Best of Meeting Abstract: Adding Steroids to Local Anesthetics May Not Change Long Term Outcomes in Chronic Non-Cancer Pain

Best of Meeting Abstract: Adding Steroids to Local Anesthetics May Not Change Long Term Outcomes in Chronic Non-Cancer Pain

Newswise — Adding steroids to local anesthetic increases the success rate of short-term but not long-term relief of chronic non-cancer pain, according to the results of a study from researchers at McMaster University in Hamilton, Ontario. Additionally, use of steroids had no effect on duration of pain relief, nor did the number of injections or dosage affect success rate.

Harsha Shanthanna, Li Wang, Alka Kaushal, Rachel Couban, Harman Chaudhry, Prathiba Harsha, Erica Suzumura, Edward Zhou, Varun Bhardwaj, Isabel Kim, Mohit Bhandari, James Paul, Jason Busse, and Lehana Thabane received a Best of Meeting Award from the American Society of Regional Anesthesia and Pain Medicine for their abstract of the study, “The Benefit of Adding Steroids to Local Anesthetics for Chronic Non-Cancer Pain Interventions: A Systematic Review and Meta-Analysis of Randomized Controlled Trials,” which will be presented on Friday, November 16, 2018, during the 17th Annual Pain Medicine Meeting in San Antonio, TX.           

Chronic non-cancer pain lasts longer than three months and commonly includes low back pain; knee, elbow, and shoulder pain; pain from carpal tunnel syndrome; and headaches. Although local anesthetics are known to be effective, their effect may be short and multiple treatments are needed. Steroids have strong anti-inflammatory and immune effects, and healthcare providers believe that adding them to local anesthetic injections can increase the success rate and lengthen the duration of pain relief, even though their use may be off-label for some conditions. However, no clear evidence currently supports this. Further, multiple steroid injections may result in osteoporosis, skin atrophy, and hormonal imbalances, as well as potentially devastating neurologic complications associated with spine injections.

Shanthanna et al. conducted a comprehensive systematic review of the published literature to investigate whether the addition of steroids to local anesthetic has an advantage over local anesthetics alone for pain relief in patients with chronic non-cancer pain conditions. They also assessed whether the number of injections, and the dose of steroid, had any effect on pain relief. Based on a meta-analysis of 40 studies, they found that the addition of steroids to local anesthetic increased the success rate of pain relief when measured at two to four weeks but not at two to four months. Addition of steroids did not seem to increase the duration of pain relief, and the number of injections or dose did not have an effect on the success rate.

“Physicians should be cautious about adding steroids and limit the number of injections and minimize the dose of steroids to prevent adverse effects,” the researchers concluded.

The 17th Annual Pain Medicine Meeting will be held November 15–17, 2018, at the JW Marriott San Antonio Hill Country Resort in Texas. The meeting brings together a world-renowned expert faculty to share their practical experience in pain medicine; discuss novel, emerging, and standard therapies; and address challenges such as the opioid crisis and financial toxicity.