You may be surprised to learn that corticosteroid drugs belong to a group of medications used for palliative care (an interdisciplinary approach to treat persons with life-limiting illnesses). To boot, the use of them for these purposes is widespread. One Canadian research focused on the ambulatory-based palliative care of cancer patients. The studied showed that almost half of all persons administer corticosteroids. The most commonly used medical remedy was dexamethasone. The identic study was held in the EU countries. During it, specialists in palliative care prescribed corticosteroids in most cases. Doctors find steroids efficient in maintaining normal life during the last period of human life.
Corticosteroids are used for treating some health issues, in particular, spinal cord compression, bowel obstruction, and increased intracranial pressure. More broad indications are also the sign for using corticosteroids. There are many functions where steroidal substances can perform, e.g., they are conducive to pain control (like nonsteroidal anti-inflammatory meds), appetite stimulation, nausea suppressing and fatigue easing. There are a few studies, which prove the efficiency of corticosteroids for these cases. Our article is devoted to the role which steroids play acting as an adjuvant analgesic to control pain. The information you will read is based only on the views of the licensed specialists and empirical materials gathered by Melissa Vyvey, MD MPhil (Can Fam Physician. 2010 Dec).
Steroids for Pain Management
An adjuvant pain drug has to be observed on every side according to the WHO pain ladder to determine the features of meds, aimed at treating the pain of different severity — from light to severe. In some patients, the pain of mixed bony & neuropathic nature may be observed, some patients develop painful sensations of other nature.
Corticosteroids are especially efficient for relieving carcinogenic metastasis pain in the bones, visceral painful sensations, and neuropathic pain. Being contributory agents, corticosteroids act as a pain reducers, they also can be combined with opioid analgesics such as oxycodone (OxyContin, Oxecta, Roxicodone, Shortec, Supeudol), hydrocodone (Vicodin, T-Gesic, Hydrocet), codeine (Glottyl, Codedrill, Codein, Aspalgin with aspirin), morphine (Astramorph PF, Avinza, DepoDur, Duramorph) for achieving action that is more strength. Besides, corticosteroids are good alternatives to opioids, which have powerful symptomatic effects.
How corticosteroids reduce the pain is the following. Glucocorticoids inhibit prostaglandin formation, because of which the inflammation emerges, and decreases vascular permeability, which leads to tissue edema. Being lipophilic molecules glucocorticoids have a possibility to penetrate the blood-brain barrier. According to some studies, the place where steroidal receptors are found is in the peripheral nerves and CNS. Steroids influence nerves’ plasticity, differentiation, and development. There are manuscripts that prove that these meds may diminish discharge in the injured nerve: wherefore, neuropathic painful sensations are reduced under the action of steroids.
Dexamethasone (marketed under such brand names as Dexasone, Daksone, Decmax, Decadronal, Dexona, Aeroseb-Dex, Dexon, Dexam, and Dexpak 10 Day) is a steroid which is prescribed frequently when there is a need to minimize (annihilate) painful sensations. We also recognize prednisone and prednisolone as effective painkillers. The healthful feature of prednisolone is that the possibility of side events in the form of myopathy is piddling. Dexamethasone causes inconspicuous water retention thanks to its weak mineralocorticoid effect, unlike other corticosteroid meds. The efficiency of these steroids is also proven by its long half-life period. Hence, they can be used once a day. There is not a certain dose of dexamethasone. It can vary from 2 to 8 milligrams. The forms of applying are oral and subcutaneous. The maximum frequency of administration is thrice daily.
Side Effects of Corticosteroids when Treating Pain
There is a diverse range of adverse events when using steroids for pain. For preventing the serious unsought effects from occurring dose starts out low. As clinic experimenters say, side effects appear because of the durable administration of the medical remedy. So, they recommend not using corticosteroids for a protracted period (from 1 to 3 weeks). As a part of palliative care, they prescribe steroids for rather durable use, especially when there are dismal projections and side effects of steroids are not likely to materialize until the patient dies. Prolonged use of corticosteroids should be under severe control. Unfortunately, there are a lot of reviews about bad controlled corticosteroid therapy during palliative care.
Corticosteroids use can be stopped with the help of special medications. If there is a risk of gastric bleeding, then gastro-protection is usually prescribed together with steroids. A patient is more likely to get bleeding in the stomach when taking nonsteroidal drugs for inflammation.
A licensed specialist should heedfully inspect any drug combination. The approach towards combining steroids with other meds should be careful.
Discontinuing Use of Corticosteroids
The two therapy is an adequate period for administering steroids without facing side effects. At the same time on some occasions, corticosteroids in even small doses can lead to problems with the HPA axis, which will appear later. A taper is needed in case of prolonged therapy. The period of taper (gradual dose reduction) is determined and defined under therapy duration. Ms. Vyvey noted that steroid withdrawal can exacerbate terminal restlessness in palliatively cared patients.