Possible reasons for the steroid’s ineffectiveness may be related to dose. “500 mg is a moderate dose of steroids but may be insufficient to counter the enormous inflammatory response to median sternotomy and cardiopulmonary bypass,” wrote the study’s authors. The timing of the doses administered may matter as well.
Another reason for the negative results might be that inflammation may not play as big a role in persistent incisional pain as was originally thought. Previous research showed that in patients recovering from lung transplantation, immunosuppressive therapy seemed to reduce persistent pain, which suggests that inflammation does play a role in persistent pain. If so, this might mean that a more specific or intense type of immunomodulation than steroids can provide is necessary to reduce persistent pain. However, Dr. Turan believes that the SIRS Trial shows that inflammation is not the main cause behind persistent pain.
“I believe inflammation is not the main driver in persistent pain. If it was, we would have seen at least a sign in the right direction given the size of our study. Unfortunately, we did not,” Dr. Turan told Clinical Pain Advisor. “Exploring steroids in different persistent surgical pain conditions needs to be explored before we can close this chapter.”
He told Clinical Pain Advisor that there are multiple factors that can be explored for further research, including “good acute postoperative pain control with regional anesthesia and other multimodal analgesic drugs, different immunemodulation drugs to control inflammation, and very importantly, genomic studies.”
“There seems to be no role of steroids in cardiac surgery to decrease inflammation and related outcomes,” Dr. Turan said.
Turan A, Belley-Cote EP, Vincent J, Sessler DI et al. Methylprednisolone Does Not Reduce Persistent Pain after Cardiac Surgery. Anesthesiology. 2015; doi:123:00-00.