1
|
Peene L, Cohen SP, Kallewaard JW, Wolff A, Huygen F, Gaag AVD, Monique S, Vissers K, Gilligan C, Van Zundert J, Van Boxem K. 1. Lumbosacral radicular pain. Pain Pract 2024; 24:525-552. [PMID: 37985718 DOI: 10.1111/papr.13317] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Patients suffering lumbosacral radicular pain report radiating pain in one or more lumbar or sacral dermatomes. In the general population, low back pain with leg pain extending below the knee has an annual prevalence that varies from 9.9% to 25%. METHODS The literature on the diagnosis and treatment of lumbosacral radicular pain was reviewed and summarized. RESULTS Although a patient's history, the pain distribution pattern, and clinical examination may yield a presumptive diagnosis of lumbosacral radicular pain, additional clinical tests may be required. Medical imaging studies can demonstrate or exclude specific underlying pathologies and identify nerve root irritation, while selective diagnostic nerve root blocks can be used to confirm the affected level(s). In subacute lumbosacral radicular pain, transforaminal corticosteroid administration provides short-term pain relief and improves mobility. In chronic lumbosacral radicular pain, pulsed radiofrequency (PRF) treatment adjacent to the spinal ganglion (DRG) can provide pain relief for a longer period in well-selected patients. In cases of refractory pain, epidural adhesiolysis and spinal cord stimulation can be considered in experienced centers. CONCLUSIONS The diagnosis of lumbosacral radicular pain is based on a combination of history, clinical examination, and additional investigations. Epidural steroids can be considered for subacute lumbosacral radicular pain. In chronic lumbosacral radicular pain, PRF adjacent to the DRG is recommended. SCS and epidural adhesiolysis can be considered for cases of refractory pain in specialized centers.
Collapse
Affiliation(s)
- Laurens Peene
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk/Lanaken, Belgium
| | - Steven P Cohen
- Pain Medicine Division, Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jan Willem Kallewaard
- Department of Anesthesiology and Pain Medicine, Rijnstate Ziekenhuis, Velp, The Netherlands
- Anesthesiology and Pain Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Andre Wolff
- Department of Anesthesiology UMCG Pain Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Frank Huygen
- Department of Anesthesiology and Pain Medicine, Erasmusmc, Rotterdam, The Netherlands
- Department of Anesthesiology and Pain Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Antal van de Gaag
- Department of Anesthesiology and Pain Medicine, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Steegers Monique
- Anesthesiology and Pain Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University, Nijmegen, The Netherlands
| | - Chris Gilligan
- Department of Anesthesiology and Pain Medicine, Brigham & Women's Spine Center, Boston, Massachusetts, USA
| | - Jan Van Zundert
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk/Lanaken, Belgium
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Koen Van Boxem
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk/Lanaken, Belgium
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| |
Collapse
|
2
|
Schuttert I, Timmerman H, Groen GJ, Petersen KK, Arendt-Nielsen L, Wolff AP. Human assumed central sensitisation (HACS) in patients with chronic low back pain radiating to the leg (CLaSSICO study). BMJ Open 2022; 12:e052703. [PMID: 35027419 PMCID: PMC8762136 DOI: 10.1136/bmjopen-2021-052703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Patients with chronic low back pain radiating to the leg (CLBPr) are sometimes referred to a specialised pain clinic for a precise diagnosis based, for example, on a diagnostic selective nerve root block. Possible interventions are therapeutic selective nerve root block or pulsed radiofrequency. Central pain sensitisation is not directly assessable in humans and therefore the term 'human assumed central sensitisation' (HACS) is proposed. The possible existence and degree of sensitisation associated with pain mechanisms assumed present in the human central nervous system, its role in the chronification of pain and its interaction with diagnostic and therapeutic interventions are largely unknown in patients with CLBPr. The aim of quantitative sensory testing (QST) is to estimate quantitatively the presence of HACS and accumulating evidence suggest that a subset of patients with CLBPr have facilitated responses to a range of QST tests.The aims of this study are to identify HACS in patients with CLBPr, to determine associations with the effect of selective nerve root blocks and compare outcomes of HACS in patients to healthy volunteers. METHODS AND ANALYSIS A prospective observational study including 50 patients with CLBPr. Measurements are performed before diagnostic and therapeutic nerve root block interventions and at 4 weeks follow-up. Data from patients will be compared with those of 50 sex-matched and age-matched healthy volunteers. The primary study parameters are the outcomes of QST and the Central Sensitisation Inventory. Statistical analyses to be performed will be analysis of variance. ETHICS AND DISSEMINATION The Medical Research Ethics Committee of the University Medical Center Groningen, Groningen, the Netherlands, approved this study (dossier NL60439.042.17). The results will be disseminated via publications in peer-reviewed journals and at conferences. TRIAL REGISTRATION NUMBER NTR NL6765.
