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The purpose of this systematic review was to compare corticosteroid injections with non-steroidal anti-inflammatory drug (NSAID) injections for musculoskeletal painin primary and secondary surgical patients with knee osteoarthritis. A systematic search of MEDLINE (1966-2005) followed by searching of Cochrane and Embase databases for any randomised, controlled trial comparing NSAID to corticosteroid injection for treatment of pain was performed. After the search, 18 randomised, double-blind, placebo-controlled trials of NSAID for osteoarthritis pain were included: 5 randomized, crossover trials; 7 case-reports; 10 case series; 6 case series in children but no placebo-controlled trials in adults. Trials of oral corticosteroids were excluded. The studies included in this systematic review were published from 1950 to 2005. There were no studies comparing corticosteroids with NSAID in secondary surgical patients with osteoarthritis during the same period. A meta-analysis on the relationship between NSAID and treatment pain was done. The mean difference, p-value and 95% confidence interval of mean pain scores after treatment of 0.1 mg NSAID was 0.3 (reference) and 0.4 (interquartile range 0.1 to 0.7) in children and 0.2 (reference) and 0.4 (interquartile range 0.1 to 0.7) in adults, whereas there was no heterogeneity found between studies in terms of treatment pain. These data show that corticosteroid injections are a much less effective treatment for pain in people with osteoarthritis compared with NSAIDs, and that the difference in pain after treatment of 0.1 mg is 0.3 or 0.4. This difference was not found in the Cochrane systematic review. These results suggest that corticosteroid injections should never be used in osteoarthritis patients, since a meta-analysis did not find any evidence of any benefit from corticosteroid injections for osteoarthritis pain . More studies are needed to confirm the findings in children and adults. Related Article: