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      New Perspectives on the Adverse Effects of NSAIDs in Cancer Pain: An Italian Delphi Study from the Rational Use of Analgesics (RUA) Group.

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          Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most frequently prescribed drugs for cancer pain. We used the Delphi methodology to evaluate the opinions of clinicians on NSAIDs and paracetamol, with a specific focus on their safety profile. Consensus was reached on seven statements. A high level of consensus was reached regarding the use of NSAIDs and gastrointestinal, cardiovascular, and renal risk in patients taking low-dose aspirin and assessment of liver function during long-term treatment with paracetamol. Consensus was also reached that assessment and monitoring of eGFR are important in the elderly being administered NSAIDs. It was further agreed that NSAIDs can often play a key role in association with opioids in the treatment of cancer pain and that paracetamol is the analgesic of first choice for patients with mild chronic pain. When NSAIDs are administered in combination with steroids, it was agreed that the risk of gastrointestinal damage is increased since steroids delay the healing of ulcers and that paracetamol can be used during pregnancy and does not affect the health of the fetus. This Delphi study highlights that there is poor agreement on how these drugs are routinely prescribed. However, a consensus was reached for seven key statements and may represent a valid contribution to daily practice.

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          Author and article information

          J Clin Med
          Journal of clinical medicine
          MDPI AG
          Dec 15 2022
          : 11
          : 24
          [1 ] Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, 00193 Rome, Italy.
          [2 ] Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, 04013 Latina, Italy.
          [3 ] Anesthesiology, Intensive Care, and Pain Medicine Unit, Sant'Andrea University Hospital, 00189 Rome, Italy.
          [4 ] Department of Medical Biotechnology and Molecular Medicine, Università degli Studi di Milano, 20121 Milan, Italy.
          [5 ] Palliative Care Unit, Department of Primary and Community Care, ASL3, 16100 Liguria, Italy.
          [6 ] IRCCS Santa Lucia Foundation, 00179 Rome, Italy.
          [7 ] Pain Medicine Unit, Istituto Europeo Oncologico, 20141 Milan, Italy.
          [8 ] Department of Interdisciplinary Medicine (DIM), University of Bari, 70124 Bari, Italy.
          [9 ] Anesthesia, Intensive Care and Pain Unit, Policlinico Hospital, 70124 Bari, Italy.
          [10 ] Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy.

          adverse events,cancer pain,paracetamol,NSAIDs
          adverse events, cancer pain, paracetamol, NSAIDs


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