scholarly journals Low back pain: Sacroiliac joint pain may be myth

BMJ ◽  
2004 ◽  
Vol 329 (7459) ◽  
pp. 232.1 ◽  
Author(s):  
Andrew N Bamji
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Sacroiliac Joint ◽  
Joint Pain ◽  
Low Back ◽  
Sacroiliac Joint Pain

scholarly journals Sacroiliac Joint Interventions: A Systematic Review

2007 ◽  
Vol 1;10 (1;1) ◽  
pp. 165-184
Author(s):  
Hans C. Hansen
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Local Anesthetic ◽  
Sacroiliac Joint ◽  
Joint Pain ◽  
Low Back ◽  
Sacroiliac Joint Pain ◽  
Radiofrequency Neurotomy ◽  
Joint Injections

Background: The sacroiliac joint is a diarthrodial synovial joint with abundant innervation and capability of being a source of low back pain and referred pain in the lower extremity. There are no definite historical, physical, or radiological features to provide definite diagnosis of sacroiliac joint pain, although many authors have advocated provocational maneuvers to suggest sacroiliac joint as a pain generator. An accurate diagnosis is made by controlled sacroiliac joint diagnostic blocks. The sacroiliac joint has been shown to be a source of pain in 10% to 27% of suspected cases with chronic low back pain utilizing controlled comparative local anesthetic blocks. Intraarticular injections, and radiofrequency neurotomy have been described as therapeutic measures. This systematic review was performed to assess diagnostic testing (non-invasive versus interventional diagnostic techniques) and to evaluate the clinical usefulness of interventional techniques in the management of chronic sacroiliac joint pain. Objective: To evaluate and update the available evidence regarding diagnostic and therapeutic sacroiliac joint interventions in the management of sacroiliac joint pain. Study Design: A systematic review using the criteria as outlined by the Agency for Healthcare Research and Quality (AHRQ), Cochrane Review Group Criteria for therapeutic interventions and AHRQ, and Quality Assessment for Diagnostic Accuracy Studies (QUADAS) for diagnostic studies. Methods: The databases of EMBASE and MEDLINE (1966 to December 2006), and Cochrane Reviews were searched. The searches included systematic reviews, narrative reviews, prospective and retrospective studies, and cross-references from articles reviewed. The search strategy included sacroiliac joint pain and dysfunction, sacroiliac joint injections, interventions, and radiofrequency. Results: The results of this systematic evaluation revealed that for diagnostic purposes, there is moderate evidence showing the accuracy of comparative, controlled local anesthetic blocks. Prevalence of sacroiliac joint pain is estimated to range between 10% and 27% using a double block paradigm. The false-positive rate of single, uncontrolled, sacroiliac joint injections is around 20%. The evidence for provocative testing to diagnose sacroiliac joint pain is limited. For therapeutic purposes, intraarticular sacroiliac joint injections with steroid and radiofrequency neurotomy were evaluated. Based on this review, there is limited evidence for short-term and longterm relief with intraarticular sacroiliac joint injections and radiofrequency thermoneurolysis. Conclusions: The evidence for the specificity and validity of diagnostic sacroiliac joint injections is moderate. The evidence for accuracy of provocative maneuvers in diagnosis of sacroiliac joint pain is limited. The evidence for therapeutic intraarticular sacroiliac joint injections is limited. The evidence for radiofrequency neurotomy in managing chronic sacroiliac joint pain is limited. Keywords: Low back pain, sacroiliac joint pain, axial pain, spinal pain, diagnostic block, sacroiliac joint injection, thermal radiofrequency, and pulsed radiofrequency

Audit of Conservative Management of Chronic Low Back Pain in a Secondary Care Setting – Part I: Facet Joint and Sacroiliac Joint Interventions

2004 ◽  
Vol 22 (4) ◽  
pp. 207-213 ◽  
Author(s):  
Robin Chakraverty ◽  
Richard Dias
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Conservative Management ◽  
Sacroiliac Joint ◽  
Joint Pain ◽  
Facet Joint ◽  
Low Back ◽  
Sacroiliac Joint Pain ◽  
Radiofrequency Denervation ◽  
Facet Joint Pain

