Journal of Pain and Symptom Management
Volume 39, Issue 3 , Pages 548-554 , March 2010

Lack of Benefit From Paracetamol (Acetaminophen) for Palliative Cancer Patients Requiring High-Dose Strong Opioids: A Randomized, Double-Blind, Placebo-Controlled, Crossover Trial

  • Fiona J. Israel, RN, MCouns

      Affiliations

    • Brisbane South Palliative Care Collaborative, Brisbane, Queensland, Australia
    • Queensland Health, Brisbane, Queensland, Australia
    • Griffith University School of Medicine, Brisbane, Queensland, Australia
    • Mt. Olivet Palliative Services, Brisbane, Queensland, Australia
    • Corresponding Author InformationAddress correspondence to: Fiona J. Israel, RN, MCouns, Brisbane South Palliative Care Collaborative, P.O. Box 4069, Eight Mile Plains, Queensland 4113, Australia.
  • ,
  • Greg Parker, MBBCH

      Affiliations

    • Queensland Health, Brisbane, Queensland, Australia
    • Brisbane South Palliative Care Services, Brisbane, Queensland, Australia
  • ,
  • Margaret Charles, BA, PhD

      Affiliations

    • School of Psychology, University of Sydney, Sydney, New South Wales, Australia
  • ,
  • Liz Reymond, MBBS(Hons), PhD, FRACGP, FAChPM

      Affiliations

    • Brisbane South Palliative Care Collaborative, Brisbane, Queensland, Australia
    • Queensland Health, Brisbane, Queensland, Australia
    • Griffith University School of Medicine, Brisbane, Queensland, Australia
    • Mt. Olivet Palliative Services, Brisbane, Queensland, Australia
    • Brisbane South Palliative Care Services, Brisbane, Queensland, Australia

,Accepted 24 July 2009.

References 

  1. World Health Organization . Cancer pain relief. Geneva, Switzerland: World Health Organization; 1986;
  2. World Health Organization . Palliative cancer pain: Pain relief and management of other symptoms. Geneva, Switzerland: World Health Organization Publications Centre; 1992;
  3. Axelsson B, Stellborn P, Strom G. Analgesic effect of paracetamol on cancer related pain in concurrent strong opioid therapy. A prospective clinical study. Acta Oncol. 2008;47:891–895
  4. McNicol ED, Strassels S, Goudas L, Lau J, Carr DB. NSAIDS or paracetamol, alone or combined with opioids, for cancer pain. Cochrane Database Syst Rev. 2005;(2):
  5. Filitz J, Ihmsen H, Gunther W, et al. Supra-additive effects of tramadol and acetaminophen in a human pain model. Pain. 2008;136:262–270
  6. Frickle JR, Hewitt DJ, Jordan DM, Fisher A, Rosenthal NR. A double-blind placebo-controlled comparison of tramadol/acetaminophen and tramadol in patients with postoperative dental pain. Pain. 2004;109:250–257
  7. Axelsson B, Christensen SB. Is there an additive analgesic effect of paracetamol at step 3? A double-blind randomized controlled study. J Palliat Med. 2003;18:724–725
  8. Stockler M, Vardy J, Pillai A, Warr D. Acetaminophen (paracetamol) improves pain and well-being in people with advanced cancer already receiving a strong opioid regimen: a randomised, double-blind, placebo-controlled cross-over trial. J Clin Oncol. 2004;22:3389–3394
  9. Hardy J, Reymond E, Charles M. Acetaminophen in cancer pain. J Clin Oncol. 2005;23:1586
  10. Farrar JT, Berlin JA, Strom BL. Clinically important changes in acute pain outcome measures: a validation study. J Pain Symptom Manage. 2003;25:406–411
  11. Kendrick DB, Strout TD. The minimum clinically significant difference in patient-assigned numeric scores for pain. Am J Emerg Med. 2005;23:828–832
  12. Hojat M, Xu G. A visitor's guide to effect sizes—Statistical significance versus practical (clinical) importance of research findings. Adv Health Sci Educ Theory Pract. 2004;9:241–249
  13. Altman DG. Practical statistics for medical research. Boca Raton, FL: Chapman & Hall/CRC; 1991;
  14. Bennett MI. Principles of designing clinical trials in palliative care. In:  Addington-Hall JM,  Bruera E,  Higginson I,  Payne S editor. Research methods in palliative care. Oxford, UK: Oxford University Press; 2007;p. 13–26

 This research was supported by the Brisbane South Palliative Care Collaborative, a joint partnership between Queensland Health, Metro South Health Service District, Griffith University School of Medicine, and Mt. Olivet Community Services.

PII: S0885-3924(09)01138-5

doi: 10.1016/j.jpainsymman.2009.07.008

Journal of Pain and Symptom Management
Volume 39, Issue 3 , Pages 548-554 , March 2010