Study compares effectiveness of pain medications for patients receiving treatment for lung condition
Use of NSAIDs versus opiates resulted in no significant difference in measures of pain but was associated with more rescue medication among patients with malignant pleural effusions undergoing pleurodesis, according to a study published in JAMA.
The incidence of malignant pleural effusion is estimated to be 150,000 new cases in the USA each year. Non-steroidal anti-inflammatory drugs (NSAIDs) are avoided for treatment because they may reduce effectiveness of pleurodesis. Smaller chest tubes may be less painful than larger tubes during pleurodesis, but efficacy has not been proven.
Najib Rahman, of the University of Oxford, and colleagues, randomly assigned 206 patients with malignant pleural effusion requiring pleurodesis undergoing thoracoscopy, and who received a larger size (24F) chest tube, to receive either opiates or NSAIDs. Those not undergoing thoracoscopy were randomised to one of four groups: 24F chest tube and opioids; 24F chest tube and NSAIDs; 12F (smaller size) chest tube and opioids; or 12F chest tube and NSAIDs. The study was conducted at 16 UK hospitals from 2007 to 2013.
The researchers found that the use of NSAIDs, compared with opiates, resulted in no significant difference in pain scores but was associated with more use of rescue medication while the chest tube was in place; however, NSAID use also resulted in non-inferior rates of pleurodesis efficacy at three months. Among patients who did not undergo thoracoscopy, placement of 12F chest tubes compared with 24F chest tubes was associated with a statistically significant but clinically modest reduction in pain scores and failed to meet non-inferiority criteria for pleurodesis efficacy.
“These results challenge current guidelines that advocate avoidance of NSAIDs and use of small chest tubes,” wrote the authors.
Source: JAMA Network
Rahman, N.J., Pepperell, J., Rehal, S., et al. (2015) Effect of opioids vs NSAIDs and larger vs smaller chest tube size on pain control and pleurodesis efficacy among patients with malignant pleural effusion: The TIME1 randomized clinical trial. JAMA 314(24), 2641–2653. doi: 10.1001/jama.2015.16840