Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2020 May 19:9:378.
doi: 10.12688/f1000research.23455.1. eCollection 2020.

Analgesic efficacy of nefopam for cancer pain: a randomized controlled study

Koravee Pasutharnchat  1 , Wichita Wichachai  1 , Rungrawan Buachai  1
Affiliations
Randomized Controlled Trial

Analgesic efficacy of nefopam for cancer pain: a randomized controlled study

Koravee Pasutharnchat et al. F1000Res. .

Abstract

Background: Nefopam is a non-opioid, non-steroidal, central acting drug used effectively for postoperative pain. The efficacy of nefopam for cancer pain remains unclear. We aimed to evaluate the analgesic efficacy of nefopam for cancer pain in a randomized controlled trial. Methods: Patients with moderate to severe cancer pain (n=40) were randomly divided into two groups. The nefopam group (n=20) received three 20 mg doses of nefopam every 8 hours. The placebo group (n=20) received normal saline. Intravenous patient-controlled analgesia with morphine was given for breakthrough pain for 48 hours. The primary outcome was significant pain reduction. Secondary outcomes were morphine consumption over 48 hours and incidence of side effects. Results: The nefopam group showed pain reduction at 12 hours (65% of patients), 24 hours (80%), 36 hours (85%), and 48 hours (65%). The placebo group showed pain reduction at 12 hours (70%), 24 hours (75%), 36 hours (80%), and 48 hours (60%). However, there were no statistically significant differences between the groups (p>0.05). The median dosage of morphine consumption in 48 hours was lower in the nefopam group (25.5 mg) compared with the placebo group (37 mg), but this was not statistically significant (p=0.499). There were no statistically significant differences in blood pressure and heart rate between the groups. Side effects in both groups were comparable. Conclusions: At dosage of 60 mg in 24 hours, nefopam did not provide significant pain reduction in moderate to severe cancer pain patients. However, there was a trend of reduced opioid consumption. Further studies with larger sample sizes, longer duration, or higher doses of nefopam are warranted. Registration: Thai Clinical Trail Registry (TCTR) ID TCTR20181016001; registered on 12 October 2018.

Keywords: analgesia; cancer; efficacy; morphine consumption; nefopam; pain; pain reduction; patient controlled analgesia; side effect.

PubMed Disclaimer

Conflict of interest statement

No competing interests were disclosed.

Figures

Figure 1.
Figure 1.. CONSORT study flow chart.
Figure 2.
Figure 2.. Flow diagram of patient enrollment.
Figure 3.
Figure 3.. Effectiveness of nefopam for median cumulative morphine consumption.
Figure 4.
Figure 4.. Effectiveness of nefopam for median cumulative morphine consumption (mg) by current opioid status.
( A) Opioid naïve subgroup; ( B) non-opioid naive subgroup.
Figure 5.
Figure 5.. Blood pressure.
Mean systolic/diastolic blood pressure and standard error of the mean for the two groups of patients.
Figure 6.
Figure 6.. Heart rate.
Mean heart rate and standard error of the mean for the two groups of patients.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Wiffen PJ, Wee B, Derry S, et al. : Opioids for cancer pain - an overview of Cochrane reviews. Cochrane Database Syst Rev. 2017;7:CD012592. 10.1002/14651858.CD012592.pub2 - DOI - PMC - PubMed
    1. van den Beuken-van Everdingen MH, Hochstenbach LM, Joosten EA, et al. : Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symptom Manage. 2016;51(6):1070–90.e9. 10.1016/j.jpainsymman.2015.12.340 - DOI - PubMed
    1. World Health Organization: WHO guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents.2018. Reference Source - PubMed
    1. Oosten AW, Oldenmenger WH, Mathijssen RH, et al. : A systematic review of prospective studies reporting adverse events of commonly used opioids for cancer-related pain: a call for the use of standardized outcome measures. J Pain. 2015;16(10):935–46. 10.1016/j.jpain.2015.05.006 - DOI - PubMed
    1. Yoon E, Babar A, Choudhary M, et al. : Acetaminophen-induced hepatotoxicity: a comprehensive update. J Clin Transl Hepatol. 2016;4(2):131–42. 10.14218/JCTH.2015.00052 - DOI - PMC - PubMed

Publication types