Inclusion Criteria:

- Verified malignant disease

- Receiving a scheduled strong or weak opioid

- Insufficient pain control: Average pain last 24 h: ≥ 4 (NRS 0-10)

- Given informed consent according to the ethical guidelines

- Able to complete planned assessment schedules

- ≥ 18 years of age

- Life expectancy > 1 month

Exclusion Criteria:

- Excruciating pain (average pain ≥ 8) (These patients should be considered as
emergency patients. Patients may be eligible for the study after stabilization)

- Dose adjustment in scheduled opioid medication last 48 hours

- Concurrent medication with NSAIDs (Patients are eligible for the study one week after
NSAIDs are discontinued)

- Receiving radiotherapy within 4 weeks before entering the study or planned within the
study period

- Started systemic treatment (chemotherapy, hormone therapy or bisphosphonates) within
4 weeks before entering the study Patients who have received chemotherapy for more
than 4 weeks are eligible for the study if it is more than 7 days since receiving the
last dose and they are not having the next dose within the study period

- Manifest spinal cord compression or in need of bone surgery

- Severe cognitive impairment

- Previously on steroids during the last 4 weeks

- Diabetes mellitus

- Known peptic ulcer disease

- Systemic fungal disease, patients vaccinated with viable viruses, and patients with
known allergies to the study medication (MethylPrednisolone)

- Female patients who are pregnant or lactating.

- Women of reproductive potential not willing or unable to employ an effective method
of contraception (be sterilized, using IUD or oral contraception)

- Patients using following medication: cyclosporin, erythromycin, phenobarbital,
phenytoin, carbamazepin, ketoconazole, methotrexate, ciclofosfamide, rifampicin,
aprepitant and diltiazem.