{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T18:09:14Z","timestamp":1777918154536,"version":"3.51.4"},"reference-count":21,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2021,10,11]],"date-time":"2021-10-11T00:00:00Z","timestamp":1633910400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Palliat Med"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Standard of care in treatment of cancer-related pain involves opioids in combination with non-steroidal anti-inflammatory drugs (NSAID). Ketorolac, a NSAID, has demonstrated opioid-sparing effects in other clinical settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>This systematic literature review investigated ketorolac\u2019s opioid-sparing effects in patients receiving opioids for chronic, cancer-related pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>The primary outcome was total daily dose of opioids. Secondary outcomes included frequency of opioid use, use and frequency of \u2018rescue\u2019 medication and adverse events. Outcomes were described, and meta-analysed where possible. PROSPERO registration CRD42019130894.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources:<\/jats:title>\n                    <jats:p>Articles included original research, from any study phase or methodology, published in English in a peer-reviewed journal or conference between 1990 and 2020; included subjects &gt;18 years; had chronic cancer-related pain and described the use of opioid-sparing effect of ketorolac.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Nine articles were included. While there was significant heterogeneity, ketorolac may have an opioid-sparing effect, with significant reductions in total daily dose of morphine observed in a single randomised controlled trial (SMD \u22124.30 mg, 95% CI \u22125.36 to \u22123.25), but the changes in the before and after studies were not statistically significant \u22120.46 mg (95% CI \u22121.14 to 0.22). Ketorolac was associated with greater likelihood of complete pain relief, but the data were heterogeneous. Insufficient data were available to analyse frequency of opioid use, or rescue medication requirements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Given the heterogeneity of the data, adequately powered, randomised controlled trials are required to establish any opioid-sparing effect of ketorolac. For patients not responding to conventional pain management, ketorolac may have a role in treatment augmentation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02692163211045310","type":"journal-article","created":{"date-parts":[[2021,10,11]],"date-time":"2021-10-11T08:50:31Z","timestamp":1633942231000},"page":"71-80","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Opioid-sparing effects of ketorolac in palliative care patients receiving opioids for chronic cancer-related pain: A systematic literature review"],"prefix":"10.1177","volume":"36","author":[{"given":"Belinda","family":"Butcher","sequence":"first","affiliation":[{"name":"WriteSource Medical Pty Ltd, Lane Cove, NSW, Australia"},{"name":"University of New South Wales, Kensington, NSW, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Hutchings","sequence":"additional","affiliation":[{"name":"WriteSource Medical Pty Ltd, Lane Cove, NSW, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Belinda","family":"Fazekas","sequence":"additional","affiliation":[{"name":"Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia"},{"name":"Australian national Palliative Care Clinical Studies Collaboration (PaCCSC), Sydney, NSW, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Clark","sequence":"additional","affiliation":[{"name":"Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia"},{"name":"Australian national Palliative Care Clinical Studies Collaboration (PaCCSC), Sydney, NSW, Australia"},{"name":"Cancer and Palliative Care Network, Northern Sydney Local Health District, Sydney, NSW, Australia"},{"name":"Northern Clinical School, The University of Sydney, Sydney, NSW, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Debra","family":"Rowett","sequence":"additional","affiliation":[{"name":"UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1988-1250","authenticated-orcid":false,"given":"David","family":"Currow","sequence":"additional","affiliation":[{"name":"Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia"},{"name":"Australian national Palliative Care Clinical Studies Collaboration (PaCCSC), Sydney, NSW, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,10,11]]},"reference":[{"key":"bibr1-02692163211045310","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdy152"},{"key":"bibr2-02692163211045310","doi-asserted-by":"publisher","DOI":"10.36076\/ppj.2008\/11\/S105"},{"issue":"12","key":"bibr3-02692163211045310","first-page":"921","volume":"9","author":"Litvak K","year":"1990","journal-title":"Clin Pharm"},{"key":"bibr4-02692163211045310","unstructured":"National Center for Biotechnology Information. 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