Effectiveness of Systemic Corticosteroids in Managing Cancer-Related Neuropathic Pain: A Multicenter Prospective Observational Study

Abstract

Background: Cancer-related neuropathic pain (CR-NP) is challenging to manage, and the effectiveness of corticosteroids remains underexplored.

Objectives: This study investigated the analgesic and functional benefits of corticosteroids in CR-NP.

Methods: This multicenter, prospective observational study enrolled patients with CR-NP who initiated or escalated corticosteroid therapy. Pain intensity and daily activities were assessed at baseline (T0), 72 (T1), and 168 h (T2). A paired-sample t-test compared pain intensity changes. Linear regression analysis examined the association between changes in opioid daily dose and pain intensity, while Pearson's correlation coefficient assessed the relationship between changes in daily activities and pain intensity.

Results: In total, 107 patients were consecutively enrolled. The mean worst pain intensity decreased from 8.2 ± 1.9 at T0 to 5.2 ± 2.9 at T1 and further to 4.4 ± 3.0 at T2. No significant correlation was found between changes in opioid daily dose and pain intensity. However, daily activities improved significantly in correlation with pain reduction (r = -0.36, p < 0.01). Over 75% of patients reported satisfaction with CR-NP management. Adverse events occurred in 21 cases and were generally mild.

Conclusions: Corticosteroids provided rapid and considerable analgesic and functional benefits for patients with CR-NP in this observational setting; further validation through comparative controlled studies is required.

Keywords: brain; cancer; cancer pain; corticosteroids; inflammation; neuropathic pain; neuropathy; palliative care; primary sensory neurons; spinal cord.

Figure 1

Flow chart of study population. ^a Within 24 h after enrollment and before starting or increasing corticosteroid treatment. ^b The 108 patients with cancer screened who started or increased the dose of corticosteroids for pain relief caused by central or peripheral neuropathic pain associated with oncologic etiologies. ^c Diagnosed at enrollment by a physician. ^d Including primary and metastatic tumors, as well as tumor-induced nerve invasion and compression. ^e During the observation period, 16 cases of corticosteroid treatment discontinuation were noted for the following reasons, excluding cases missing data: 5 cases due to completion of follow-up (discharge to home, transfer, or death), 4 cases due to lack of effectiveness for pain, 3 cases due to complete symptom relief, 2 cases due to adverse events, and 2 cases due to other reasons. ^f The primary endpoint was the change in the worst and average background pain intensity scores from T0 to T1 and T2. ^g 72 h post-enrollment and assessed within 24 h. ^h 168 h post-enrollment and assessed within 24 h.

Figure 2

Changes in pain intensity by oncologic etiologies of neuropathic pain. (a) Change in worst pain intensity on the NRS ^a by the pathophysiological mechanism of CR-NP ^b; (b) Change in average pain intensity on the NRS ^a by the pathophysiological mechanism of CR-NP ^b. All data are presented as the mean ± standard deviation (paired t-tests, *, 0.01 ≤ p < 0.05; **, p < 0.01; n.s. (not significant), p > 0.05.). ^a NRS, numerical rating scale ranging from 0 to 10. ^b CR-NP, cancer-related neuropathic pain. ^c Including primary and metastatic tumors, infiltration, and compression. Vertical axis: Pain intensity score on the NRS. Horizontal axis: Time from enrollment and initiation or dose increase of corticosteroid to T1 (72 h post-enrollment) and T2 (168 h post-enrollment).