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Steroid injections and placebo produced same effect on lateral epicondylitis pain

The prospective study also found dexamethasone and placebo injection affected elbow disability similarly.

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SEATTLE — Investigators who conducted a randomized placebo-controlled trial using corticosteroid injections to treat lateral elbow pain attributed the similar results they saw between steroid and placebo injections to psychosocial factors that affected the patients.

David C. Ring, MD, of Boston, who presented results of the double-blinded study here at the American Society for Surgery of the Hand 62nd Annual Meeting, called the phenomenon “catastrophizing.”

Of 64 patients with lateral elbow pain enrolled in the study (27 men, 37 women), 31 were randomized for dexamethasone injections and 33 for placebo injections of lidocaine. Investigators reported at the meeting on the preliminary data through 6 months post-treatment for 43 patients, including 20 in the steroid group and 23 in the placebo groups.

Patients and surgeons were blinded to who got which type of injection.

After 1 and 6 months, researchers analyzed results for pain, grip strength and the DASH score and found no difference between the groups, although improvements in those factors were statistically significant for each group.

Psychosocial and coping skills may be responsible for these results, Ring said. For example, DASH scores positively correlated with depression and with coping/catastrophizing (P<0.01 for both).

There were few adverse events, he noted.

One limitation of the study invovled a power analysis, which showed that 23 patients were needed for each group.

In summarizing the results, Ring said this was the best science available in this area and he asked his colleagues to remind their patients with lateral epicondylitis to “be patient,” since it often eventually resolves on its own.

For more information:

• David C. Ring, MD, indicated he received research or institutional support from the AO Foundation, Small Bone Innovations, Smith & Nephew, Wright Medical and Biomet.
• Henket M, Ring DC, Cowan J, et al. Corticosteroid injection for lateral elbow pain: A randomized placebo-controlled clinical trial. #CT-1. Presented at the 62nd Annual Meeting of the American Society for Surgery of the Hand. Sept. 27-29, 2007. Seattle.