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Predictors of Pain During and The Day After Corticosteroid Injection for Idiopathic Trigger Finger
David C. Ring, MD, PhD; Abishek Julka, MD; Ana-Maria Vranceanu, PhD; Apurva Shah, MD; Frank Peters, MD
Hand and Upper Extremity Services, Massachusetts General Hospital, Boston, MA

Background: Some patients report a transient increase in pain the day after a corticosteroid injection. We investigated factors associated with greater pain during and the day after a corticosteroid injection for idiopathic trigger finger.

Methods: One hundred patients with trigger finger completed questionnaires measuring heightened illness concern, pain catastrophizing, depression, perceived health, expected pain, pain with injection and pain the day after injection. Bivariate analysis was performed to determine variables associated with pain with injection, next day pain and next day pain greater than 4 points on an 11-point ordinal scale. Variables with a significant correlation were entered into multivariable logistic regression model.

Results: The average pain with injection and the day after injection were 4.3 (SD 2.8) and 1.8 (SD 2.0), respectively. Expected pain, heightened illness concern, pain catastrophizing, symptoms of depression, and sex correlated with pain with injection. A multivariable regression model conducted in backward stepwise fashion demonstrated that symptoms of depression, expected pain, and female sex explained 25% of the variance in pain with injection. Pain with injection was the only significant predictor of next day pain and pain greater than 4 points the day after injection.

Conclusion: Our data suggests psychosocial factors are the strongest correlates of pain with corticosteroid injection. Future research will investigate cognitive/behavioral methods for decreasing pain with injection.

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