The adjuvant analgesics or co-analgesic drugs are not true analgesics in the pharmacological sense but may contribute substantially to pain relief when used either alone or in combination with analgesics. They can have an analgesic-sparing effect and should be considered in the treatment of all types of cancer-related pain. They are of particular use for opioid-insensitive pain, including neuropathic pain.     Action-Corticosteroids inhibit prostaglandin production with reduction of inflammation and oedema associated with tumour deposits. They also have a central action, evidenced by their effect on mood and appetite. In patients with lymphoproliferative disorders, and a few with breast and prostate cancers, there is also an antitumour effect.     Indications-Corticosteroids are particularly useful for pain related to raised intracranial pressure, extradural spinal cord compression and tumour compression and invasion of nerve roots or individual peripheral nerves.     Corticosteroids are effective in treating the pain of bone metastases and that due to capsular stretching by metastases in the liver and other viscera. Pain associated with vena caval obstruction and lymphoedema may be reduced by the use of corticosteroids. The generalised bone and endosteal pain associated with haematological malignancies, as well as the pain related to hepato-splenomegaly or lymphadenopathy, frequently respond to corticosteroids.     Contraindications-There are no absolute contraindications to corticosteroid therapy, but the presence or severity of some side effects may limit the dose.     Preparations-The commonly used corticosteroid preparations are prednisolone, dexamethasone and hydrocortisone.     Choice of preparation-If parenteral therapy is required, dexamethasone is cheaper than hydrocortisone and has less mineralocorticoid side effects. If continued oral therapy is anticipated, especially at moderate or high dosage, dexamethasone is preferable to prednisolone because of the lesser mineralocorticoid effects.     Dose-Acute neurological problems, including spinal cord compression and raised intracranial pressure, are treated with dexamethasone 16-24 mg/day. The dose is weaned as soon as clinically feasible.     For other indications, dexamethasone 2-4 mg/d or prednisolone 15-30 mg/d are frequently effective; however treatment can be initiated at a higher dose, in order not to miss a treatment effect, and the dose then weaned.     At such time as patients taking corticosteroids lose the ability to swallow, consideration can be given as to the need to continue treatment. Dexamethasone can be mixed with morphine for SC infusion providing this is done at body temperature and not room temperature; others recommend dexamethasone be given as a separate infusion.     Side effects-The side effects of corticosteroids relate to both the dose employed and the duration of treatment. For patients with cancer, the clinical importance of these side effects depends on their life expectancy.     Patients taking corticosteroids for more than a few weeks will develop a Cushingoid facies and body habitus, to some degree, depending on the dose. Oropharyngeal candidiasis is common. Dyspepsia occurs relatively frequently, particularly in patients also receiving aspirin or NSAID, and treatment with antacids, an H2-receptor antagonist or misoprostol may be considered. There may be subjective improvement in muscle strength, which is often transient. Chronic administration of corticosteroids leads to proximal myopathy and weakness which can be debilitating. The production or aggravation of diabetes may require therapy. Fluid retention and oedema may occur with high doses. Abrupt withdrawal of steroids can produce hypoadrenalism and some patients suffer severe arthralgia.     The neuropsychological side effects of corticosteroids are variable. There is frequently an improved sense of well-being, although many patients suffer insomnia. Less frequently, patients develop more serious side effects including frank psychosis.*59\55\2*

Stage OneNote: this is a clean-up diet rather than an elimination diet for allergies, but in fact some people have found that after cleansing the bowel, if they combine foods carefully they can tolerate foods which had previously caused trouble. Also note you are not going to feel good initially, in fact as you detoxify you could feel tired and heavy-limbed. Some people experience a furred tongue, nausea and joint pains. This is why cleaning out in stages has been suggested. Try to stay with it; the feelings pass in a few days and remember the worse you feel the cleaner you are becoming inside.Getting StartedThink about what you are putting in your mouth; has it been messed about? Does it contain chemicals? What has been lost in the processing? How is it packaged? Do you really want to eat dyes, or munch snacks covered with large quantities of salt to conceal the fact that they have been cooked in rancid fat? Your body is just not built to cope with this.GIVE UP:1 Regular consumption of junk foods2 All dairy products (except live yogurt), even for a month; these are the main cause of allergic problems in infants and adults so it makes sense to start here.This request usually brings cries of protest, ‘But how can I live without cheese or milk’ – you can, and you will be surprised how quickly the desire for these foods will go. You could substitute goat’s or sheep’s milk, yogurt and cheese. Some people use soya milk for drinking, cooking and making yogurt.CUT DOWN:3 Tea, coffee, chocolate and all soft drinks (see page 38).4 Alcohol. Make sure you eat fruit or drink fruit juice at the time you would normally have an alcoholic drink.Increase ‘Dredger Food’1 Wholegrains: oats, brown rice, barley, millet, rye2 Pulses: lentils, beans, peas3 Fruit and vegetables including sea vegetables (sounds better than seaweed)4 Fish, olive oil, sunflower oil5 Nuts (not peanuts) and seeds6 Take water, fruit juice, herb teas or coffee substitute at some of your tea breaks.Stage TwoYou might be ready for this after a week but if you are still struggling continue stage one for another week.CUT DOWN:1 Meat, eggs, and poultry2 Tea, coffee, soft drinks and alcohol more than in stage one.Increase Whole Clean FoodsMore vegetables, fruit, grains as in stage one.Stage ThreeOn paper this is going to look depressing, but when you are up to stage three you should be used to being deprived. (Although hearty bowls of lentil and vegetable soup, or baked potatoes with nut butter or yogurt and herbs, curried vegetables and rice or pasta tossed in olive oil with garlic mushrooms and tomatoes is not exactly starvation rations, is it?)EAT ONLY:Whole grains, vegetables, sea vegetables, fruit: fresh or dried, nuts, seeds, olive oil or sunflower oil, or products made from any of these if they do not contain additives.DRINK:Water, bottled or fdtered if possible, fruit juices preferably diluted, bancha tea, herb teas, coffee substitutes or, if you cannot make it without, one cup of weak tea or fdtered coffee per day.Your Hard Work Will Be RewardedBy now you might be ready to rush out for fish and chips to settle your nerves – don’t despair and think what you will gain:1 The bowel will work more efficiently, the absorption sites will be cleared, enzyme production will increase and as a result your bowel should be less irritable.2 Because you have eaten less concentrated protein you will have been eating better combinations of foods. Also your kidneys and liver will have been rested.3 Because of reducing your sugar intake your pancreas will be less strained and your blood sugar levels should be more stable.4 You will probably have lost some excess weight or puffmess.5 You will look healthier.*55\326\8*

The skin test reactions are graded from 0, 1, 2, 3, and 4 + depending upon the degree of swelling and redness produced, and are compared against control test site. The larger the size of the weal or the lump, (the positive reaction) the greater is the tendency to allergic reaction. A positive reaction of significance must be correlated with the clinical history of the patient.Negative reactions normally indicate the absence of antibody against the allergen tested, but sometimes the use of inadequate, weak or deteriorated extracts can also account for the negative reaction.A positive test may not necessarily mean that the child has symptoms at the time of testing, as skin tests may be positive years before symptoms begin and remain positive long after allergy symptoms subside.Skin tests are helpful in identifying an allergy to inhaled substances such as house dust mites, moulds, pollen, or animal saliva and dander. These tests are an accurate way of determining the presence of allergies and totally safe when carried out under the supervision of a doctor specialising in allergies.*52\260\8*