Injection site pain steroids

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  • Citation tools Download this article to citation manager Crawshaw Dickon P , Helliwell Philip S , Hensor Elizabeth M A , Hay Elaine M , Aldous Simon J , Conaghan Philip G et al. Exercise therapy after corticosteroid injection for moderate to severe shoulder pain: large pragmatic randomised trial BMJ 2010; 340 :c3037
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    I had an MRI in May. The images showed excessive fluid buildup and inflammation in the bursa, and a small incomplete tear in my rotator cuff. The tear is in line with the fibers of my cuff, much like a split in a seam. It’s unclear whether I had the tear before the shot or whether the shot caused it. I’d had no prior symptoms, and Annunziata says the shot might either have caused the tear – if the needle went into the cuff – or stirred up a prolonged inflammatory response in the area, causing the tear to become painful.

    Steroid injection has been around since the early 1950s, and it remains a primary treatment for general practitioners all the way to orthopedic surgeons. Why? First of all, it offers the hope of quick relief. Second, it’s a Big Fat Cash Cow. Let’s do the math. Say you have sciatica, and you go to see Dr. Prick Butt and he says, “Not much I can do for you other than give you a steroid injection. Of course, it may take up to three of these to achieve the best results.” Three injections @ $150 per injection = $450. Now, taking into account that the average orthopedist probably sees at least 20 patients a day and works 180 days a year, that comes to 3,600 patients. If 20 percent of those patients get three steroid injections, that’s an annual income of $324,000 ($450 X 750 patients). That’s for 10 minutes of work per patient. And you wonder why things haven’t changed in more than 50 years.

    I sense the answer lies in between comments by Dr. John & RWK. In an ideal world – there would be prospective, randomized, double-blind trials as per the last few sentences in Dr. John’s last comment. That clearly is the GOAL. For “evidence” – such studies ought to be prospective and controlled rather than literature reviews that depend on studies already done (and methodologies that are often hard to asses and lacking). But pain assessment and treatment IS indeed highly subjective, hard to tease out – and patient groups are often far from manifesting homogeneous “focal spine pathology” – so I sense it will be difficult to truly ever attain that nirvana state of a perfect study in this area. We are left with the “art of medicine” to truly individualize and assess what may be best for each patient with active incorporation of informed joint-decision-making along the way. Continuation of the trend where relatively few providers are responsible for a disproportionally high percentage of injections is clearly not optimal (and raises question of the appropriateness of injections by at least some of those providers). On the other hand – selective use of injections for candidates with best chance to benefit (which I believe is RWK’s perspective) may be both indicated and beneficial. Careful record-keeping that documents functional improvement for individuals so treated should help to justify appropriateness of such selective injection treatments until such time that a better objective data set on the pros and cons of spinal injections might be obtained.

    As a skilled and experienced Pain Medicine Interventionalist, Dr. Levin evaluates each patient very thoroughly and carefully to help determine appropriate treatment options in order to provide the most effective individualized care.  These treatment options may include:  Lumbar, Thoracic and Cervical Epidural Steroid Injections utilizing targeted transforaminal techniques, Lumbar and Cervical Sympathetic Blocks, Sphenopalatine, Facial and Head and Neck Procedures, Discography, Percutaneuos Discectomy or Disc Decompression procedures, precision joint and nerve injections, Radiofrequency Neuroablative procedures, Peripheral or Spinal Cord Stimulator trials and implants, Foraminoplasties and several patented and patent pending advanced interventional procedures.

    Injection site pain steroids

    injection site pain steroids

    I sense the answer lies in between comments by Dr. John & RWK. In an ideal world – there would be prospective, randomized, double-blind trials as per the last few sentences in Dr. John’s last comment. That clearly is the GOAL. For “evidence” – such studies ought to be prospective and controlled rather than literature reviews that depend on studies already done (and methodologies that are often hard to asses and lacking). But pain assessment and treatment IS indeed highly subjective, hard to tease out – and patient groups are often far from manifesting homogeneous “focal spine pathology” – so I sense it will be difficult to truly ever attain that nirvana state of a perfect study in this area. We are left with the “art of medicine” to truly individualize and assess what may be best for each patient with active incorporation of informed joint-decision-making along the way. Continuation of the trend where relatively few providers are responsible for a disproportionally high percentage of injections is clearly not optimal (and raises question of the appropriateness of injections by at least some of those providers). On the other hand – selective use of injections for candidates with best chance to benefit (which I believe is RWK’s perspective) may be both indicated and beneficial. Careful record-keeping that documents functional improvement for individuals so treated should help to justify appropriateness of such selective injection treatments until such time that a better objective data set on the pros and cons of spinal injections might be obtained.

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