Steroids are often given for severe inflammatory pain associated with rheumatoid arthritis. For acute surgical pain, however, these drugs are rarely used, even though inflammation is probably the major cause of postoperative pain. What is the rationale for the contrasting approaches?
Steroids are indeed capable of suppressing inflammatory pain. They work by decreasing inflammation and reducing the activity of the immune system, which is why they are frequently used against inflammation not associated with invasive procedures. In the case of surgeries and surgical pain, however, their use is much smaller in comparison. The main concern is that the suppression of the immune response could lead to a higher chance of the development of infections in a patient, leading to a much higher number of hospital-acquired diseases.
There have been several studies to determine how feasible it is to use steroids in post-operative pain management. Research by Polderman et al. (2018) showed that the use of dexamethasone in surgical patients did not lead to a higher number of HAI, though the quality of the studies reviewed was low to medium. Gardiner et al. (2020) found that low-dose steroids and opioids used for managing pain after lumbar laminectomy and/or discectomy did not increase rehospitalization rates, but did improve pain management. Finally, an older study by Fleischli and Adams (1999) claimed that steroids delay healing, inhibit collagen synthesis, and increase the risk of postoperative infection. The evidence found on the subject, therefore, is conflicting. Some researchers show little to no negative side effects to careful and situational use of steroids in treating post-surgery patients, while others list a number of complications that warrant opting for other methods. Overall, the use of steroids in post-operational pain remains a contentious subject, though the situation may change once more evidence is acquired.
Fleischli, J. W., & Adams, W. R. (1999). Use of postoperative steroids to reduce pain and inflammation. The Journal of Foot and Ankle Surgery, 38(3), 232-237.
Gardiner, D., McShane, B. J., Kerr, M., Agarwal, P., Saylany, A., Sharma, N.,… & Welch, W. C. (2020). Low-dose steroids to decrease postoperative pain and opioid use. The Journal for Nurse Practitioners, 16(7), 523-527.
McKibben, L. (2017). Conflict management: Importance and implications. British Journal of Nursing, 26(2), 100-103.
Polderman, J. A. W., Farhang‐Razi, V., van Dieren, S., Kranke, P., DeVries, J. H., Hollmann, M. W.,… & Hermanides, J. (2019). Adverse side‐effects of dexamethasone in surgical patients. Anaesthesia, 74(7), 929-939.