You may be surprised but corticosteroid drugs belong to the group of medications for keeping 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 concerning ambulatory based palliative care about patients, who suffer from cancer, shows that almost a 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 the normal life during the last period of human life.
Corticosteroids are used for treating some health issues as well, in particular spinal cord compression, bowel obstruction & increased intracranial pressure. More broad indications are also the sign for using corticosteroids. There are many functions steroidal substances can perform, e.g., they are conducive to pain controlling (like nonsteroidal anti-inflammatory meds), appetite stimulation, nausea suppressing and fatigue alleviating. Nevertheless, there is a small quantity of studies, which prove the efficiency of corticosteroids for using in these cases. Our article is devoted to the role which steroids play acting as 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
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 pain of different severity — from light to severe. In some patients, pain of mixed bony & neuropathic nature may be observed, some patients develop painful sensations of other nature.
Corticosteroids are especially efficient for alleviation of metastasis pain in 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 strengthy. Besides, corticosteroids are good alternatives to opioids, which have powerful symptomatic effects in addition to reducing pain.
The way in which corticosteroids reduce the pain is the following. Glucocorticoids inhibit prostaglandin formation, due to which the inflammation emerges, and decrease vascular permeability, which in turn leads to tissue edema. Being lipophilic molecules glucocorticoids have a possibility to penetrate into blood-brain barrier. According to some studies, the place where steroidal receptors are found are 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 act 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 almost in all occasions when there is a need to minimize (annihilate) painful sensations. Additionally, prednisone & prednisolone are also recognized as effective painkillers. The healthful feature of prednisolone is that the possibility of side events in form of myopathy is piddling. Dexamethasone, in turn, 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 certain dose of dexamethasone. It can vary from 2 to 8 milligrams. The forms of applying are oral and subcutaneous. The maximal possible frequency of administration is thrice daily.
Side Effects of Corticosteroids when Treating Pain
There is diverse range of adverse events, which steroids for pain can cause. For preventing serious unsought effects from occurring dose lowering is practiced. As clinic experimenters say, side effects appear as a result of durable administration of the medical remedy. So, it is recommended to use corticosteroids for not protracted period (from 1 to 3 weeks). As a part of palliative care, steroids are prescribed for rather durable using, especially when there are dismal projections and side effects of steroids are not likely to materialize until the patient die. Nevertheless, prolonged use of corticosteroids should be under severe control. Unfortunately, there are a lot of reviews about bad controlled corticosteroid therapy during the palliative care.
If undesirable effects aren’t severe of there is a need to continue durable administering of corticosteroids, they can be removed with the help of special medications. If there is a risk that gastric bleed can occur, agents for gastroprotection are usually prescribed together with steroids.
A patient is more likely to get bleeding in stomach when taking nonsteroidal drug against inflammation and steroids. The licensed specialist should heedfully inspect any combination. The approach towards combining steroids with other meds should be careful.
Discontinuing Use of Corticosteroids
The 2-week therapy is adequate period of administering steroids without facing side effects. At the same time in some occasions, corticosteroids in even small doses can lead to problems with HPA axis, which will appear in some time. A taper is needed in case of prolonged therapy. The period of taper (gradual dose reduction) is not still determined and is defined in accordance with therapy duration. Ms. Vyvey noted that steroid withdrawal can exacerbate terminal restlessness in palliatively cared patients.