Sublingual piroxicam for cancer pain

Pain is the most feared complication of cancer. In our previous studies we have showed that non steroid anti-inflammatory drugs (NSAIDs) can be effectively used for the treatment of cancer pain and sublingual form of piroxicam has recently been available. So we started another study to investigate the efficacy of piroxicam in sublingual form in the treatment of cancer pain. A total of 21 patients were enrolled. Pain is assessed with a 10-point visual analogue scale (VAS). After administration of a single dose of 20 mg piroxicam sublingually the patients were asked to show the severity of pain on the VAS scale 15, 30, 60, 120, 180 and 360 minutes later. The mean initial VAS score was 7.61 +/- 2.133. The analgesic effect of piroxicam started as early as 15 min and peaked at 30 min. The mean VAS scores at 15, 30, 60, 120, 180 and 360 min were 6.28 +/- 2.75, 5.33 +/- 3.526, 5.42 +/- 3.74, 5.71 +/- 3.73, 5.76 +/- 3.87 and 6.04 +/- 3.82 respectively. Although the mean VAS scores were statistically lower this was not clinically significant. Complete relief was achieved only in three patients and partial relief was detected in four (14.2% and 19% respectively). Cancer pain can be relieved in 80-90% of cases with proper treatment. Although all patients tolerated the drug very well without any significant side effects, we achieved only 33% relief with piroxicam. This figure is far from satisfactory and not acceptable for the treatment of cancer pain at this dosage and schedule.