Disability and Pain after Cortisone versus Placebo Injection for Trapeziometacarpal Arthrosis and De Quervain Syndrome

Abstract

Background This study tested the null hypothesis that type of injection (corticosteroid vs. placebo) is not a predictor of arm-specific disability as measured with the Disabilities of Arm, Shoulder and Hand questionnaire 1 to 3 months after injection of dexamethasone or placebo for treatment of trapeziometacarpal (TMC) arthrosis or de Quervain syndrome. Secondly, we tested if type of injection was a predictor of pain intensity. Methods Thirty-six English-speaking adults with TMC arthrosis or de Quervain syndrome were randomized for a dexamethasone or a placebo injection. At time of the injection, patients completed a demographic data sheet and validated questionnaires assessing arm-specific disability, pain intensity, depressive symptoms, pain catastrophizing, and patient's health-related beliefs. At an average of 1.4 ± 0.42 months (range, 0.79-2.5 months) after the injection, patients completed questionnaires regarding arm-specific disability, pain, and treatment satisfaction. Grip and pinch strength measurements were measured at both time points. Bivariable and multivariable analyses assessed predictors of arm-specific disability and pain intensity at follow-up. Results Type of injection was not a predictor of arm-specific disability or pain intensity 1 to 3 months after injection. The best model both for arm-specific disability and pain intensity at follow-up included pain catastrophizing and explained 18 % and 33 % of the variability, respectively. Conclusions Catastrophic thinking was a better predictor of both of arm-specific disability and pain intensity than diagnosis or type of injection (steroid vs. placebo) 1to 3 months after an injection.

The Role of Psychosocial Processes in the Development and Maintenance of Chronic Pain

“…93;110 Longitudinal studies show associations of catastrophizing with worsening pain and reduced treatment benefit among, for example, arthritis patients recovering from knee surgery. 60;70;195;238 Multiple randomized controlled trials have shown that pain patients with high pre-treatment catastrophizing scores report less benefit from topical analgesics 151 , cortisone 150 , oral analgesics 200 , pain-relieving surgeries 238 , and psychosocial treatments such as CBT. 53;232 …”

Patient phenotyping in clinical trials of chronic pain treatments: IMMPACT recommendations

“…Retrospective survey studies in patients with musculoskeletal pain have indicated that catastrophizing often emerges as one of the most important pre-treatment variables predicting surgical outcomes [154;213], and a risk factor that impairs the effectiveness of pain-relieving interventions [123;138]. Multiple RCTs in various neuropathic and musculoskeletal pain conditions have shown that pain patients with high pre-treatment catastrophizing report less benefit from topical analgesics [165], cortisone [163], an oral acetaminophen and tramadol combination [209], and psychosocial treatments such as cognitive behavioral therapy (CBT) [68;232], though few of these studies tested for treatment effect modification. A recent study of patients with persistent temporomandibular joint pain, randomized to 6 weeks of either standard care or CBT and followed for 12 months, confirmed the long-term predictive effects of catastrophizing [158].…”

Conservative treatment of lateral epicondylitis: The impact of psychosocial factors on perceived treatment efficacy

“…Although previous studies have compared the effect of brace types on pain relief and functional outcomes in the past, none to our knowledge have investigated the relationship between disability and pain with regard to treatment [13,14]. However, there is a growing body of evidence that suggests that disability related to upper extremity musculoskeletal conditions in general and lateral epicondylitis in particular, is affected by more than pain [15][16][17]. Other factors contributing to disability may include catastrophic thinking, kinesophobia, as well as occupational and psychological stresses [15][16][17].…”

“…There is a growing body of evidence that suggests disability related to musculoskeletal conditions is not only associated with pain but also by patient coping strategies, as well as kinesophobia [15][16][17]. That is, patients may develop patterns of catastrophic thinking, feelings of helplessness related to the pain and fear of its worsening, which thereby affect disease-related disability.…”

“…Patients may also experience kinesophobia, the pathologic fear of movement, related to notions of a serious underlying medical condition and ideas that movement may result in further injury [18]. Both kinesophobia and catastrophic thinking have previously demonstrated pertinence to disability related to musculoskeletal conditions of the upper extremity generally [15,16], but not lateral epicondylitis specifically.…”