It is better to prevent the problem of pain flare than to play catch up with pain medications down the road.
—Brian D. Kavanagh, MD, MPH, FASTRO
You don’t need high-tech interventions to prove value. Sometimes we can use a medication that has been around a long time,” declared press conference moderator Brian D. Kavanagh, MD, MPH, FASTRO, of the University of Colorado, Anschutz Medical Campus, Denver.
“It is better to prevent the problem of pain flare than to play catch up with pain medications down the road. This study showed that a few doses of an inexpensive, oral, well-tolerated medication can reduce the incidence of pain flare as well as severity and should change the standard of care,” he continued.
Zain A. Husain, MD, Assistant Professor of Therapeutic Radiology at Yale University School of Medicine, New Haven, Connecticut, also commented on this paper. “Dexamethasone is a relatively easy to use, well-tolerated, inexpensive drug to give. About one-third of patients have significant pain flare, and there is something you can do about it,” he said.
At Yale, pain premedication is reserved for patients undergoing stereotactic body radiation therapy, who have a high rate of pain flare. Dr. Husain and his colleagues have started using dexamethasone in this setting in a similar regimen as that used by Dr. Fairchild’s group. “We haven’t prophylaxed patients receiving conventional dose radiotherapy yet,” he said.
Dr. Husain pointed out that the percentage of patients who experience pain flare is still a minority. “It would be good to identify factors associated with risk of pain flare. The study includes about 300 patients, so hopefully the investigators will analyze the data to identify those who have pain flare vs those who do not,” he commented. ■
Disclosure: Drs. Kavanagh and Husain reported no potential conflicts of interest.
Bone is a common site of metastasis for prostate, breast, and lung cancers, and palliative radiotherapy is often used to treat these metastases. Although it is an effective therapy, severe pain flare following radiation occurs in about one-third of patients. It usually resolves within 10 days, but...