Overview of local corticosteroid injections for musculoskeletal pain

Intra-articular injection, or injection into soft tissue, of a long-acting or depot corticosteroid can provide analgesia for musculoskeletal pain. The potential benefits and harms of corticosteroid injections vary with different musculoskeletal conditions and patient factors.

When considering using a local corticosteroid for musculoskeletal pain, clinicians should be aware that:

• only corticosteroids specifically formulated for intra-articular injection or injection into soft tissue should be used
• local anaesthetic may be used before, or mixed with, the corticosteroid injection
• most locally injected corticosteroids will have a similar therapeutic effect; drug choice is often influenced by availability.

The following features of specific corticosteroids may also influence choice:

• betamethasone sodium phosphate plus betamethasone acetate is usually used for injection into smaller joints and superficial soft tissues as it is more soluble and may cause less irritation
• methylprednisolone acetate is crystalline and is formulated as a suspension; it is usually used for injection into larger joints
• triamcinolone hexacetonide is preferred (and only available for use) in children and needle-phobic adolescents, because of its longer half-life and decreased frequency of injection.

Therapeutic anticoagulation is not a contraindication to local corticosteroid injectionConway, 2013.

For principles of using of systemic corticosteroids, see Principles of immunomodulatory drug use.