Paulsen, O., Aass, N., Kaasa, S., & Dale, O. (2013). Do corticosteroids provide analgesic effects in cancer patients? A systematic literature review. Journal of Pain and Symptom Management, 46, 96–105.

STUDY PURPOSE: To assess the evidence for use of corticosteroids as adjuvant analgesics in patients with cancer pain

TYPE OF STUDY: Systematic review

DATABASES USED: PubMed, EMBASE, Cochrane Collaboration, Cochrane Central Register of Controlled Trials

KEYWORDS: Specific search terms for PubMed are provided.

INCLUSION CRITERIA: RCT; adult patients with cancer; compared corticosteroids when added to standard pain treatment; assessed outcomes in pain, analgesic use, and adverse events

EXCLUSION CRITERIA: Non-English language

TOTAL REFERENCES RETRIEVED = 514

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Grading of Recommendations Assessment, Development and Evaluation; overall study quality in terms of risk of bias was low.

• FINAL NUMBER STUDIES INCLUDED = Four included, but only one study met all inclusion criteria
• SAMPLE RANGE ACROSS STUDIES = 40–403
• TOTAL PATIENTS INCLUDED IN REVIEW = 667
• KEY SAMPLE CHARACTERISTICS: Primary cancers were gastrointestinal, breast, lung, and genitourinary. All patients were receiving palliative intervention.

• PHASE OF CARE: End-of-life care
• APPLICATIONS: Palliative care

Of the four studies included, one showed lower pain severity and analgesic consumption with steroid, two had unclear results because of lack of findings reported, and one showed no benefit.

The evidence regarding efficacy of adjuvant corticosteroids for pain management in patients with cancer is insufficient to draw firm conclusions. No current evidence is strong enough to show efficacy, and information is limited about adverse events with any long-term use.

• Very few studies
• Most studies had low quality.
• 50% of studies did not provide reporting of any adverse events.
• Studies were short-term.
• Despite limitations, authors suggest at least a weak recommendation for the use of corticosteroids.

Evidence is insufficient to demonstrate benefit from the addition of corticosteroids to usual pain management in patients with cancer, and evidence is very limited regarding adverse effects in this setting. Studies only have been reported with short-term use, so long-term adverse effects are not clearly known.