Dosing of Dexamethasone in Chronic Cancer Pain

Submit Manuscript | http://medcraveonline.com Corticosteroids are a versatile group of drugs widely being used in cancer for a range of indications. They are used in conditions with proven evidence of their role like metastatic spinal cord compression [3], superior vena caval syndrome, raised intracranial pressure, bowel obstruction as well in those conditions lacking definitive role of steroids like chronic cancer pain, nausea, fatigue, and anorexia. They are also used to prevent immediate pain flare up following radiotherapy in vertebral metastases [4]. In relation to chronic cancer pain, it is being used in bony pain, visceral pain due to obstruction of hollow viscus, organ capsule distension, neuropathic pain due to infiltration or compression of neural structures and metastatic spinal cord compression. The possible role of steroids in every step of nociception: transduction, transmission, modulation and pain perception has been raised though the exact mechanism of action remains unclear. The mechanisms suggested include-inhibition of collagenase expression (key enzyme involved in tissue destruction during inflammation), reduction of pro-inflammatory cytokines and stimulation of lipotropin synthesis (inhibition of eicosanoid production). Hence steroids are most effective in inflammatory pain. They also inhibit spontaneous discharges from injured nerve and modulate neuroimmune interactions thereby decreasing neuropathic pain.