addition to step III opioids
The data permit a weak recommendation to add
NSAIDs to step III opioids to improve analgesia or
reduce the opioid dose required to achieve analgesia.
The use of NSAIDs, however, should be restricted
because of the risks of serious adverse effects, in
particular in elderly patients and those with renal,
hepatic, or cardiac failure. The data also permit a weak
recommendation that paracetamol should be preferred
to NSAIDs in combination with step III opioids because
of a more favourable side-effect profile, but its efficacy
is not well documented