{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:48:30Z","timestamp":1787017710792,"version":"build-2736575974"},"reference-count":26,"publisher":"Wiley","license":[{"start":{"date-parts":[[2022,11,28]],"date-time":"2022-11-28T00:00:00Z","timestamp":1669593600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pain Research and Management"],"published-print":{"date-parts":[[2022,11,28]]},"abstract":"<jats:p>\n                    Objective. Dexamethasone could be an effective prophylactic agent for the prevention of pain flares after palliative radiotherapy (RT) for uncomplicated bone metastases. To date, there are no data on its prophylactic coanalgesic (opioid-sparing) effect after RT in patients with complicated bone metastases compared to uncomplicated ones, which is the aim of our study. Methods. Twenty-nine American Society of Anaesthesiologists (ASA) III-IV patients, aged \u226518, treated with single-fraction 8\u2009Gy\/1 or multi-fraction 20\u2009Gy\/5\u2009RT for painful uncomplicated bone metastases (steroid na\u00efve patients, n\u2009=\u200914) or complicated ones (steroid non-na\u00efve patients, n\u2009=\u200915), were examined retrospectively. All patients received parenteral dexamethasone (4\u2009mg or 8\u2009mg daily, 1 hour before RT, followed by the same dose for the next 4 days) along with their background and breakthrough pain opioid intake (morphine equivalents) during their 5-day in-hospital stay. Pain severity (numeric rating scale) and analgesic consumption were recorded at admission, daily during the hospital stay, and for 10 days following treatment. Binary logistic regression was used to determine predictive factors for pain flare occurrence. Results. A higher ASA score is the only determinant positively influencing opioid consumption (\n                    <jats:inline-formula>\n                      <a:math xmlns:a=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\">\n                        <a:mi>P<\/a:mi>\n                      <\/a:math>\n                    <\/jats:inline-formula>\n                    \u2009=\u20090.018) and pain flare as well (OR\u2009=\u200915.00; 95% CI: 2, 24\u2013100, 48;\n                    <jats:inline-formula>\n                      <c:math xmlns:c=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\">\n                        <c:mi>P<\/c:mi>\n                      <\/c:math>\n                    <\/jats:inline-formula>\n                    \u2009=\u20090.005). Lower dose 4\u2009mg dexamethasone was revealed as a moderate analgesic agent in steroid na\u00efve patients with no side effects, whereas in steroid non-na\u00efve patients the predominantly higher dose 8\u2009mg dexamethasone had minimal impact on pain flares prevention at the expense of more pronounced immunosuppression (\n                    <jats:inline-formula>\n                      <e:math xmlns:e=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M3\">\n                        <e:mi>P<\/e:mi>\n                      <\/e:math>\n                    <\/jats:inline-formula>\n                    \u2009=\u20090.039). Conclusions. Irrespective of the supporting evidence of dexamethasone potential for prevention of RT-induced pain flare, our data failed to reveal its efficacy in the real practice world (a case mix of uncomplicated and complicated bone metastases). Further dose-effect bigger studies are needed, identifying optimal doses of dexamethasone intake and its optimal duration in high-risk patients.\n                  <\/jats:p>","DOI":"10.1155\/2022\/6153955","type":"journal-article","created":{"date-parts":[[2022,11,29]],"date-time":"2022-11-29T01:58:14Z","timestamp":1669687094000},"page":"1-7","source":"Crossref","is-referenced-by-count":3,"title":["Dexamethasone Coanalgesic Administration in Steroid Na\u00efve and Steroid Non-Na\u00efve Patients for the Prevention of Pain Flares after Palliative Radiotherapy for Bone Metastases"],"prefix":"10.1155","volume":"2022","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4408-6443","authenticated-orcid":true,"given":"Dimitar G.","family":"Tonev","sequence":"first","affiliation":[{"name":"Medical University of Sofia, Sofia, Bulgaria"},{"name":"Clinic of Anesthesiology and Intensive Care, University Hospital \u201cTsaritsa Joanna-ISUL\u201d, Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia A.","family":"Lalova","sequence":"additional","affiliation":[{"name":"Radiotherapy Clinic, National Oncology Hospital, Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena P.","family":"Petkova-Lungova","sequence":"additional","affiliation":[{"name":"Radiotherapy Clinic, National Oncology Hospital, Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolay V.","family":"Timenov","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, National Oncology Hospital, Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela M.","family":"Radeva","sequence":"additional","affiliation":[{"name":"Medical University of Sofia, Sofia, Bulgaria"},{"name":"Medical Oncology Clinic, University Hospital \u201cTsaritsa Joanna-ISUL\u201d, Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todor G.","family":"Kundurzhiev","sequence":"additional","affiliation":[{"name":"Medical University of Sofia, Sofia, Bulgaria"},{"name":"Faculty of Public Health, Medical University of Sofia, Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.1097\/cco.0b013e3281214400"},{"key":"2","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2018.01.003"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbo.2014.10.001"},{"key":"4","doi-asserted-by":"publisher","DOI":"10.1016\/s1470-2045(15)00199-0"},{"key":"5","doi-asserted-by":"publisher","DOI":"10.1097\/00000421-198212000-00014"},{"key":"6","doi-asserted-by":"publisher","DOI":"10.4103\/0019-5049.79879"},{"key":"7","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aen103"},{"key":"8","doi-asserted-by":"publisher","DOI":"10.3390\/cancers11030390"},{"key":"9","doi-asserted-by":"publisher","DOI":"10.5301\/tj.5000658"},{"key":"10","doi-asserted-by":"publisher","DOI":"10.1111\/papr.12823"},{"key":"11","doi-asserted-by":"publisher","DOI":"10.1111\/pme.12299"},{"key":"12","doi-asserted-by":"publisher","DOI":"10.2217\/pmt-2018-0073"},{"key":"13","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2020.07.019"},{"key":"14","doi-asserted-by":"publisher","DOI":"10.21037\/apm.2019.07.09"},{"key":"15","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2019.06.037"},{"key":"16","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctro.2020.03.009"},{"key":"17","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2014.07.037"},{"key":"18","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-007-0217-z"},{"key":"19","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-015-2659-z"},{"key":"20","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-019-02801-2"},{"key":"21","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-014-2415-9"},{"key":"22","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2020.05.007"},{"key":"23","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-017-5320-3"},{"key":"24","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2006.02.007"},{"key":"25","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-015-2957-5"},{"key":"26","doi-asserted-by":"publisher","DOI":"10.1016\/s1470-2045(17)30612-5"}],"container-title":["Pain 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