June Pearl #2: Steroids for refractory pain in cancer patients

A patient with lung cancer with multiple areas of metastasis presented to our EM-2 bay with significant boney pain. Their pain continued to be severe despite multiple high doses of opioid pain medications. Dr. Joan Noelker offered the pearl that steroids can be used for refractory pain in cancer patients.

Reviews on the use of steroids in cancer patients can be found here:

The Role of Corticosteroids in the Treatment of Pain in Cancer Patients

A little Help from steroids in oncology

The summary of these articles is that the data set is small in terms of RCTs, but prospective and retrospective studies indicate patients find relief in the short term.

In general dexamethasone seems to be favored for its anti-inflammatory effects and decreased mineralocorticoid action.

Summary, post, and review by: John E. Schneider MD PGY4

Table 2: adapted from: Stewart PM. The adrenal cortex. In: Larsen PR, Kronenberg HM, Melmed S, Polonsky KS, editors. Williams Textbook of endocrinology. Philadelphia: Saunders; 2002. pp. 491–507. [Google Scholar]

Table 4: adapted from: Exton L, Walsh D, Caraceni AT, Fainsinger R, Foley K, Glare P, et al. Palliative medicine. Philadelphia: Elsevier; 2009. Corticosteroids; pp. 797–801. [Google Scholar]