Do corticosteroids provide analgesic effects in cancer patients? A systematic literature review

Abstract

Context: Corticosteroids are frequently used in cancer patients for their analgesic properties. The evidence for analgesic effects of corticosteroids in palliative care has not been established.

Objectives: To assess the evidence for the use of corticosteroids in cancer pain management.

Methods: A systematic literature search was performed. The articles were evaluated according to the Grading of Recommendations Assessment, Development and Evaluations system by two independent reviewers.

Results: The search provided 514 references, four of which were included. Another two trials were identified from reference lists. Two of these six studies were excluded from the qualitative review. One crossover study showed a significant reduction in pain intensity of 13 (visual analogue 0-100 scale) accompanied by significant lower analgesic consumption in favor of the steroid group. In another study, the addition of steroids did not have any effect on pain. In two studies, outcomes of pain intensity or analgesic consumption were not adequately reported. However, one of these studies showed significant pain reduction, whereas the other found no effect. Corticosteroids given in medium doses were well tolerated in studies for up to seven days. However, the studies indicated that corticosteroids may have serious toxicity and even higher mortality when administered in high doses over eight weeks.

Conclusion: Corticosteroids may have a moderate analgesic effect in cancer patients. The paucity of relevant studies was striking; consequently, the evidence was graded as "very low." More studies addressing the analgesic efficacy in cancer patients are required.

Keywords: Corticosteroids; cancer; pain; palliative care.