Repeated Joint Injections for Chronic Pain?
Joseph Lee, MD
Intra-articular injections (these are the cortisone shots which far too many of your employees are having done in the GP’s office JES note) are routinely performed in physicians’ offices, typically with a mix of steroid and anaesthetic medications. Recent studies, however, have shown potential chondrocyte toxicity when local anesthetics are used for intra-articular purposes. ( in other words these injections cause more issues of a serious nature than solve for your employees!))
J Bone Joint Surg Am. 2010;92:599-608
This study demonstrates in vivo the potential chondrotoxicity associated with intra-articular bupivacaine use. Although these findings seem to be subtle and are probably subclinical after just 1 injection, they indicate the possible spectrum of iatrogenic injury that may be caused by repeated injections of local anaesthetics commonly used to treat articular pain. Current literature would suggest that physicians exercise caution when using high-dose, intra-articular local anesthetics, particularly when given with a corticosteroid.
Jane’s note and interpretation; this is why the use of cortisone steroid injections into and around joints is NOT recommended by the authors of Best Practice Standards including The Cochrane Network, The Official Disability Guidelines 2010 and the ACOEM 2010. GP’s treating your employees must be encourage by you as the employer and payer to use Best Practices at ALL times.
Want to learn how to influence the way GPs practice medicine relative to your employees; Reference Return to Work Compliance Toolkit Pub Carswell.com