What is the role of intra-articular corticosteroids in pain management?

Updated: Jun 19, 2018
  • Author: Anthony H Wheeler, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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The prevalence of cervical zygapophyseal joint pain has been studied and estimated at 65%. Intra-articular corticosteroids have been used for presumptive zygapophyseal joint pain involving the lumbar and cervical spine. A carefully designed, double-blind study of intra-articular steroids versus saline for lumbar zygapophyseal joint pain revealed no clinically significant differences between groups at 1- or 6-month follow-up. No controlled studies of the value of intra-articular steroids for neck pain have been published. The concept of denervating painful zygapophyseal joints has been explored.

Some investigators have identified modest benefit from medial branch neurolysis with phenol. Percutaneous radiofrequency neurotomy has been advocated for neurolysis of the medial branch or for facet articular denervation as a treatment for both neck and back pain. A recent double-blind, randomized, controlled study comparing percutaneous radiofrequency neurotomy for chronic cervical zygapophyseal joint pain showed approximately 50% improvement in pain for a mean duration greater than 8 months when compared with an identical sham procedure.

A prospective, randomized, double-blind study of injections into diskography-confirmed painful disks showed no significant difference in benefit between corticosteroids and LAs. Other interventions used to disrupt painful epidural adhesions have included hyaluronidase, hypertonic saline, and corticosteroids. Intrathecal morphine and dorsal column stimulation have been proposed as options in specific cases of severe, disabling, and intractable low back pain.

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