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Text
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<a href="http://doi.org/10.1002/14651858.cd002068" target="_blank" rel="noreferrer">http://doi.org/10.1002/14651858.cd002068</a>
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Title
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Bisphosphonates for the relief of pain secondary to bone metastases
Publisher
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Cochrane Database Of Systematic Reviews
Date
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2002
Subject
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Humans; Analgesics; Pain/drug therapy; Non-Narcotic/therapeutic use; Antineoplastic Agents/therapeutic use; Bone Neoplasms/complications/drug therapy/secondary; Clodronate; Clodronic Acid/therapeutic use; Diphosphonates/therapeutic use; Etidronic Acid/therapeutic use; Randomized Controlled Trials
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Wong R; Wiffen PJ
Description
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BACKGROUND: Bisphosphonates form part of standard therapy for hypercalcemia and the prevention of skeletal events in some cancers. However, the role of bisphosphonates in pain relief for bony metastases remains uncertain. OBJECTIVES: To determine the effectiveness of bisphosphonates for the relief of pain from bone metastases. SEARCH STRATEGY: MEDLINE (1966-1999), EMBASE (1980-1999), CancerLit (1966-1999), the Cochrane library (Issue 1, 2000) and the Oxford Pain Database were searched using the strategy devised by the Cochrane Pain, Palliative and Supportive Care Group with additional terms 'diphosphonate', 'bisphosphonate', 'multiple myeloma' and 'bone neoplasms'. (Last search: January 2000). SELECTION CRITERIA: Randomized trials of bisphosphonates compared with open, blinded, or different doses/types of bisphosphonates in cancer patients were included where pain and/or analgesic consumption were outcome measures. Studies where pain was reported only by observers were excluded. DATA COLLECTION AND ANALYSIS: Article eligibility, quality assessment and data extraction were undertaken by both reviewers. The proportions of patients with pain relief at 4, 8 and 12 weeks were assessed. The proportion of patients with analgesic reduction, the mean pain score, mean analgesic consumption, adverse drug reactions, and quality of life data were compared as secondary outcomes. MAIN RESULTS: Thirty randomized controlled studies (21 blinded, four open and five active control) with a total of 3682 subjects were included. For each outcome, there were few studies with available data. For the proportion of patients with pain relief (eight studies) pooled data showed benefits for the treatment group, with an NNT at 4 weeks of 11[95% CI 6-36] and at 12 weeks of 7 [95% CI 5-12]. In terms of adverse drug reactions, the NNH was 16 [95% CI 12-27] for discontinuation of therapy. Nausea and vomiting were reported in 24 studies with a non-significant trend for greater risk in the treatment group. One study showed a small improvement in quality of life for the treatment group at 4 weeks. The small number of studies in each subgroup with relevant data limited our ability to explore the most effective bisphosphonates and their relative effectiveness for different primary neoplasms. REVIEWER'S CONCLUSIONS: There is evidence to support the effectiveness of bisphosphonates in providing some pain relief for bone metastases. There is insufficient evidence to recommend bisphosphonates for immediate effect; as first line therapy; to define the most effective bisphosphonates or their relative effectiveness for different primary neoplasms. Bisphosphonates should be considered where analgesics and/or radiotherapy are inadequate for the management of painful bone metastases.
2002
Identifier
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<a href="http://doi.org/10.1002/14651858.cd002068" target="_blank" rel="noreferrer">10.1002/14651858.cd002068</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
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Journal Article
2002
Analgesics
Antineoplastic Agents/therapeutic use
Backlog
Bone Neoplasms/complications/drug therapy/secondary
Clodronate
Clodronic Acid/therapeutic use
Cochrane Database of Systematic Reviews
Diphosphonates/therapeutic use
Etidronic Acid/therapeutic use
Humans
Journal Article
Non-Narcotic/therapeutic use
Pain/drug Therapy
Randomized Controlled Trials
Wiffen PJ
Wong R