Haywood, A., Good, P., Khan, S., Leupp, A., Jenkins-Marsh, S., Rickett, K., & Hardy, J.R. (2015). Corticosteroids for the management of cancer-related pain in adults. Cochrane Database of Systematic Reviews, 4, CD010756.
Studies included were of steroids used as a treatment with pain assessed as an outcome. Dexamethasone was used in eight studies. Nine of the studies were designed with pain as an outcome. Six were placebo-controlled studies, one was a crossover study with a placebo, five had active controls, one was an open-label study, and two were low- versus high-dose studies. There did not appear to be a statistic benefit to the use of corticosteroids for all patients with cancer-related pain. Studies compared corticosteroids to standard therapy. A meta-analysis was done of six studies, and the others were not included because of missing data. There was insufficient data to do a subgroup analysis. A data point of one week was used as a standardization point for the interventions of the six studies in the meta-analysis. The meta-analysis showed an overall mean difference of –0.84 (p = 0.002) in favor of corticosteroids. There was insufficient evidence to evaluate side effects.
Evidence appeared to be weak in regard to the efficacy of corticosteroids for pain relief in patients with cancer. Although the meta-analysis suggested some benefit, the confidence interval was wide, and the quality of the studies included was low.
There was limited evidence to support the use of corticosteroids for chronic pain. If used, their benefit should be evaluated frequently and discontinued if none is found. Corticosteroids have numerous side effects, and the benefits versus harms must be weighed before their use in patients with cancer-related pain.