Chow, E., Meyer, R.M., Ding, K., Nabid, A., Chabot, P., Wong, P., . . . Wong, R.K. (2015). Dexamethasone in the prophylaxis of radiation-induced pain flare after palliative radiotherapy for bone metastases: A double-blind, randomised placebo-controlled, phase 3 trial. Lancet Oncology, 16, 1463–1472.
To compare the efficacy of dexamethasone to placebo for prevention of pain flare after palliative radiotherapy
Patients were randomized to receive either 8 mg dexamethasone or placebo at least one hour before the start of radiotherapy and then daily while receiving radiotherapy. Patients completed study assessments at baseline, day 10, and day 42 after radiation treatment.
Median follow-up ranged from 1-39 months. Ninety-two patients experienced pain flare on days 0–10, 26% in the dexamethasone group and 35% in the placebo group (p = 0.05). The incidence of pain flare was 11.8% lower in the dexamethasone group (p = 0.01). No significant differences were noted between groups in overall pain reduction from radiotherapy or analgesic intake. Three patients on dexamethasone stopped the study medication due to hyperglycemic events. Two of these had preexisting diabetes.
Provision of 8 mg dexamethasone prior to and daily during palliative radiation therapy for bone metastases was effective in the prevention of radiation-associated pain flare compared to placebo.
This study showed that administration of dexamethasone during palliative radiation therapy for bone metastases was effective in preventing bone flare pain. A few patients developed hyperglycemic episodes while on dexamethasone, so nurses need to be aware of this potential, particularly in patients with preexisting diabetes. The purpose of palliative radiation is pain reduction, so it also makes sense to intervene to prevent pain flare that can occur from that treatment. Further research is warranted to compare prophylactic versus treatment of bone flare pain, and potential efficacy of other adjuvant medications.