Steroids Provide Temporary Improvement of Refractory Pain Following Subarachnoid Hemorrhage

Author:

Jaffa Matthew N.12ORCID,Podell Jamie E.12,Foroutan Arshom1,Motta Melissa12,Chang Wan-Tsu W.123ORCID,Cherian Jacob4,Pergakis Melissa B.12,Parikh Gunjan Y.12,Simard J. Marc456,Armahizer Michael J.7,Badjatia Neeraj12,Morris Nicholas A.12ORCID

Affiliation:

1. Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA

2. Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA

3. Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

4. Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA

5. Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA

6. Department of Physiology, University of Maryland School of Medicine, Baltimore, MD, USA

7. Department of Pharmacy Services, University of Maryland Medical Center, Baltimore, MD, USA

Abstract

Introduction Evidence for optimal analgesia following subarachnoid hemorrhage (SAH) is limited. Steroid therapy for pain refractory to standard regimens is common despite lack of evidence for its efficacy. We sought to determine if steroids reduced pain or utilization of other analgesics when given for refractory headache following SAH. Methods We performed a retrospective within-subjects cohort study of SAH patients who received steroids for refractory headache. We compared daily pain scores, total daily opioid, and acetaminophen doses before, during, and after steroids. Repeated measures were analyzed with a multivariable general linear model and generalized estimating equations. Results Included 52 patients treated with dexamethasone following SAH, of whom 11 received a second course, increasing total to 63 treatment epochs. Mean pain score on the first day of therapy was 7.92 (standard error of the mean [SEM] .37) and decreased to 6.68 (SEM .36) on the second day before quickly returning to baseline levels, 7.36 (SEM .33), following completion of treatment. Total daily analgesics mirrored this trend. Mean total opioid and acetaminophen doses on days one and two and two days after treatment were 47.83mg (SEM 6.22) and 1848mg (SEM 170.66), 34.24mg (SEM 5.12) and 1809mg (SEM 150.28), and 46.38mg (SEM 11.64) and 1833mg (SEM 174.23), respectively. Response to therapy was associated with older age, decreasing acetaminophen dosing, and longer duration of steroids. Hyperglycemia and sleep disturbance/delirium effected 28.6% and 55.6% of cases, respectively. Conclusion Steroid therapy for refractory pain in SAH patients may have modest, transient effects in select patients.

Funder

University of Maryland Baltimore, Institute for Clinical and Translational Research

Department of Veterans Affairs

The National Heart, Lung and Blood Institute

The National Institute of Neurological Disorders and Stroke

Publisher

SAGE Publications

Subject

Neurology (clinical)

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