Q: I'm thinking about having a cortisone injection into my shoulder. Since I'm very sensitive to all medications, can I suggest the physician use a lower dose than usual? Is this out of line?

A: Cortisone injections for various shoulder problems are often used in an attempt to reduce inflammation causing pain and swelling. One of the most common uses is for a condition called subacromial impingement. Subacromial impingement refers to pinching of the soft tissues (bursa, tendons) that pass underneath the acromion (the roof of the shoulder).

Studies have shown the value of corticosteroid injections as a means of reducing inflammation and pain. With accurate injection into the bursa, success has been reported in up to 83 per cent of patients. Now researchers are turning their attention toward finding out the exact dosages that work best.

Like yourself, some people simply respond better if the body isn't overwhelmed by the amount of medication used. Other people may get better results depending on what phase of injury versus recovery they may be in.

For example, there is a question of whether patients with early symptoms get the same (more, less?) results with steroid injections when compared with patients who have chronic shoulder pain (lasting more than six months). In other words, if there isn't active ongoing inflammation, should steroid injections even be used at all?

There was a recent study comparing a low-dose (20mg) of a long-acting corticosteroid to a high-dose (40mg) with patients who had a diagnosis of subacromial impingement. They found that low-dose corticosteroid injection for subacromial impingement was just as effective as high-dose and with fewer side effects.

Certainly talk with your physician about your concerns and questions. If you are going to have a series of one to three injections, ask about the possibility of escalating (increasing) doses from the first to third injection.

It is suggested that the low-dose injection be used as the first injection on a trial basis. Since many patients get up to three injections spaced apart, a low-dose injection could be followed by a higher-dose injection if results of the first injection are not satisfactory.

Reference: Ji Yeon Hong, MD, et al. Comparison of High- and Low-Dose Corticosteroid in Subacromial Injection for Periarticular Shoulder Disorder: A Randomized, Triple-Blind, Placebo-Controlled Trial. In Archives of Physical Medicine and Rehabilitation. December 2011. Vol. 92. No. 12. Pp. 1951-1960.