Article Figures & Data
Figures
- Figure 1.
Participant flowchart.
HNP=hernia nuclei pulposi.
a All patients were included in the repeated measurement analysis.
b For the repeated measurement analysis on recovery, at least 1 follow-up assessment was needed to be included in the analysis.
- Figure 2.
Course of mean pain intensity (and standard error) at rest and on activity during the 12-month follow-up period for injection group (n = 60) and usual care group (n = 59), on a visual analog scale (VAS)
- Figure 3.
Course of recovery during 12-months for injection group (n = 60) and usual care group (n = 60).
Tables
Characteristic Usual Care Group (n=60) Intervention Group (n=60) Total (N=120) EQ-5D = EuroQol; WOMAC = Western Ontario and McMaster Universities Osteoarthritis Index. a Scored on a range from 0–100, with high values indicating more pain or lower physical functioning. b Scored on a range from 0–10, where 0 = no pain and 10 = worst conceivable pain. c Scored on a range from 0–1, where 0 = worst quality of life and 1 = best quality of life. Age, mean (SD), y 54.8 (14.7) 57.7 (13.9) 56 (14.3) Women, n (%) 48 (80) 44 (73.3) 92 (76.7) Paid job, n (%) 24 (40) 26 (43.3) 50 (41.7) Body mass index, mean (SD) 26.3 (3.6) 26.9 (3.8) 26.6 (3.7)) WOMAC pain, mean (SD)a 52.4 (19.1) 48.8 (16.1) 50.6 (17.7) WOMAC function, mean (SD)a 49.2 (19.6) 43.9 (17.0) 47.0 (18.4) Pain at rest, mean (SD)b 5.33 (2.2) 5.05 (2.2) 5.19 (2.2) Pain with activity, mean (SD)b 6.63 (2.6) 6.82 (1.9) 6.73 (2.3) Quality of life, EQ-5D,mean (SD)c 0.72 (0.2) 0.76 (0.2) 0.74 (0.2) Education level, n (%) Low (vocational) 17 (28.3) 22 (36.7) 39 (32.5) Middle (secondary) 33 (55) 29 (48.3) 62 (51.7) High (university) 10 (16.7) 9 (15) 19 (15.8) Duration of complaints, n (%) 1–2 mo 30 (50.8) 27 (45.0) 57 (47.9) 2–6 mo 14 (23.7) 20 (33.3) 34 (28.6) >6 mo 15 (25.4) 13 (21.7) 28 (23.5) Comorbidity, n (%) None 25 (41.7) 22 (36.7) 47 (39.2) Low-back pain 21 (35) 22 (36.7) 43 (35.8) Hip osteoarthritis 8 (13.3) 10 (16.7) 18 (15) Low-back pain and hip osteoarthritis 6 (10) 6 (10) 12 (10) Usual Care (n = 59) Injection (n=60) Outcome Baseline 3 mo 12 mo Baseline 3 mo 12 mo 3 mo OR (95% CI) 12 mo OR (95%CI) EQ-5D = a quality-of-life instrument from EuroQol; WOMAC = Western Ontario and McMaster Universities Osteoarthritis Index. a Fully or strongly recovered. b Adjusted for baseline values of the outcome. c Scored on a range from 0–10, where 0 = no pain and 10 = worst conceivable pain. d Scored on a range from 0–100, with high values indicating more pain or lower physical functioning. e Scored on a range from 0–1, where 0 = worst quality of life and 1 = best quality of life. Recovered,n/N (%)a – 20/59 (34) 33/55 (60) – 33/60 (55) 34/56 (61) 2.38 (1.14 to 5.00) 1.05 (0.50 to 2.27) Difference at 3 mo (95% CI)b Difference at 12 mo (95% CI) Pain at rest, mean (SD)c 5.3 (2.2) 3.7 (2.5) 2.3 (2.3) 5.1 (2.2) 2.5 (2.5) 2.1 (2.5) 1.18 (0.31 to 2.05) 0.14 (−0.75 to 1.04) Pain with activity, mean (SD)c 6.6 (2.60) 4.8 (2.8) 3.2 (2.9) 6.7 (1.9) 3.6 (2.8) 2.8 (2.8) 1.30 (0.32 to 2.29) 0.45 (−0.55 to 1.46) Secondary outcomes WOMAC pain, mean (SD)d 52.4 (19.1) 37.6 (22.7)1 22.9 (22.8) 48.8 (16.1) 23.6 (21.3) 18 (19.6) 12.40 (4.86 to 19.93) 2.67 (−4.98 to 10.32) WOMAC function, mean (SD)d 49.2 (19.6) 34.2 (21.3) 21.7 (22.7) 43.9 (17.0) 21.3 (19.3) 17.4 (19.6) 11.36 (4.01 to 18.70) 1.01 (−6.37 to 8.39) EQ-5D, mean (SD)e 0.72 (0.2) 0.79 (0.17) 0.85 (0.17) 0.74 (0.2) 0.81 (0.2) 0.82 (0.2) −0.02 (−0.08 to 0.04) −0.004 (−0.05 to 0.06) Adverse Event Intervention Group Usual Care Group Hot flushes 11 12 Disturbance in menstruation pattern 3 5 General allergic reaction (eg, itching all over the body, urticaria, head-ache, shortness of breath) 9 12 Superficial pain at site of injection < 1 day 23 0 ≥1 day 3 0 Missing 11 0 Other reported side-effects Insensible spot 1 0 Extravasation of blood 1 0 Sore spot 1 0 Small lump at injection place 1 0
The Article in Brief
Corticosteroid Injections for Greater Trochanteric Pain Syndrome: A Randomized Controlled Trial in Primary Care
Aaltien Brinks , and colleagues
Background Greater trochanteric pain syndrome (GTPS), also known as trochanteric bursitis, is a common cause of hip pain. This study compared usual care (analgesic pain medicines as needed) and corticosteroid injection in primary care patients with GTPS.
What This Study Found For patients with GTPS, corticosteroid injections offer better short-term pain relief than pain medicines. At the 3-month follow-up, 34 percent of patients in the usual care group had recovered compared with 55 percent in the injection group. At 3 months, pain severity at rest and on activity decreased in both groups, but the decrease was greater in the injection group. At the 12-month follow-up visit, the differences in outcomes were no longer present.
Implications
- Although local corticosteroid injections are frequently given for GTPS, this study is the first to examine the additional value of injection therapy, providing physicians with a more evidence-based rationale for offering it to patients.
Correction
Brinks A, van Rijn RM, Willemsen SP, et al. Corticosteroid injections for greater trochanteric pain syndrome: a randomized controlled trial in primary care. Ann Fam Med. 2011;9(3):226-234.
Under the Participants heading in the Methods section, the American College of Rheumatology criteria for osteoarthritis should include morning stiffness of up to 60 minutes, not longer than 60 minutes as mentioned in this study.
In Table 2. Primary and Secondary Outcome Measures at the 3- and 12-Month Follow-up. Under the column heading Secondary outcomes, Usual Care, 3 mo, a superscript 1 beside (22.7) in the 2nd set of numbers across from WOMAC pain, Mean (SD), is in error and should be ignored.
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