Original Research
Evaluating Short-Term Pain After Steroid Injection
Am J Orthop. 2007 March;36(3):128-131
Author and Disclosure Information
Ronit Wollstein, MD, Gerson Chaimsky, MD, Lois Carlson, OTR/L, CHT, H. K Watson, MD, Gadi Wollstein, MD, and Jaber Saleh, MD
Dr. Ronit Wollstein is Assistant Clinical Professor, Connecticut Combined Hand Surgery, Hartford Hospital, University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford, Connecticut and Yale University, New Haven, Connecticut, and Instructor, Department of Orthopedic Surgery, Hadassah University Medical Center, Jerusalem, Israel.
Dr. Chaimsky is Instructor, Department of Orthopedic Surgery, Hadassah University Medical Center, Jerusalem, Israel.
Ms. Carlson is Hand Therapist, Connecticut Combined Hand Therapy, Hartford, Connecticut.
Dr. Watson is Associate Professor, Connecticut Combined Hand Surgery, Hartford Hospital, University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford, Connecticut and Yale University, New Haven, Connecticut.
Dr. Gadi Wollstein is Assistant Professor, UPMC Eye Center, University of Pittsburgh, Pittsburgh, Pennsylvania.
Dr. Saleh is Instructor, Department of Orthopedic Surgery, Hadassah University Medical Center, Jerusalem, Israel.
Steroids are injected into joints for various indications. All steroid preparations relieve pain similarly over the long term. Therefore, decisions about which preparation to use are often arbitrary. We evaluated methylprednisolone acetate and a combination of betamethasone diproprionate and betamethasone sodium phosphate for short-term pain and the predictive value of short-term pain.
Eighty-five patients were injected in prospective double-blind randomized fashion. Pain was evaluated by visual analog scale (1 = no pain, 10 = severe pain) at baseline, 3 days, and 3 weeks.
No patient had joint pain immediately after injection. Three days after injection, mean (SD) pain levels were 5.1 (2.9) for methylprednisolone and 5.2 (2.6) for betamethasone (P = .97); 3 weeks after injection, they were 4.0 (2.8) and 3.7 (2.5), respectively (P = .57). Short-term pain increased from baseline for both preparations and decreased from 3 days to 3 weeks. Pain at 3 days and 3 weeks was positively correlated.
This study does not support a difference in short-term pain between preparations. The significant correlation between short- and long-term pain may justify early decisions regarding treatment, especially in patients with high levels of initial pain.