In a comparison of low- and high-dose corticosteroid injections for severe pain related to adhesive capsulitis, low-dose corticosteroids were shown to provide adequate pain relief similar in scale to the high-dose injections, according to the results of research published in Pain Medicine.
Researchers compared injections of 20 mg triamcinolone acetonide (low dose) with 40 mg triamcinolone acetonide (high dose) in patients diagnosed with adhesive capsulitis who had severe pain with a score ≥8 on a numeric rating scale. The primary outcome was the change in score on a numeric rating scale for shoulder pain intensity 3 weeks postinjection. The secondary outcomes were scores on the Shoulder Pain and Disability Index and the passive range of motion scale in 4 directions.
Pain scores improved significantly 3 weeks postinjection for both low- and high-dose injections (P =.01 for both); however, no significant difference between the groups was noted at 3 weeks (P =.63).
Shoulder Pain and Disability Index scores were improved in the low- and high-dose groups (P =.02 and P <.01, respectively). Again, no difference was noted between the groups (P =.06). In a similar manner, the change in the passive range of motion in 4 directions was not significantly different between the groups.
The study authors concluded that “an injection of 20 mg of triamcinolone acetonide into the glenohumeral joint is sufficient to elicit rapid symptom relief in patients with severe adhesive capsulitis; hence, 20 mg of triamcinolone acetonide must be recommended initially in patients with adhesive capsulitis irrespective of the initial pain severity.”
Kim KH, Park JW, Kim SJ. High- vs low-dose corticosteroid injection in the treatment of adhesive capsulitis with severe pain: a randomized controlled double-blind study [published online October 7, 2017]. Pain Medicine. doi: 10.1093/pm/pnx227