The Efficacy of Local Anesthetics to Reduce Shoulder Pain Post-Steroid Injections
Overview
- Phase
- Phase 4
- Intervention
- lidocaine
- Conditions
- Shoulder Pain
- Sponsor
- Milton S. Hershey Medical Center
- Enrollment
- 19
- Locations
- 1
- Primary Endpoint
- Change in Pain Assessment
- Status
- Terminated
- Last Updated
- 7 years ago
Overview
Brief Summary
The specific aim of this prospective study is to determine whether local anesthetics prior to subacromial steroid injections reduce pain and consequently if they are cost-effective in the treatment for shoulder pathology.
Detailed Description
Shoulder pain is a common problem that can be estimated to be prevalent in up to 15 percent of the patient population registered to general practices and is second only to back pain in patients seeking treatment for musculoskeletal issues in the primary care setting. As a common source of distress, shoulder pain contributes significantly to health care costs. Rotator cuff disease due to impingement, tendonitis or bursitis is a frequent cause of shoulder pain and dysfunction. Initial treatment consists of a conservative approach of activity modification, oral nonsteroidal anti-inflammatory drugs (NSAIDs) and supervised physical therapy. However, if the patients' symptoms persist, subacromial injections of a local anesthetic such as lidocaine, and a corticosteroid may be indicated as a sequential treatment option. The steroid injection itself can be a painful process, so administering a local anesthetic prior to the steroid injection is thought to mitigate pain or reduce possible discomfort during and immediately following the procedure. Though there is evidence advocating for the benefits of combining local anesthetics and corticosteroids for the treatment of subacromial pathologies, it is not conclusive whether local anesthesia significantly enhances the pain relieving effect of steroids. Should local anesthesia not have a significant impact on the patient's pain intensity, then the use of corticosteroids alone could potentially result in reduced costs in care.
Investigators
Robert A. Gallo
Assistant Professor of Surgery Orthopaedics
Milton S. Hershey Medical Center
Eligibility Criteria
Inclusion Criteria
- •Ages 18 to 70 years old
- •Shoulder pain lasting at least 4 weeks
- •Inability to use arm with restriction of movement and loss of full function.
- •Able to understand study and provide voluntary, written informed consent
Exclusion Criteria
- •Less than 18 or greater than 70 years old
- •Contraindications of previous injections and previous shoulder surgery
- •Unable to understand consent form (in the opinion of the PI)
- •Non-English speaking individuals
- •Medication contradictions to lidocaine, corticosteroids
Arms & Interventions
no topical or subcutaneous anesthetic
Injection of 1 ml of 40 mg Kenalog combined with 4 ml of 1% lidocaine
Intervention: lidocaine
no topical or subcutaneous anesthetic
Injection of 1 ml of 40 mg Kenalog combined with 4 ml of 1% lidocaine
Intervention: Kenalog
subcutaneous lidocaine
Injection of 1 ml of 40 mg Kenalog combined with 4 ml of 1% lidocaine after 2 ml or 1% lidocaine by subcutaneous injection
Intervention: lidocaine
subcutaneous lidocaine
Injection of 1 ml of 40 mg Kenalog combined with 4 ml of 1% lidocaine after 2 ml or 1% lidocaine by subcutaneous injection
Intervention: Kenalog
topical ethyl chloride
Injection of 1 ml of 40 mg Kenalog combined with 4 ml of 1% lidocaine after applying ethyl chloride spray for 3 seconds
Intervention: lidocaine
topical ethyl chloride
Injection of 1 ml of 40 mg Kenalog combined with 4 ml of 1% lidocaine after applying ethyl chloride spray for 3 seconds
Intervention: ethyl chloride
topical ethyl chloride
Injection of 1 ml of 40 mg Kenalog combined with 4 ml of 1% lidocaine after applying ethyl chloride spray for 3 seconds
Intervention: Kenalog
Outcomes
Primary Outcomes
Change in Pain Assessment
Time Frame: change from baseline assessment before injection at 10 minutes post injection
Pain assessed on a visual analog scale from 1 (no pain) to 10 (worst pain imaginable). Pain score at 10 minutes post-injection is subtracted from baseline pre-injection score. Positive numbers to represent increases and negative numbers to represent decreases.