• Jan Gaertner, Ulrike M Stamer, Constanze Remi, Raymond Voltz, Claudia Bausewein, Rainer Sabatowski, Stefan Wirz, Gabriele Müller-Mundt, Steffen T Simon, Anne Pralong, Friedemann Nauck, Markus Follmann, Lukas Radbruch, and Winfried Meißner.
• 1 Clinic for Palliative Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
• Palliat Med. 2017 Jan 1; 31 (1): 26-34.

BackgroundDipyrone (metamizole) is one of the most widely used non-opioid analgesics for the treatment of cancer pain.AimBecause 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.DesignFirst, 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.Data SourcesThe 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.ResultsOf 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.ConclusionDipyrone 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.

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