Oral Prednisolone Effect on Cancer WHO Stepladder Analgesia Protocol

Introduction; World Health Organization (WHO) analgesic ladder; Step I recommends non-opioid analgesics for mild pain. Step II specifies the use of weak opioids for moderate pain. Step III comprises the use of strong opioids for severe pain. Cancer pain management using opioids administered alone or in combination with adjuvant analgesics. Corticosteroids adjuvant use for neuropathic and bone pain treatment. However, despite widespread use of corticosteroids, scientific evidence about its efficacy in cancer pain management is limited. This protocol aims to clarify pors and cons of interrupted steroid dosing in chronic cancer pain WHO stepladder analgesia protocol. Methods; Prospective quizi-pre-post experimental study will be conducted after IRB approval in the Mansoura oncology canter pain clinic-Faculty of medicine Mansoura University Egypt. Verbal informed consent will be obtained from the respondents (patients) for the interview. Furthermore, the data collected from each patient will be kept confidential and used strictly only for the purpose of the study. Patients will be allocated as single group and will take oral prednisolone (sulopride10 mg) single dose every two days for 4 successive weeks then the next two weeks as washout period (stop dosing gradually by taking 5 mgs for 3 successive dosing every 2nd day over a week, then stop the oral steroid drug totally over the 2nd week of the washout period. The second period of the study will start by taking the oral prednisolone (sulopride10 mg) every fourth day for the next 4 weeks after which the patient will get another washout two weeks period (stop dosing gradually 5 mgs for 3 successive dosing every 4th day then stop the drug totally).A questionnaire-based interview using Brief Pain Inventory-Short Form (BPI-sf) (16) based on VAS pain score as a rough tool for pain intensity Data collection: Primary Outcome: global Pain intensity, assessed by a visual analogue scale (VAS) 0-10. Secondary outcomes based on the Brief Pain Inventory short form (BPI-sf).

Sex

All

Minimum age

18 Years

Maximum age

75 Years

Inclusion Criteria: Patients will be considered eligible if they fulfill the following criteria: age≥ 18 years old; diagnosed with any type of cancer: on regular visits every 14 days to the Mansoura oncology center pain clinic.

Exclusion Criteria:

patients with severe other medical disease (organ failure-uncontrolled DM-uncontrolled Hypertension) or psychiatric problems and unable or unwilling to provide the required information will be excluded from the study, patients on chemotherapy or radiotherapy during the study period.