Nonsteroidal anti-inflammatory drugs for pain in palliative care
If a nonsteroidal anti-inflammatory drug (NSAID) is indicated to manage pain in palliative care (see Principles of pharmacological management of pain in palliative care for indications), use:
1celecoxib 100 to 200 mg orally, twice daily. Review response after 1 week; stop if not tolerated or ineffective celecoxib
OR
1ibuprofen 200 to 400 mg orally, 3 times daily1. Review response after 1 week; stop if not tolerated or ineffective ibuprofen
OR
1naproxen 250 to 500 mg orally, twice daily23. Review response after 1 week; stop if not tolerated or ineffective. naproxen
Monitor ongoing therapy for effectiveness and tolerability—see Monitoring analgesic therapy in palliative care.
NSAIDs can cause significant adverse effects (particularly cardiovascular, gastrointestinal and kidney adverse effects). Adverse effects are dose- and duration-dependent and more likely in certain conditions that are common in patients with palliative care needs (eg cirrhosis, kidney impairment, peptic ulcer disease, cardiovascular disease, heart failure). Use the lowest effective dose of an NSAID for the shortest possible time.
The protective cardiovascular effects of low-dose aspirin are reduced by concomitant administration of other NSAIDs. If an NSAID is used to manage pain in palliative care in a patient who is taking low-dose aspirin, consider whether the aspirin should be continued based on its indication for use and an assessment of the likely benefits and harms—see Rationalising antiplatelet drugs in palliative care.
For specific contraindications to and precautions for NSAID use, and further information on adverse effects, see the Pain and Analgesia guidelines.