Corticosteroids for pain relief

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Corticosteroids are often used as an adjunct to analgesics to treat pain, including cancer and non-cancer pain. Corticosteroids reduce inflammation and they are therefore useful in treating pain where inflammation or oedema is causing symptoms. They may be given orally, intravenously or via injections into joints.

What are corticosteroids?

Corticosteroids are synthetic versions of naturally occurring adrenocortical steroids, which are produced by the adrenal glands (which sit above the kidneys). They have both anti-inflammatory (glucocorticoid) and salt-retaining (mineralocorticoid) properties.

When are corticosteroids used to treat pain?

Corticosteroids can be used to treat pain that results from inflammation or oedema, which may be cancer related or non-cancer related. Non-cancer forms of pain that may be treated with corticosteroids include some forms of arthritis including rheumatoid arthritis, ankylosing spondylitis, osteoarthritis and many others. Treatment may be in the form of tablets or injections directly into joints or soft tissues. For cancer related pain it is often given intravenously (via a drip).

What are the side effects from corticosteroids?

Side effects from long term corticosteroid use are numerous and include:

Metabolic effects including Diabetes
Hypertriglyceridaemia
Osteoporosis
Psychological disturbance
Skin atrophy
Hypothalamic-pituitary-adrenal axis suppression
Increased risk of infections
Immunosuppression
Ocular effects
Growth retardation
Myopathy
Gastrointestinal side effects including dyspepsia, peptic ulceration and gastrointestinal bleeding

In general, a short course of higher dose corticosteroids has less side effects than prolonged treatment with lower dose corticosteroids. Corticosteroids given by injections into a joint or soft tissue is less likely to cause the above side effects, however the injection may have some risks including bleeding, infection and damage to the tissues surrounding the site of injection. For more information about corticosteroids talk to your doctor.

Reference

Bajwa, Z. Warfield, C. Pharmacologic therapy of cancer pain. UpToDate. 2006.
eTG complete [Internet]. Melbourne: Therapeutic Guidelines Limited; 2006 Jan. Accessed 2006 April 4.
Kumar, P. Clark, M. Clinical Medicine. 5th ed. 2002. W. B. Saunders. Edinburgh