The incidence of flare reaction and short-term outcome following steroid injection in the shoulder

Fawi, Hassan; Hossain, Munier; Matthews, T.

doi:10.1177/1758573217693808

Cited by 9 publications

(7 citation statements)

References 30 publications

(38 reference statements)

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“…A few studies have previously investigated the incidence of postinjection pain flares and symptomatic improvement following injection, as well as location of injection and incidence of postinjection pain flares. Fawi et al 8 reported that 35.3% of patients receiving a shoulder corticosteroid injection experienced postinjection pain, with a mean duration of symptoms of 3.9 days, but this did not seem to have any detrimental effect on overall outcome. Their duration was similar to those reported in our study.…”

Section: Discussionmentioning

confidence: 99%

“…First, the other studies did not use ultrasound guidance, which has been demonstrated to improve accuracy of injection placement 9 ; injections external to the source of pain may cause a transient flare of pain. Second, these studies looked at more focused areas (shoulder, 8 hand tendons, 10 and hand/elbow 22 ): these upper extremity areas may be more prone to flares than those seen in the lower extremity, which made up a subset of our injections. We did not explicitly evaluate this in our regression model, due to the large number of areas injected, which, even if categorized, would result in a lower statistical power.…”

Section: Discussionmentioning

confidence: 99%

“…A postinjection pain flare was allowed, to be subjective. Prior literature has defined it as a 2-point increase on the visual analog scale (VAS), 8 which was based on the minimal clinically important difference in pain for the numeric pain rating. In this study, however, we chose to exclude the defined value of 2 numeric points when asking patients about a flare, instead allowing the patient to decide whether it was clinically important or not.…”

Section: Methodsmentioning

confidence: 99%

“…1,17,20 There is little in the literature reporting on who will experience a pain flare following a corticosteroid injection, even though the incidence of postinjection pain flares range in incidence from 33% to 50%. 8,10,22 To the best of the authors’ knowledge, no studies have identified a patient population at increased risk of experiencing postinjection pain flares.…”

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confidence: 99%

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Prospective Evaluation of Pain Flares and Time Until Pain Relief Following Musculoskeletal Corticosteroid Injections

Cushman¹,

Kobayashi²,

Wheelwright³

et al. 2022

Sports Health: A Multidisciplinary Approach

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Background: Corticosteroid injections are used ubiquitously within musculoskeletal medicine. One of the most common side effects is a postinjection pain flare, though little is known regarding this phenomenon. Hypothesis: Some risk factors are related to postinjection pain flare following an ultrasound-guided corticosteroid injection. Study Design: Prospective clinical research study. Level of Evidence: Level 2. Methods: Patients undergoing ultrasound-guided corticosteroid injections in an academic orthopaedic and sports medicine clinic were approached to participate. Patients completed a survey immediately following their injection and again 2 weeks later, asking them about their pain and side effects. A postinjection pain flare was defined as an increase in pain, as defined by the patient. Results: A total of 140 patients completed the entirety of the study, with 29 (20.7%) patients reporting a flare of pain. There was a significant effect of younger age on the development of a pain flare after the injection, estimated as 5.5% decreased odds of developing a flare per year of age ( P < 0.01). Gender, injection location, body mass index (BMI), preinjection pain, and corticosteroid type had no contributing effect. When patients obtained relief following the corticosteroid injection, 60.4% had improved pain within 3 days, whereas over 93.7% obtained relief within a week. Conclusion: Pain flares seem to affect approximately 1 in 5 patients. With increasing age, the likelihood of postinjection pain flare becomes less likely. Sex, injection location, BMI, preinjection pain, and corticosteroid type do not seem to significantly relate to an increase in pain following injection. Clinical Relevance: Corticosteroid injections are common procedures in the orthopaedic and sports medicine settings. Younger patients can be counseled on the higher likelihood of a pain flare following a corticosteroid injection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Prospective Evaluation of Pain Flares and Time Until Pain Relief Following Musculoskeletal Corticosteroid Injections

Cushman¹,

Kobayashi²,

Wheelwright³

et al. 2022

Sports Health: A Multidisciplinary Approach

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“…We also found that a single intraarticular administration of allogeneic MSCs was well-tolerated, and except for transient joint pain in a few dogs, did not result in any severe adverse reactions. It has been reported that "joint flare" reactions can happen with intra-articular corticosteroid injections, and this may also be the case with administration of MSCs (49). Intra-articular administration of stem cells in patients with OA is the preferred method of administration because it concentrates the cells at the site of injury and potentially has a lower chance of distribution of stem cells to other organs.…”

Section: Discussionmentioning

confidence: 99%

Intra-articular Administration of Allogeneic Adipose Derived MSCs Reduces Pain and Lameness in Dogs With Hip Osteoarthritis: A Double Blinded, Randomized, Placebo Controlled Pilot Study

Maki

Beck²,

Wallis

et al. 2020

Front. Vet. Sci.

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This study was conducted to investigate the therapeutic effect of allogeneic adipose-derived MSCs on dogs with hip osteoarthritis (OA). Twenty dogs with bilateral osteoarthritis of the coxofemoral (hip) joint, diagnosed by a veterinarian through physical examination and radiographs were randomly allocated into four groups. Group 1 served as a placebo control and were injected with 0.9% sodium chloride (saline) (n = 4). Group 2 were injected with a single dose of 5 million MSCs (n = 5). Group 3 received a single dose of 25 million MSCs (n = 6) and Group 4 received a single dose of 50 million MSCs (n = 5). Intra-articular administration of allogeneic MSCs into multiple joints did not result in any serious adverse events. The average lameness score of the dogs in the placebo control group (−0.31) did not show improvement after 90 days of intra-articular saline administration. However, the average lameness score of the all MSC-treated dogs was improved 2.11 grade at this time point (P < 0.001). Overall, sixty five percent (65%) of the dogs that received various doses of MSCs showed improvement in lameness scores 90 days after intra-articular MSC administration. Our results showed that intra-articular administration of allogeneic adipose derived MSCs was well-tolerated and improved lameness scores and reduced pain in dogs associated with hip OA. All doses of MSCs were effective. Subsequent studies with more animals per group are needed to make a conclusion about the dose response. The improved lameness effect was present up to 90 days post-injection. Serum interleukin 10 was increased in a majority of the dogs that received MSCs and that also had improved lameness.

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Knee Injection and Needling Therapy

Charalambous

2021

The Knee Made Easy

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The incidence of flare reaction and short-term outcome following steroid injection in the shoulder

Abstract: One in three patients developed delayed post-injection pain. Flare phenomenon had no determinate effect on outcome. Patients' pain response by 6 weeks is predictive of final outcome at 6 months and may help clinicians plan further treatment without delay.

Cited by 9 publications

References 30 publications

Prospective Evaluation of Pain Flares and Time Until Pain Relief Following Musculoskeletal Corticosteroid Injections

Prospective Evaluation of Pain Flares and Time Until Pain Relief Following Musculoskeletal Corticosteroid Injections

Intra-articular Administration of Allogeneic Adipose Derived MSCs Reduces Pain and Lameness in Dogs With Hip Osteoarthritis: A Double Blinded, Randomized, Placebo Controlled Pilot Study

Knee Injection and Needling Therapy

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