Sufficient therapy of pain is essential for the treatment of tumor patients. World Health Organisation (WHO)-guidelines recommend a combination of opioids with non-opioid-analgesics (NOA) for patients with medium to strong pain. Cancer pain is often a combination of pain caused by the tumor itself, tumor associated and pain caused by therapy. Various substances act by different mechanisms and therefore combinations may demonstrate superior effects. Opioids („central analgesics”) inhibit neuronal transduction within the spinal cord, enhance inhibiting function of midbrain nuclei on ascending pain transduction and influence pain perception via modulation of the limbic system. NOAs („peripheral analgesics”) inhibit cyclooxygenase hindering activation of the peripheral nociceptorsystem. There are 2 different classes of NOAs: 1) non-acidic, antipyretic analgesics like pyrazolones (metamizol) and anilin-derivates (paracetamol) and 2) non-steroidal antirheumatics (NSAR) like salicylates (acetylsalicylic acid), derivates of propionic acid (ibuprofen, naproxen), acetate acid (indomethacin, diclofenac), enolic acid (piroxicam, meloxicam) and anthranil acid (mefenamin). Adjuvant therapy is necessary to control common NSAR-side-effects like dyspepsia, ulcer and gastrointestinal bleeding. Due to its exceptional analgesic, antipyretic and spasmolytic properties, metamizol is an essential substance in tumor therapy. As agranulocytosis-incidence of 1: is low, good gastrointestinal and renal tolerance makes metamizol an excellent alternative to NSAR. There is scientific evidence that adequate combinations of non-opioids, opioids and adjuvant drugs, considering adverse side effects, were effective and safe in the treatment of cancer pain.
Aspirin sensitivity is an important underlying disease in patients with nasal polyps, intrinsic asthma or urticaria. The terms “Aspirin- (or analgetics-) induced asthma” or “Aspirin-exacerbated respiratory disease“ (AERD) describe the syndrome of chronic rhinosinusititis, polyposis nasi, asthma and acute reaction after ingestion of non-steroid antiinflammatory drugs (NSAID). The disease affects mainly women in the third decade or older. Nasal symptoms often appear many years previous to asthma and acute intolerance reactions. Nasal polyps not rarely require surgical interventions. However, polyps often relapse after weeks or few months after resection. The intrinsic asthma is difficult to control and patients often require treatment with oral steroids. The disease is not caused by the ingestion of NSAID, the sensitivity represents a phenomenon of the underlying metabolic disorder. Aspirin sensitivity is not an allergic disease based on IgE-mediated reactions. In contrast it is due to a metabolic overexpression of cysteinyl leucotrienes. Thus, skin tests and specific antibodies in the blood are always negative. Recent studies indicate that NSAID sensitivity may be proven and differentiated by sophisticated in vitro tests. However, nasal, bronchial, and oral provocation testing remains the standard of diagnosis. Aspirin desensitization is the most relevant therapeutical approach which improves nasal symptoms in the majority of patients and may stabilize intrinsic asthma.
Uganuća, istegnuća i druge povrede mekih tkiva su česte i za njihovo liječenje su potrebni lijekovi protiv bolova (analgetici). Ti lijekovi najčešće se daju u obliku tablete koja se uzima na usta (oralno). Postoje mnogi oblici oralnih lijekova protiv bolova za liječenje tih povreda, ali nije poznato je li koji bolji u odnosu na druge. U ovom Cochrane sustavnom pregledu ispitan je učinak lijekova protiv bolova na smanjenje boli, oticanja i funkcije kod povreda primjenom nesteroidnih protuupalnih lijekova (engl. non-steroidal anti-inflammatory drugs, NSAID) u usporedbi s paracetamolom, opijatima (primjerice kodein), te s postupcima alternativne medicine ili nekom od kombinacija navedenog. Također su istražene nuspojave ovih oblika liječenja.