Monotherapy vs. combination paracetamol and tramadol for cancer-related pain in the emergency department: a comparative study.

OBJECTIVE

The effective management of pain in patients diagnosed with gastrointestinal (GI) and genitourinary (GU) cancer remains a clinical challenge, particularly in acute care settings. The objective of this study was to evaluate and compare the analgesic efficacy and safety profiles of intravenous paracetamol, tramadol, and their combination in patients presenting with malignancy-associated acute pain.

METHODS

In this prospective, single-blind, randomized controlled trial, 108 adult patients with GI or GU malignancy-related pain (NRS ≥ 4) were randomly assigned to receive paracetamol (1 g), tramadol (100 mg), or their combination. The severity of pain was measured using the Numerical Rating Scale (NRS) at 0, 30, 60, and 120 min after treatment. The primary outcome of the study was a change in pain scores; secondary outcomes included the requirement for rescue analgesia and adverse events.

RESULTS

While all groups demonstrated a reduction in pain over time, the combination therapy group achieved significantly greater reductions in both absolute and percentage pain scores at 60 and 120 min (p < 0.001), and required less rescue analgesia (2.8% vs. 19.4-25.0%). No significant increase in adverse effects (hypotension, desaturation, nausea) was observed in the combination group.

CONCLUSION

The co-administration of paracetamol and tramadol intravenously resulted in superior and sustained analgesia when compared with monotherapy, without an increase in adverse effects. These findings provide support for the utilization of this combination as a safe and effective multimodal strategy in the acute management of cancer-related pain in the emergency department.