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Steroid added to pain drugs relieves fatigue, appetite loss and quality of life, but not pain


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Jim Marshall (not a doctor) said ...

Unfortunately pain is often a part of advanced prostate cancer.


Treatment with morphine and related drugs is often effective. But fatigue and appetite loss and a lower satisfaction with life often accompany this time.


The small study below looked at whether steroids added to the mix would improve pain control. Unfortunately, there was no pain improvement. 


But patients reported less fatigue, better appetite, and a higher quality of life.


So, if fatigue, appetite, or satisfaction with your lot are a problem at this time, your doctor may consider adding a steroid to see if this helps. The steroid used in the study was methylprednisolone.

... end Jim


J Clin Oncol. 2014 Jul 7. pii: JCO.2013.54.3926. [Epub ahead of print]

Efficacy of Methylprednisolone on Pain, Fatigue, and Appetite Loss in Patients With Advanced Cancer Using Opioids: A Randomized, Placebo-Controlled, Double-Blind Trial.

Paulsen O1, Klepstad P2, Rosland JH2, Aass N2, Albert E2, Fayers P2, Kaasa S2.

Author information





Corticosteroids are frequently used in cancer pain management despite limited evidence. This study compares the analgesic efficacy of corticosteroid therapy with placebo.


Adult patients with cancer receiving opioids with average pain intensity ≥ 4 (numeric rating scale [NRS], 0 to 10) in the last 24 hours were eligible. Patients were randomly assigned to methylprednisolone (MP) 16 mg twice daily or placebo (PL) for 7 days. Primary outcome was average pain intensity measured at day 7 (NRS, 0 to 10); secondary outcomes were analgesic consumption (oral morphine equivalents), fatigue and appetite loss (European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire C30, 0 to 100), and patient satisfaction (NRS, 0 to 10).


A total of 592 patients were screened; 50 were randomly assigned, and 47 were analyzed. Baseline opioid level was 269.9 mg in the MP arm and 160.4 mg in the PL arm. At day-7 evaluation, there was no difference between the groups in pain intensity (MP, 3.60 v PL, 3.68; P = .88) or relative analgesic consumption (MP, 1.19 v PL, 1.20; P = .95). Clinically and statistically significant improvements were found in fatigue (-17 v 3 points; P .003), appetite loss (-24 v 2 points; P = .003), and patient satisfaction (5.4 v 2.0 points; P = .001) in favor of the MP compared with the PL group, respectively. There were no differences in adverse effects between the groups.


MP 32 mg daily did not provide additional analgesia in patients with cancer receiving opioids, but it improved fatigue, appetite loss, and patient satisfaction. Clinical benefit beyond a short-term effect must be examined in a future study.

©American Society of Clinical Oncology.

PMID: 25002731


This extract can be found on http://PubMed.com, and is in the public domain.

On PubMed.com there will be a link to the full paper (often $30, sometimes free).


Any highlighting (except the title) is not by the author, but by Jim Marshall.

Jim is not a doctor.

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