Researchers from Australia have reported that the use of acetaminophen for patients with advanced cancer receiving opioids decreases pain and improves well-being. This placebo-controlled study appeared in the August 15 issue of the Journal of Clinical Oncology.

Pain control is a major problem for patients with advanced cancer. The usual sequence of therapy includes initial treatment with acetaminophen or a nonsteroidal anti-inflammatory (NSAID) with progression to weak and then strong opioids. Many patients have pain despite strong opioid administration. In this study, researchers sought to determine if the addition of acetaminophen to strong opioids improved pain control. They randomly allocated patients to receive a placebo or acetaminophen for 48 hours in addition to strong opioids, usually morphine. After 48 hours, patients were switched to receive the alternative therapy, i.e. acetaminophen or placebo. They reported that pain and well-being were improved by the addition of acetaminophen compared to placebo. However, there were no differences in other parameters such as nausea and vomiting. These authors concluded that the addition of acetaminophen to strong opioids was a reasonable therapeutic option for patients with advanced cancer.

Comments: This study clearly demonstrates that the addition of a relatively non-toxic pain medicine can augment the pain control achieved by narcotics in cancer patients.

Reference: Stockler M, Vardy J, Pillai A, et al. Acetaminophen (Paracetamol) improves pain and well-being in people with advanced cancer already receiving a strong opioid regimen: A randomized, double-blind, placebo controlled cross-over trial. Journal of Clinical Oncology. 2004; 22: 3389-3394.