title: Metamizole/dipyrone for the relief of cancer pain: A systematic review and evidence-based recommendations for clinical practice.
abstract: Dipyrone (metamizole) is one of the most widely used non-opioid analgesics for the treatment of cancer pain.
  
  
  
  Because evidence-based recommendations are not yet available, a systematic review was conducted for the German Guideline Program in Oncology to provide recommendations for the use of dipyrone in cancer pain.
  
  
  
  First, a systematic review for clinical trials assessing dipyrone in adult patients with cancer pain was conducted. Endpoints were pain intensity, opioid-sparing effects, safety, and quality of life.
  
  
  
  The search was performed in MedLine, Embase (via Ovid), and the Cochrane Library (1948-2013) and additional hand search was conducted. Finally, recommendations were developed and agreed in a formal structured consensus process by 53 representatives of scientific medical societies and 49 experts.
  
  
  
  Of 177 retrieved studies, 4 could be included (3 randomized controlled trials and 1 cohort study, n = 252 patients): dipyrone significantly decreased pain intensity compared to placebo, even if low doses (1.5-2 g/day) were used. Higher doses (3 × 2 g/day) were more effective than low doses (3 × 1 g/day), but equally effective as 60 mg oral morphine/day. Pain reduction of dipyrone and non-steroidal anti-inflammatory drugs did not differ significantly. Compared to placebo, non-steroidal anti-inflammatory drugs, and morphine, the incidence of adverse effects was not increased.
  
  
  
  Dipyrone can be recommended for the treatment of cancer pain as an alternative to other non-opioids either alone or in combination with opioids. It can be preferred over non-steroidal anti-inflammatory drugs due to the presumably favorable side effect profile in long-term use, but comparative studies are not available for long-term use.
authors.affiliation: 1 Clinic for Palliative Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Gaertner
authors.affiliation: 2 Department of Anesthesiology and Pain Medicine, Inselspital, University of Bern, Bern, Switzerland.
authors.forename: Ulrike M
authors.initials: UM
authors.lastname: Stamer
authors.affiliation: 3 Department of Palliative Medicine, University Hospital Bonn, Germany.
authors.forename: Constanze
authors.initials: C
authors.lastname: Remi
authors.affiliation: 4 Department of Palliative Care, University Hospital Cologne, Cologne, Germany.
authors.forename: Raymond
authors.initials: R
authors.lastname: Voltz
authors.affiliation: 3 Department of Palliative Medicine, University Hospital Bonn, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Bausewein
authors.affiliation: 5 Comprehensive Pain Centre, University Hospital Carl Gustav Carus Dresden, Dresden, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Sabatowski
authors.affiliation: 6 Department for Anaesthesiology, Intensive Medicine, Pain/Palliative Care, GFO CURA Hospital, Bad Honnef, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Wirz
authors.affiliation: 7 Institute for General Practice, Hannover Medical School, Hannover, Germany.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Müller-Mundt
authors.affiliation: 4 Department of Palliative Care, University Hospital Cologne, Cologne, Germany.
authors.forename: Steffen T
authors.initials: ST
authors.lastname: Simon
authors.affiliation: 4 Department of Palliative Care, University Hospital Cologne, Cologne, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Pralong
authors.affiliation: 8 Department of Palliative Medicine, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Friedemann
authors.initials: F
authors.lastname: Nauck
authors.affiliation: 9 Department of Guideline Development, German Cancer Society (DKG), Berlin, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Follmann
authors.affiliation: 10 Department of Palliative Medicine, University Hospital Bonn, Germany.
authors.forename: Lukas
authors.initials: L
authors.lastname: Radbruch
authors.affiliation: 11 Department of Palliative Care, Jena University Hospital, Jena, Germany.
authors.forename: Winfried
authors.initials: W
authors.lastname: Meißner
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D000072716:Cancer Pain / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D004177:Dipyrone / Q000009:adverse effects / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D006801:Humans; D059408:Pain Management / Q000379:methods; D010166:Palliative Care / Q000379:methods; D011788:Quality of Life
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004177:Dipyrone
keywords: Dipyrone; neoplasms; non-steroidal anti-inflammatory agents; pain management; palliative care; review