Lower Dose of Corticosteroids Just As Effective as Higher for Shoulder Pain
Philadelphia, PA, October 27, 2011 – Although corticosteroid injections are one of the most common treatments for shoulder pain, there have been relatively few high-quality investigations of their efficacy and duration of action. In a study scheduled for publication in the December issue of the Archives of Physical Medicine and Rehabilitation, researchers report on the first comparative study of the two most commonly corticosteroid doses administered for shoulder pain. They found that lower doses were just as effective as higher doses in terms of reduction of pain, improved range of motion and duration of efficacy.
"There has been no guidance for adequate corticosteroid doses during subacromial injection. Physicians have depended mainly on their experience for the selection of dose”, commented lead investigator Seung-Hyun Yoon, MD, PhD, Assistant Professor, Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Republic of Korea. "This is the first study to assess the efficacy of corticosteroid according to two different doses, which are the most widely used in subacromial injection for participants with periarticular shoulder disorders. Initial use of a low dose is encouraged because there was no difference in efficacy according to dose, and the effect of corticosteroid lasted up to 8 weeks."
Investigators conducted a randomized, triple-blind, placebo-controlled clinical trial in which 79 patients with at least one month's duration of pain were enrolled. Subjects were randomly assigned to three groups with 27 participants receiving a 40 mg dose of triamcinolone acetonide; 25 a 20 mg dose and 27 a placebo injection. All were followed up at 2, 4, and 8 weeks after treatment. All injections were performed using ultrasound guidance to insure proper placement of the therapeutic agent in the bursa.
Participants were asked to rate their degree of shoulder pain on a 0 to 10 scale and to answer a Shoulder Disability Questionnaire. They also were asked to move their shoulders slowly until they experienced pain, and evaluators measured the Active Range of Motion (AROM) in 4 different directions (forward flexion, abduction, internal rotation, and external rotation of the shoulder in a standing position).
Compared with pretreatment (within-group comparisons), the high- (40 mg) and low-dose corticosteroid (20 mg) groups both showed improvement in pain, disability, and AROM, while the placebo group showed no difference. Importantly, this study showed no significant inter-group differences between the high- and low-dose corticosteroid groups. Because a higher dose may increase the incidence of local and general complications, a lower dose is indicated at the initial treatment stage.
The article is “Comparison of High- and Low-Dose Corticosteroid in Subacromial Injection for Periarticular Shoulder Disorder: A Randomized, Triple-Blind, Placebo-Controlled Trial” by Ji Yeon Hong, MD, Seung-Hyun Yoon, MD, PhD, Do Jun Moon, MD, Kyu-Sung Kwack, MD, PhD, Bohyun Joen, MD, and Hyun Young Lee, MS. It will appear in the Archives of Physical Medicine and Rehabilitation, Volume 92, Issue 12 (December 2011), published by Elsevier. doi:10.1016/j.apmr.2011.06.033.
# # #
NOTES FOR EDITORS
Full text of the article is available to credentialed journalists upon request; contact Shannon Magee at 215-239-3730 email@example.com. To schedule an interview with the authors please contact Seung-Hyun Yoon at +82-31-219-5279 firstname.lastname@example.org.
Ji Yeon Hong, MD Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine and Ajou University Hospital, Suwon, Republic of Korea
Seung-Hyun Yoon, MD, PhD Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine and Ajou University Hospital, Suwon, Republic of Korea
Do Jun Moon, MD Department of Physical Medicine, and Rehabilitation, Goyang Healings Hospital, Goyang, Republic of Korea
Kyu-Sung Kwack, MD, PhD Department of Radiology, Ajou University School of Medicine and Ajou University Hospital, Suwon, Republic of Korea
Bohyun Joen, MD Department of Physical Medicine and Rehabilitation, Ajou Good Hospital, Suwon, Republic of Korea
Hyun Young Lee, MS Regional Clinical Trial Center, Ajou University School of Medicine and Ajou University Hospital, Suwon, Republic of Korea
ABOUT THE ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
The journal publishes original articles that report on important trends and developments in physical medicine and rehabilitation and in the more interdisciplinary field of rehabilitation. Archives of Physical Medicine and Rehabilitation brings readers authoritative information on the therapeutic utilization of physical and pharmaceutical agents in providing comprehensive care for persons with disabilities and chronically ill individuals. Archives began publication in 1920, publishes monthly, and is the official journal of the American Congress of Rehabilitation Medicine. Its papers are cited more often than any other rehabilitation journal. www.archives-pmr.org
ABOUT THE AMERICAN CONGRESS OF REHABILITATION MEDICINE
The American Congress of Rehabilitation Medicine serves people with disabling conditions by promoting rehabilitation research and facilitating information dissemination and the transfer of technology. We value rehabilitation research that promotes health, independence, productivity, and quality of life for people with disabling conditions. We are committed to research that is relevant to consumers, educates providers to deliver best practices, and supports advocacy efforts that ensure adequate public funding for our research endeavors. www.acrm.org
Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals, empowering them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides web-based, digital solutions — among them ScienceDirect, Scopus, Research Intelligence and ClinicalKey— and publishes over 2,500 journals, including The Lancet and Cell, and more than 35,000 book titles, including a number of iconic reference works. Elsevier is part of RELX Group, a world-leading provider of information and analytics for professional and business customers across industries. www.elsevier.com
Shannon Magee, Publisher