Corticosteroids are recommended as an adjuvant analgesic for cancer-related bone pain. The mechanism of action is likely related to decreasing tumor-related edema or inhibition of prostaglandin and leukotriene synthesis.
Dexamethasone is commonly used due to its lower mineralocorticoid effect and long half-life, which allows once-daily dosing.
Reported starting dosages include dexamethasone 4-8 mg PO daily, methylprednisolone 16-32 mg PO 2-3 times per day or prednisone 20-30 mg PO 2-3 times per day.
If no benefit is seen within 5-7 days the drug should be discontinued. If beneficial, the drug should be tapered to the lowest effective dose or, if possible, discontinued to avoid long-term adverse effects.
Side effects account for discontinuation of steroids in 5% of patients.
- Acute side effects include thrush (30%), edema (20%), dyspepsia and peptic ulcer diseases, psychiatric symptoms (insomnia, delirium and anxiety), and glucose intolerance.
- Delayed side effects from long term use include adrenal suppression, moon facies/fat redistribution, increased susceptibility to infection, osteoporosis, skin fragility and impaired wound healing.
See reference for more information.
Adapted from Weinstein E, Arnold R. Steroids in bone pain. Palliative Care Network of Wisconsin. Fast facts and concepts #129. Internet. Accessed on January 8, 2019.