Comparison of fluoroscopically guided and blind corticosteroid injections for greater trochanteric pain syndrome: multicentre randomised controlled trialBMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b1088 (Published 14 April 2009) Cite this as: BMJ 2009;338:b1088
- Steven P Cohen, associate professor12,
- Scott A Strassels, assistant professor 3,
- Leslie Foster, assistant professor4,
- John Marvel, assistant professor5,
- Kayode Williams, assistant professor5,
- Matthew Crooks, assistant professor5,
- Andrew Gross, pain management fellow6,
- Connie Kurihara, pain management center2,
- Cuong Nguyen, chief7,
- Necia Williams, chief8
- 1Departments of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- 2Walter Reed Army Medical Center, Washington, DC, USA
- 3Division of Pharmacy Practice, University of Texas at Austin, Austin, TX, USA
- 4Department of Orthopedic Surgery, Walter Reed Army Medical Center
- 5Department of Anesthesiology, Johns Hopkins School of Medicine
- 6Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA
- 7Physical Medicine and Rehabilitation Service, Department of Surgery, Landstuhl Regional Medical Center, Landstuhl, Germany
- 8Integrated Anesthesia Services, Walter Reed Army Medical Center and National Naval Medical Center, Bethesda, MD
- Correspondence to: S P Cohen, 550 North Broadway, Suite 301, Baltimore, MD 21029
- Accepted 15 December 2008
Objective To determine whether fluoroscopic guidance improves outcomes of injections for greater trochanteric pain syndrome.
Design Multicentre double blind randomised controlled study.
Setting Three academic and military treatment facilities in the United States and Germany.
Participants 65 patients with a clinical diagnosis of greater trochanteric pain syndrome.
Interventions Injections of corticosteroid and local anaesthetic into the trochanteric bursa, using fluoroscopy (n=32) or landmarks (that is, “blind” injections; n=33) for guidance.
Main outcome measures Primary outcome measures: 0-10 numerical rating scale pain scores at rest and with activity at one month (positive categorical outcome predefined as ≥50% pain reduction either at rest or with activity, coupled with positive global perceived effect). Secondary outcome measures included Oswestry disability scores, SF-36 scores, reduction in drug use, and patients’ satisfaction.
Results No differences in outcomes occurred favouring either the fluoroscopy or blind treatment groups. One month after injection the average pain scores were 2.7 at rest and 5.0 with activity in the fluoroscopy group compared with 2.2 and 4.0 in the blind injection group. Three months after the injection, 15 (47%) patients in the blind group and 13 (41%) in the fluoroscopy group continued to have a positive outcome.
Conclusion Although using fluoroscopic guidance dramatically increases treatment costs for greater trochanteric pain syndrome, it does not necessarily improve outcomes.
Trial registration Clinical trials NCT00480675
Contributors: SPC conceived and designed the study. SPC, JM, AG, and NW wrote the protocols for the participating institutions. SAS analysed the data. SPC and SAS drafted the manuscript. SPC, LF, KW, MC, CN, and NW recruited and enrolled patients and gave injections. CK and JM randomised participants and assisted with follow-up. All authors edited the final version of the manuscript. SPC is the guarantor.
Funding: This study was funded in part by a congressional grant from the John P Murtha Neuroscience and Pain Institute, Johnstown, PA; the US Army; and the Army Regional Anesthesia and Pain Medicine Initiative, Washington, DC. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.
Competing interests: None declared.
Ethics approval: Internal review boards at Johns Hopkins and Walter Reed Army Medical Center gave approval for the study. Landstuhl Regional Medical Center fell under the jurisdiction of Walter Reed Army Medical Center. All patients gave informed consent.
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