The work of a chronic back pain service in secondary care in the West Midlands is reported. The service offers acupuncture, spinal injection procedures, osteopathy and a range of other interventions for patients whose back pain has not responded to conservative management. This section of the report focuses on injection procedures for lumbar facet joint and sacroiliac joint pain, which have been shown to be the cause of chronic low back pain in 16–40% and 13–19% of patients respectively. Diagnosis relies on the use of intra-articular or sensory nerve block injections with local anaesthetic. Possible treatments following diagnosis include intra-articular corticosteroid, radiofrequency denervation (for facet joint pain) or ligament prolotherapy injections (for sacroiliac joint pain). The results of several hospital audits are reported. At six month follow up, 50% of 38 patients undergoing radiofrequency denervation following diagnostic blocks for facet joint pain had improved by more than 50%, compared to 29% of 34 patients treated with intra-articular corticosteroid injection. Sixty three per cent of 19 patients undergoing prolotherapy following diagnostic block injection for sacroiliac joint pain had improved at six months, compared to 33% of 33 who had intra-articular corticosteroid. Both radiofrequency denervation and sacroiliac prolotherapy showed good long-term outcomes at one year.

scholarly journals A Systematic Evaluation of Prevalence and Diagnostic Accuracy of Sacroiliac Joint Interventions

2012 ◽  
Vol 3;15 (3;5) ◽  
pp. E305-E344 ◽  
Author(s):  
Thomas T. Simopoulos
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Diagnostic Accuracy ◽  
Local Anesthetic ◽  
Sacroiliac Joint ◽  
Joint Pain ◽  
The United States ◽  
Low Back ◽  
Sacroiliac Joint Pain

Background: The contributions of the sacroiliac joint to low back and lower extremity pain have been a subject of considerable debate and research. It is generally accepted that 10% to 25% of patients with persistent mechanical low back pain below L5 have pain secondary to sacroiliac joint pathology. However, no single historical, physical exam, or radiological feature can definitively establish a diagnosis of sacroiliac joint pain. Based on present knowledge, a proper diagnosis can only be made using controlled diagnostic blocks. The diagnosis and treatment of sacroiliac joint pain continue to be characterized by wide variability and a paucity of the literature. Objective: To evaluate the accuracy of diagnostic sacroiliac joint interventions. Study Design: A systematic review of diagnostic sacroiliac joint interventions. Methods: Methodological quality assessment of included studies was performed using Quality Appraisal of Reliability Studies (QAREL). Only diagnostic accuracy studies meeting at least 50% of the designated inclusion criteria were utilized for analysis. Studies scoring less than 50% are presented descriptively and analyzed critically. The level of evidence was classified as good, fair, or limited (or poor) based on the quality of evidence developed by the United States Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to December 2011, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: In this evaluation we utilized controlled local anesthetic blocks using at least 50% pain relief as the reference standard. Results: The evidence is good for the diagnosis of sacroiliac joint pain utilizing controlled comparative local anesthetic blocks. The prevalence of sacroiliac joint pain is estimated to range between 10% and 62% based on the setting; however, the majority of analyzed studies suggest a point prevalence of around 25%, with a false-positive rate for uncontrolled blocks of approximately 20%. The evidence for provocative testing to diagnose sacroiliac joint pain was fair. The evidence for the diagnostic accuracy of imaging is limited. Limitations: The limitations of this systematic review include a paucity of literature, variations in technique, and variable criterion standards for the diagnosis of sacroiliac joint pain. Conclusions: Based on this systematic review, the evidence for the diagnostic accuracy of sacroiliac joint injections is good, the evidence for provocation maneuvers is fair, and evidence for imaging is limited. Key words: Chronic low back pain, sacroiliac joint pain, sacroiliitis, sacroiliac joint injection, sacroiliac joint dysfunction, provocation manuevers, controlled diagnostic blocks, intraarticular injection, extraarticular injection.

scholarly journals Is the History of a Surgical Discectomy Related to the Source of Chronic Low Back Pain?

