Intrathecal betamethasone pain relief in cancer patients with vertebral metastasis: a pilot study

• Published in: Acta anaesthesiologica Scandinavica Vol. 51; no. 4; pp. 490 - 494
• Main Authors: Inada, T., Kushida, A., Sakamoto, S., Taguchi, H., Shingu, K.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.04.2007; Blackwell
• Subjects: Aged; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Inflammatory Agents - administration & dosage; Anti-Inflammatory Agents - cerebrospinal fluid; Anti-Inflammatory Agents - therapeutic use; Betamethasone - administration & dosage; Betamethasone - cerebrospinal fluid; Betamethasone - therapeutic use; Biological and medical sciences; Biomarkers - cerebrospinal fluid; cancer; cerebrospinal fluid; Dinoprostone - cerebrospinal fluid; Enzyme-Linked Immunosorbent Assay - methods; Female; Humans; Injections, Spinal; interleukin-8; Interleukins - cerebrospinal fluid; intrathecal betamethasone; Luminescent Measurements - methods; Male; Medical sciences; Middle Aged; pain; Pain Measurement - methods; Pain, Intractable - drug therapy; Pain, Intractable - etiology; Pilot Projects; prostaglandin E2; Spinal Neoplasms - cerebrospinal fluid; Spinal Neoplasms - secondary; Treatment Outcome; Tumor Necrosis Factor-alpha - cerebrospinal fluid; Human; Corticosteroid; intrathecal betamethasone; Antiinflammatory agent; Prostaglandin E2; Cerebrospinal fluid; Metastasis; Malignant tumor; interleukin-8; Pain; Anesthesia; Fluorine Organic compounds; Betamethasone; Interleukin 8; Cancer
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/j.1399-6576.2007.01272.x

Background:  We have reported previously the usefulness of intrathecal betamethasone for pain relief in cancer patients who suffer from intractable pain caused by vertebral metastasis. The mechanism by which betamethasone relieves pain may be related to alterations in cerebrospinal fluid (CSF) concentrations of pro‐inflammatory cytokines and prostanoids. Methods:  Thirteen cancer patients with intractable pain caused by vertebral metastasis received 2–3 mg betamethasone in the lumbar subarachnoid space. CSF concentrations of tumor necrosis factor‐α (TNF‐α), interleukin‐1β (IL‐1β), IL‐6, IL‐8 and prostaglandin E2 (PGE2) were measured with an enzyme‐linked immunosorbent assay (ELISA) and a chemiluminescence enzyme immunoassay. Pain was measured using a numerical pain score (range, 0–10; 0, no pain; 10, worst pain imaginable). Results:  Intrathecal betamethasone was associated with a significant decrease in the pain score in six patients. In these cases, the pain score decreased from 6.7 ± 0.5 (mean ± standard error of the mean) to 3.3 ± 0.3 (P < 0.05), and the CSF concentrations of IL‐8 and PGE2 decreased significantly compared with pre‐treatment levels (IL‐8, 183.3 ± 21.2 to 116.5 ± 10.6 pg/ml; PGE2, 43.8 ± 10.3 to 14.7 ± 3.0 pg/ml). There were no significant changes in the CSF concentrations of cytokines and PGE2 in the remaining seven patients. Conclusion:  Pain relief with intrathecal betamethasone is related to decreases in the CSF concentration of IL‐8 and PGE2.