LACK OF EFFECT OF INTRAARTICULAR CORTICOSTEROIDS FOR CHRONIC PAIN IN THE CERVICAL ZYGAPOPHYSEAL JOINTS

Background. Chronic pain in the cervical zygapophyseal joints is a com mon problem after a whiplash injury. Treatment with intraarticular inj ections of corticosteroid preparations has been advocated, but the val ue of this approach has not been established. We compared the efficacy of a depot injection of a corticosteroid preparation with the efficac y of an injection of a local anesthetic agent in patients with painful cervical zygapophyseal joints. Methods. Sixteen men and 25 women with pain in one or more cervical zygapophyseal joints after automobile ac cidents (mean age, 43 years; median duration of pain, 39 months) were randomly assigned to receive a 1-ml intraarticular injection of either bupivacaine (0.5 percent) or betamethasone (5.7 mg) under double-blin d conditions. The patients were followed by means of regular telephone contact and clinic visits until they reported a return to a level of pain equivalent to 50 percent of the preinjection level. The time from treatment to a 50 percent return of pain was compared in the two grou ps with the use of a survival analysis. Results. Less than half the pa tients reported relief of pain for more than one week, and less than o ne in five patients reported relief for more than one month, irrespect ive of the treatment received. The median time to a return of 50 perce nt of the preinjection level of pain was 3 days in the 21 patients in the corticosteroid group and 3.5 days in the 20 patients in the local- anesthetic group (P = 0.42). Conclusions. Intraarticular injection of betamethasone is not effective therapy for pain in the cervical zygapo physeal joints after a whiplash injury.