Half life echoes 29/10/2023 ![]() Glucocorticoids reduce pain by inhibiting prostaglandin synthesis, which leads to inflammation, and reducing vascular permeability that results in tissue edema. 12 As adjuvant agents, corticosteroids can directly reduce pain, reduce pain in concert with opioid use, allow for reduction of opioid dose, and have beneficial symptomatic effects outside of pain relief. 11 Steroids are particularly useful as adjuvant therapy for metastatic bone pain, neuropathic pain, and visceral pain. ![]() shows evidence of mixed bony and neuropathic pain. ![]() 2, 8, 9 This article will address the role of steroids in controlling pain as an adjuvant analgesic, a practice that is based primarily on expert opinion and empirical evidence.Īn adjuvant pain medication should be considered at all stages of the World Health Organization’s pain ladder for mild to severe pain. However, there is little objective evidence in the literature for this broader use of corticosteroids. 7 Corticosteroids are also commonly used for broader indications, such as to control pain, stimulate appetite, suppress nausea, and alleviate fatigue. There is evidence for the use of corticosteroids for specific indications, such as spinal cord compression, 5 raised intracranial pressure, 6 and bowel obstruction. 1 This study echoes European studies in which corticosteroids were among the drugs most commonly prescribed by hospital-based palliative care services. A Canadian study of ambulatory palliative care patients with cancer demonstrated that 40% of patients were receiving corticosteroids, and dexamethasone was the medication most commonly added by palliative care specialists. Steroids are among the most commonly used medications in palliative care. You consider adding a corticosteroid as an adjuvant analgesic to Mr C.’s hydromorphone regimen. The pain is moderate in severity and described as aching and constant in his neck, with intermittent, sharp, shooting pain through his left upper back and shoulder. Despite escalating doses, he presents to your office with increasing pain. developed bony pain from his cervical spine disease and was started on hydromorphone. Since then, his symptoms have been well controlled with intermittent chemotherapy despite his known liver and multiple spinal metastases. Ten years ago he was diagnosed with a pancreatic carcinoid tumour and underwent a Whipple procedure. is a married, 80-year-old man with a straight posture and a sharp wit. ![]()
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