor
Janet Abrahm, MD
Deputy Editor
Diane MF Savarese, MD


Opioid therapy is the first-line approach for moderate or severe chronic pain in populations with active cancer. (See "Cancer pain management with opioids: Optimizing analgesia".) However, the comprehensive management of pain in patients with cancer also requires expertise in the use of the nonopioid analgesics, such as acetaminophen (also known as paracetamol), non-steroidal antiinflammatory agents (NSAIDs), and a group of drugs referred to as "adjuvant" analgesics or coanalgesics.

A stepwise approach to management of cancer pain that includes both opioid and nonopioid drugs has been codified in the World Health Organization (WHO) "analgesic ladder" approach to cancer pain management (figure 1) [1]:

Step 1, which represents mild to moderate cancer-related pain, suggests the use of acetaminophen or an NSAID, possibly combined with an adjuvant drug to provide additional analgesia, treat a side effect, or manage a coexisting symptom. (See "Cancer pain management: Adjuvant analgesics (coanalgesics)".)

For patients with moderate or severe pain, and for those who do not achieve adequate relief with acetaminophen or a NSAID alone, treatment with a step 2 opioid (conventionally used for moderate pain) or a step 3 opioid (conventionally used for severe pain) is appropriate. On both steps 2 and 3, the use of acetaminophen or an NSAID could be considered, as well as other drugs to enhance analgesia or treat side effects.

The analgesic ladder approach is not an evidence-based guideline, but it provides a framework for the stepwise and systematic approach to managing cancer pain. (See "Cancer pain management: General principles and risk management for patients receiving opioids", section on 'General principles of pain management'.)


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Literature review current through: Sep 2016. | This topic last updated: Nov 19, 2015.
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