2012 ◽  
Vol 1;15 (1;1) ◽  
pp. E53-E58
Author(s):  
Michael J. DePalma
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Sacroiliac Joint ◽  
Joint Pain ◽  
Facet Joint ◽  
Small Sample ◽  
Medial Branch ◽  
Low Back ◽  
Discogenic Pain ◽  
History Of

Background: Recurrent or persistent low back pain (LBP) after surgical discectomy (SD) for intervertebral disc herniation has been well documented. The source of low back pain in these patients has not been examined. Objective: To compare the distribution of the source of chronic LBP between patients with and without a history of SD. Study Design: Retrospective chart review. Setting: Academic spine center. Patients: Charts from 358 consecutive patients were reviewed. Charts noting the absence/ presence of SD in patients who subsequently underwent diagnostic injections to determine the source of chronic LBP were included resulting in 158 unique cases for analysis. Methods: Patients underwent either dual diagnostic facet joint blocks, intra-articular diagnostic sacroiliac joint injections, provocation lumbar discography, or anesthetic injection into putatively painful interspinous ligaments/opposing spinous processes/posterior fusion hardware. If the initial diagnostic procedure was negative, the next most likely structure in the diagnostic algorithm was interrogated. Subsequent diagnostic procedures were not performed after the source of chronic LBP was identified. Outcome: The source of chronic LBP was diagnosed as discogenic pain (DP), facet joint pain (FJP), sacroiliac joint pain (SIJP), or other sources of chronic LBP. Results: Based on a Fisher’s exact test, there was marginal evidence the distribution of the source of chronic LBP differed for those with and without a history of SD (P = 0.080). Posthoc comparisons suggested that patients with a history of SD have a higher probability of DP compared to those without a history of SD (82% versus 41%; P = 0.011). Differences in the probability of FJP, SIJP, or other sources between the SD history groups were not significant. Limitations: Small sample size, restrospective design, and possible false-positive results. Conclusions: This is the first published investigation of the tissue source of chronic LBP after SD. It appears that DP is the most common reason for chronic LBP after SD. If more rigorous study confirms our findings, future biologic treatments may hold value in repairing symptomatic annular fissures after SD. Key words: surgical discectomy, chornic low back pain, discogenic pain, facet joint, sacroiliac joint, low back pain, diagnostic injections, medial branch block, lumbar provcation discography

scholarly journals POLA DISTRIBUSI NYERI ALIH DAN POSISI TUBUH PENCETUS NYERI SENDI SAKROILIAKA

2018 ◽  
Vol 35 (2) ◽  
Author(s):  
Yusak Mangara Tua Siahaan ◽  
Vivien Puspitasari ◽  
Vinson Hartoyo
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Distribution Pattern ◽  
Sacroiliac Joint ◽  
Joint Pain ◽  
Lateral Part ◽  
Low Back ◽  
Long Period ◽  
Pain Area ◽  
Pain Distribution

