Rationale:
The majority of patients with persistent musculoskeletal pain have complex and non-specific complaints. For these conditions, there is little to no evidence supporting injection treatment. Studies show that injection therapy for tendinopathies (including lateral epicondylalgia, patellar tendinopathy, and Achilles tendinopathy) is less effective than an active, exercise-based approach. When treating patients with long-term musculoskeletal pain, the most important aspects are patient education and guidance to enhance understanding, along with an approach that emphasizes active self-management.
References:
- «Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial» Mellor et al, BMJ, 2018
- “Conservative treatments for greater trochanteric pain syndrome: a systematic review” Baratt et al, BJSM 2017
- «Prevention and treatment of low back pain: evidence, challenges, and promising directions» Foster et al, The Lancet, 2018
- «Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial» Coombes et al, Jama, 2013
- Trygg på skulder i primærhelsetjenesten. Faglig veileder Helsedirektoratet, helsebiblioteket.no (Juel 2019)
- Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy, Kongsgaard et al, 2009