Intrathecal betamethasone for cancer pain: A study of its analgesic efficacy and safety

Abstract

Background A preliminary study has shown effective cancer pain relief by intrathecal betamethasone (ITB). However, further evidence is needed to support this new approach. Methods Cancer patients with opioid‐resistant pain received lumbar intrathecal administration of betamethasone 2 or 3 mg once a week for 28 days. Immediate and short‐term analgesia (using a percentage pain reduction scale and a numerical rating scale, NRS) and long‐term analgesia (using NRS) were assessed. Patients were classified into two groups according to the most painful site of metastasis: vertebral column and/or surrounding nerve plexus metastases (group A) and other metastases distal from the vertebral column (group B). Results A total of 104 patients received ITB. Pain relief was observed not only in the lower half but also in the upper half of the body. The proportion of group A patients who experienced immediate analgesia was 81% (47/58), which was significantly greater than that of group B (P < 0.001). A decrease in NRS scores 1 day after ITB administration was observed in significantly more patients in group A than in group B (P < 0.001). Long‐term analgesia was also recorded in a greater proportion of patients in group A than in group B in the 7‐day (59%, 38/64 vs 6%, 2/33) and 28‐day periods (71%, 40/56 vs 31%, 8/26) (P < 0.001). No adverse effects related to neurotoxicity were recorded. Conclusion Intrathecal injection of betamethasone produced analgesia for opioid‐resistant cancer pain, and may be a potent therapeutic option for intolerable pain from vertebral column and/or surrounding nerve plexus metastases.

Intrathecal therapy for pain in cancer patients

“…In a recent article [12], a monocentric retrospective study involving 104 patients showed a significant improvement in pain by injecting intrathecally 2-3 mg of betamethasone once a week for 1 month in cancer patients with opioid-refractory pain. This improvement was present and significant only in patients with secondary spinal lesions.…”

Comparison between Two Different Doses of Intrathecal Dexamethasone Added to Bupivacaine for Post-operative Analgesia in Patients Undergoing Abdominal Hysterectomy

“…Additionally, group D4 had a considerably longer duration to the first rescue analgesic dose (min) than the other two groups. Taguchi et al (12) revealed that three patients with unremitting cancer pain had their pain score successfully reduced by intrathecal injection of betamethasone. According to a different study, laparoscopic cholecystectomy with dexamethasone (4 mg) lowers post-operative pain scores and morphine usage (13) .…”