title: Local steroid injections for tennis elbow: does the pain get worse before it gets better?: Results from a randomized controlled trial.
abstract: OBJECTIVE
  To compare the early effects of local corticosteroid injection, naproxen, and placebo as treatments for tennis elbow in primary care. Specifically, to find out whether the extra pain reduction experienced by patients who are given the steroid injection in the short-term would be realized within the first 5 days of treatment and to attempt to assess how much extra pain may be associated with the injection initially.
  
  
  METHODS
  A randomized controlled trial carried out in 23 family practices in the United Kingdom. A total of 164 patients aged 18 to 70 years presenting with a new episode of tennis elbow were recruited and invited to keep a daily record of their pain intensity and medication use over the first 5 days of randomized treatment using a "diary."
  
  
  RESULTS
  On day 1, pain scores were higher in the injection group compared with the naproxen group and placebo group, and the injection group was also taking more painkillers. By day 4, the converse was true, pain scores were significantly lower in the injection group than the other 2 groups, and patients given an injection were less likely to be taking painkillers than those in the placebo group.
  
  
  CONCLUSIONS
  Steroid injection was associated with an increase in reported pain for the first 24 hours of treatment, but the therapeutic benefits compared with naproxen and placebo were evident 3 to 4 days after the start of treatment.
authors.affiliation: Primary Care Sciences Research Centre, Keele University, Staffordshire, United Kingdom. a.m.lewis@cphc.keele.ac.uk
authors.forename: Martyn
authors.initials: M
authors.lastname: Lewis
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Hay
authors.forename: Susan M
authors.initials: SM
authors.lastname: Paterson
authors.forename: Peter
authors.initials: P
authors.lastname: Croft
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D005194:Family Practice; D005938:Glucocorticoids / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007273:Injections, Intramuscular; D007279:Injections, Subcutaneous; D008297:Male; D008499:Medical Records; D008775:Methylprednisolone / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D008875:Middle Aged; D009288:Naproxen / Q000494:pharmacology / Q000627:therapeutic use; D010147:Pain Measurement / Q000187:drug effects*; D010919:Placebos; D013716:Tennis Elbow / Q000188:drug therapy* / Q000523:psychology; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D010919:Placebos; D009288:Naproxen; D008775:Methylprednisolone