Are non-steroidal anti-inflammatory drug injections an alternative to steroid injections for musculoskeletal pain?: A systematic review

BACKGROUND: Given the potential side effect profile of steroids, the need for an alternative injectable anti-inflammatory is needed. The purpose of this systematic review was to compare corticosteroid injections with non-steroidal anti-inflammatory drug (NSAID) injections for musculoskeletal pain. METHODS: Reviewers with methodological and content expertise searched three databases: PUBMED, Medline and EMBASE. Two blinded reviewers searched, screened, and evaluated the data quality. Data was abstracted in duplicate. Agreement and descriptive statistics are presented. RESULTS: Four studies were included. All four studies found no statistically significant differences in improvements on the visual analog scale. The follow-up period within the four studies ranged between 2 weeks and 3 months. No statistically significant differences were demonstrated between the two groups with regards to functional outcomes. INTERPRETATION: The studies reviewed, while limited in quantity, show that compared with corticosteroids, NSAIDs provide equivalent, if not better, pain relief from the musculoskeletal ailments assessed. Further, there is weak evidence supporting a lower recurrence rate of symptoms with NSAIDs when compared to corticosteroids. There is a need for more long-term high-quality studies on this topic. LEVEL OF EVIDENCE: Level II (Systematic review of Level II and III studies).