A more recent study of patients having injections for trigger digits (Julka 2012) tried to study factors which might predict pain both at the time of injection itself, and during the next 24 hours (looking for the phenomenon of 'steroid flare'). They used the familar 0-10 subjective pain scale where 0=no pain and 10=the worst pain imaginable. For trigger digit injections the mean pain score was with a range from 0 to 10! and the average pain score 24 hours later was with 17/100 patients reporting pain the following day which was equal to or greater than the pain experienced with the injection itself - a possible indicator of 'steroid flare'. The best predictor of pain on injection was the patient's pre-injection expectation - ie those patients who expected it to hurt a lot tended to experience more pain. Females and patients with high scores on a questionnaire designed to detect depression also had higher pain scores. The only predictor of next day pain was the pain experienced at the time of the injection. It may well be, therefore, that patients who do experience a lot of pain on injection might be causing others to experience more pain on injection by going around telling everyone what a terrible experience injection was!
Many doctors suggest that younger patients – mostly under 30 years old – who have only experienced mild carpal tunnel symptoms have a much greater probability of benefiting from cortisone shots Still, that’s not to say that steroid treatment is totally ineffective. As with many medical treatments, the impact that steroid treatment has is dependent on the severity and duration of the patient’s symptoms. Many doctors suggest that younger patients – mostly under 30 years old – who have only experienced mild carpal tunnel symptoms have a much greater probability of benefiting from cortisone shots. Since the symptoms haven’t been present for as long as a patient with a more protracted case of carpal tunnel, the pressure on the median nerve isn’t as severe. This allows the steroid injections to have a greater effect on the tissue.