REFERRAL PAIN DISTRIBUTION PATTERN AND TRIGGERING POSITION OF SACROILIAC JOINT PAINABSTRACTIntroduction: sacroiliac joint (sIJ) contribution to cause low back pain is still widely debated. sIJ is hardly distinguished from facet joint pain or other musculoskeletal disorder causing low back pain and leads to diagnostic difficulties. There are several factors that contribute to SIJ pain diagnosis, which are referral pain area and triggering position.Aim: To investigate the distribution pattern of referral pain and position that could trigger the sacroiliac joint pain.Method: Patients with complaints of pain in buttock area and diagnosed as sIJ pain by intra articular block diagnostic test at Neurology Clinic of of siloam Hospitals Lippo Village between August to december 2017 were interviewed to record the area of referral pain and position which triggered the pain.Results: 114 subjects with complaint of buttock pain, ratio between men and women was 1:2.35 (n=34 and 80), were included in this study. Posterior compartment of the thigh (19.3%, n=22) is the most common referral pain area followed by lateral part of the thigh (11.4%, n=13). Getting up from sitting position and long period of sitting were the two most dominant factors that could trigger pain (61.4%, n=70 and 49.1%, n=56).Discussion: The referral pain distribution pattern of sacroiliac joint pain was dominated by the posterior part and lateral part of thigh, while getting up from sitting and long period of sitting is found in majority of the subjects as the most dominant triggering position.Keywords: Pain pattern, sacroiliac joint pain, triggering positionABSTRAKPendahuluan: Kontribusi nyeri sendi sakroiliaka sebagai penyebab nyeri pinggang masih menjadi perdebatan. Secara klinis, nyeri sendi sakroiliaka sulit dibedakan dengan nyeri sendi faset lumbal maupun gangguan muskuloskeletal lainnya sehingga menyulitkan dalam diagnosis. Terdapat faktor yang memengaruhi terjadinya nyeri sendi sakroiliaka antara lain posisi tubuh yang mencetuskan nyeri dan area nyeri alih yang menyertainya.Tujuan: Untuk mengetahui pola distribusi nyeri alih dan faktor posisi tubuh yang mencetuskan atau memperberat nyeri sendi sakroiliaka.Metode: Pasien yang datang dengan keluhan nyeri bokong yang terdiagnosis mengalami nyeri sendi sakroiliaka berdasarkan tes diagnostik injeksi blok intraartikular di poliklinik saraf RS Siloam Lippo Village dalam rentang waktu Agustus–Desember 2017 dilakukan wawancara untuk mengetahui area nyeri alih dan posisi pencetus nyeri.Hasil: Sebanyak 114 pasien dengan keluhan pada area bokong, rasio antara laki-laki dan perempuan dengan perbandingan 1:2,35 (n=34 dan 80) diikutsertakan dalam studi ini. Paha bagian posterior merupakan area nyeri alih terbanyak (19,3%, n=22) diikuti area paha lateralis (11,4%, n=13). Sedangkan posisi tubuh yang paling dominan memicu timbulnya nyeri sendi sakroiliaka adalah posisi bangun dari duduk (61,4%, n=70) dan duduk lama (49,1%, n=56).Diskusi: Pola distribusi nyeri alih pada pasien nyeri sendi sakroiliaka yang paling banyak ditemukan adalah nyeri pada daerah paha sisi posterior dan paha sisi lateral sedangkan faktor yang paling dominan mencetuskan atau memperberat nyeri sendi sakroiliaka adalah posisi bangun dari duduk dan posisi duduk yang lama.Kata kunci: Nyeri sendi sakroiliaka, pola nyeri, posisi tubuh pencetus

scholarly journals Multivariable Analysis of the Relationship Between Pain Referral Patterns and the Source of Chronic Low Back Pain

2012 ◽  
Vol 2;15 (2;3) ◽  
pp. 171-178
Author(s):  
Michael J. DePalma
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Sacroiliac Joint ◽  
Joint Pain ◽  
Facet Joint ◽  
Thigh Pain ◽  
Leg Pain ◽  
Low Back ◽  
Referral Patterns

Background: Discogenic, facet joint, and sacroiliac joint mediated axial low back pain may be associated with overlapping pain referral patterns into the lower limb. Differences between pain referral patterns for these three structures have not been systematically investigated. Objective: To examine the individual and combined relationship of age, hip/girdle pain, leg pain, and thigh pain and the source of internal disc disruption (IDD), facet joint pain (FJP), or sacroiliac joint pain (SIJP) in consecutive chronic low back pain (CLBP) patients. Design: Retrospective chart review. Setting: Community based interventional spine practice. Patients: 378 cases from 358 consecutive patients were reviewed and 157 independent cases from 153 patients who underwent definitive diagnostic injections were analyzed. Methods: Charts of consecutive low back pain patients who underwent definitive diagnostic spinal procedures were retrospectively reviewed. Patients underwent provocation lumbar discography, dual diagnostic medial branch blocks, or intra-articular diagnostic sacroiliac joint injections based on clinical presentation. Some subjects underwent multiple diagnostic injections until the source of their chronic low back pain (CLBP) was identified. Main Outcome Measurements: Based on the results of diagnostic injections, subjects were classified as having IDD, FJP, SIJP, or other. The mean age/standard deviation and the count/percentage of patients reporting hip girdle pain, leg pain, or thigh pain were estimated for each diagnostic group and compared statistically among the IDD, FJP, SIJP, and other source groups. Next, the 4 predictor variables were simultaneously modeled with a single multinomial logistic regression model to explore the adjusted relationship between the predictors and the source of CLBP. Results: The mean age was significantly different among the source groups. IDD cases were significantly younger than FJP, SIJP, and other source groups and FJP cases were significantly younger than other sources. The age by thigh pain interaction effect was statistically significant (P = 0.021), indicating that the effect of age on the source of CLBP depends on thigh pain, and similarly, that the effect of thigh pain on the source of CLBP depends on age. Limitations: Retrospective study design. Conclusions: The presence or absence of thigh pain possesses a significant correlation on the source of CLBP for varying ages, whereas the presence of hip/girdle pain or leg pain did not significantly discriminate among IDD, FJP, or SIJP as the etiology of CLBP. Younger age was predictive of IDD regardless of the presence or absence of thigh pain. Key words: low back pain, intervertebral disc, zygapophyseal joint, sacroiliac joint, pain referral patterns

