Suprascapular nerve block with Marcaine alone effectively controls chronic shoulder pain in patients with rheumatoid arthritis

ABSTRACT

Chronic shoulder pain is a frequent and disabling symptom in patients with rheumatoid arthritis [RA]. It has previously been shown that a suprascapular nerve block [SSNB] using the standard mixture of bupivacaine and adrenaline [Ba] plus methylprednisolonc [P] which is routinely used in pain clinics results in a significant improvement in pain relief and range of movement compared to conventional intra-articular steroid injections in such patients. We conducted a double blind study in 29 patients with RA to compare SSNB induced with Ba [Marcain] alone to that induced by using the conventional mixture of Ba plus P. Highly significant improvements [p < 0.001] were noted in measures of pain, stiffness and range of most movements for both treatments [up to 3 months] compared to baseline. Results favoured Marcain alone, the differences between the two therapies reached statistical significance [p < 0.05] for stiffness [at 12 weeks] and active abduction [at 1 week]. We conclude that the addition of methylprednisolone to the SSNB mixture confers no benefit. This has implications for the management of other causes of shoulder pain