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

Abstract

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.

Incidence and Risk Factors of Systemic Adverse Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections

“…A recent study on post-GCI pain flares has also shown that older patients are less likely to experience that particular local adverse effect. 18 One of the reasons why the female sex is a risk factor for having more systemic adverse effects and complications is the higher rate of flushing in women and the incidence of AUB being significantly greater than the incidence of erectile dysfunction, according to our data. In addition, women have on average a lower mean height and weight, but their GCI doses are often the same as men.…”

“…In addition, they might be affected by recall bias to a greater degree. A recent study on post-GCI pain flares has also shown that older patients are less likely to experience that particular local adverse effect 18 …”

Pain Management Strategies in Osteoarthritis

“…In the management of both acute and chronic inflammatory conditions, intra-articular corticosteroid injections are commonly employed [37]. These injections are particularly beneficial during osteoarthritis (OA) flares where indications of inflammation and joint effusion are present [38]. In this context, numerous meta-analyses have been conducted, investigating the optimal type of corticosteroid, assessing treatment safety, and, most importantly, evaluating its effectiveness in relation to pain relief duration.…”

Summary Report of the Arthritis Foundation and the American Orthopaedic Foot & Ankle Society’s Symposium on Targets for Osteoarthritis Research: Part 1: Epidemiology, Pathophysiology, and Current Imaging Approaches

“…57 The evidence regarding injections in the foot and ankle consists mostly of case series with very few randomized controlled trials. 12,25 Side effects and risks of corticosteroid injections include pain flare (~1/5 patients), 14 infection (~1/10 000 to 1/50 000 patients, or 1/170 physician-years of practice), 11 bruising, nerve injury, and arterial injury. There are many adverse effects of corticosteroids, with main concerns being the disruption of the musculoskeletal, endocrine, and dermatologic systems.…”