scholarly journals Chronic sacroiliac joint pain treated with pulsed radiofrequency ablation

2020 ◽  
Vol 3 (1) ◽  
pp. 9-11
Author(s):  
Farid Yudoyono ◽  
Dewi Pratiwi ◽  
Hendra Gunawan ◽  
Deasy Herminawaty
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Radiofrequency Ablation ◽  
Sacroiliac Joint ◽  
Joint Pain ◽  
Low Back ◽  
Pulsed Radiofrequency ◽  
Sacroiliac Joints ◽  
Aging Society ◽  
Si Joint

Chronic sacroiliac joint (SI) pain can cause disability in an aging society. Effective treatment of low back pain (LBP) originating from sacroiliac joints is difficult to achieve. We report the successful treatment of pulsed radiofrequency (PRF) ablation in a patient with chronic SI joint pain. There were no post-interventional complications. Clinical improvement reported after 12 months.

scholarly journals Fluoroscopic-guided sacroiliac joint injections for treatment of chronic axial low back pain in a tertiary Hospital in Nigeria: a preliminary study

2018 ◽  
Vol 52 (3) ◽  
pp. 153-157
Author(s):  
Zakari A. Suleiman ◽  
Israel K. Kolawole ◽  
Ajibade Okeyemi
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Relief ◽  
Chronic Low Back Pain ◽  
Sacroiliac Joint ◽  
Joint Pain ◽  
Steroid Injection ◽  
Tertiary Hospital ◽  
Low Back ◽  
Si Joint

Background: The injection of mixture of plain bupivacaine and triamcinolone acetonide into the sacroiliac joint (SIJ) to relieve chronic low back pain is uncommon in the West African sub-region. The objective of this study was to demonstrate the efficacy or otherwise of fluoroscopic-guided SI joint injection in the management of chronic axial low back pain in Nigeria.Design: This was a prospective observational interventional studySetting: The study was carried out at a tertiary hospital in NigeriaParticipants: Twenty-six patients with SI joint pain, based on IASP diagnostic criteria, who presented to our unit over 36 months from March 2012 to March 2015 and.Interventions: Fluoroscopic-guided injections of 5mls mixture of bupivacaine and triamcinolone acetonide into the sacro-iliac (SI) joints of 26 patients with SI joint pain out of 116 patients who were offered different interventions for chronic low back pain. The patients were followed up for year and pain intensity and functional status were assessed at 3-, 6- and 12 months post-intervention.Main outcome measures: Pain relief and functional improvement were the main outcome measures.Results: The mean numeric rating score (NRS) and Oswestry Disability index (ODI) score in 14 (53.9%) patients at 12 months post-interventions were significantly lower compared with baseline values; 3.19 ± 1.10 vs 8.54 ±1.14 p=0.000 and 25.35 ± 5.40 vs 37.54 ±8.41, p=0.000 respectively.Conclusion: Fluoroscopic-guided steroid injection into the SI joint resulted into reduction in pain intensity and improved physical function in the majority of patients with SI joint pain. Funding: Not declaredKeywords: Axial low back pain, sacroiliac joint, steroid injection, fluoroscopy, pain relief

Sign in / Sign up

Export Citation Format

Share Document