Collapse
Affiliation(s)
- Ingrid Schuttert
- Department of Anesthesiology, Pain Center, University Medical Centre Groningen, Groningen, The Netherlands
| | - Hans Timmerman
- Department of Anesthesiology, Pain Center, University Medical Centre Groningen, Groningen, The Netherlands
| | - Gerbrand J Groen
- Department of Anesthesiology, Pain Center, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Aalborg Universitet, Aalborg, Denmark
- Department of Medical Gastroenterology (Mech-Sense), Aalborg University Hospital, Aalborg, Denmark
| | - Andre P Wolff
- Department of Anesthesiology, Pain Center, University Medical Centre Groningen, Groningen, The Netherlands
| |
Collapse
|
3
|
Takahashi N, Kikuchi SI, Yabuki S, Otani K, Konno SI. Diagnostic value of the lumbar extension-loading test in patients with lumbar spinal stenosis: a cross-sectional study. BMC Musculoskelet Disord 2014; 15:259. [PMID: 25080292 PMCID: PMC4236630 DOI: 10.1186/1471-2474-15-259] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 07/18/2014] [Indexed: 11/10/2022] Open
Abstract
Background The gait-loading test is a well known, important test with which to assess the involved spinal level in patients with lumbar spinal stenosis. The lumbar extension-loading test also functions as a diagnostic loading test in patients with lumbar spinal stenosis; however, its efficacy remains uncertain. The purpose of this study was to compare the diagnostic value of the lumbar extension-loading test with that of the gait-loading test in patients with lumbar spinal stenosis. Methods A total of 116 consecutive patients (62 men and 54 women) diagnosed with lumbar spinal stenosis were included in this cross-sectional study of the lumbar extension-loading test. Subjective symptoms and objective neurological findings (motor, sensory, and reflex) were examined before and after the lumbar extension-loading and gait-loading tests. The efficacy of the lumbar extension-loading test for establishment of a correct diagnosis of the involved spinal level was assessed and compared with that of the gait-loading test. Results There were no significant differences between the lumbar extension-loading test and the gait-loading test in terms of subjective symptoms, objective neurological findings, or changes in the involved spinal level before and after each loading test. Conclusions The lumbar extension-loading test is useful for assessment of lumbar spinal stenosis pathology and is capable of accurately determining the involved spinal level.
Collapse
Affiliation(s)
- Naoto Takahashi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan.
| | | | | | | | | |
Collapse
|
4
|
The role of needle tip position on the accuracy of diagnostic selective nerve root blocks in spinal deformity. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23 Suppl 1:S33-9. [PMID: 24458935 DOI: 10.1007/s00586-014-3188-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 01/08/2014] [Accepted: 01/09/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The specificity of a selective nerve root block (SNRB) is dependant on isolating only the required nerve root whilst avoiding injectate flow to traversing nerves. Needle tip position is therefore crucial. Nerve root blocks (SNRBs) in the presence of deformity can be particularly technically challenging to perform. The aims of this study were to document the relationship of needle tip position and SNRB accuracy in patients with and without spinal deformity. METHODS Over an 8-month period, all SNRBs performed by one spinal surgeon were included. Patients with radiographic evidence of spinal deformity were analysed separately and their lumbar deformity graded using the Schwab grading system. Needle tip position in relation to the superior pedicle and flow of contrast was documented. RESULTS 76 patients received 85 injections without deformity, 26 patients with deformity underwent 30 SNRBs. In the normal spinal alignment group, there was on overall accuracy of 70.1% regardless of needle tip position, which improved to 91.8% for a lateral needle tip position (P < 0.001). In patients with deformity, the overall accuracy was significantly lower irrespective of needle tip position 36 versus 70%, respectively (P < 0.0019). CONCLUSIONS Selective nerve root blocks are accurate in patients without deformity where a needle tip placement lateral to the middle third of the pedicle is achieved. The presence of spinal deformity significantly reduces the accuracy of SNRBs with a higher chance of epidural infiltration.
Collapse
|
5
|
Shanthanna H, Chan P, McChesney J, Thabane L, Paul J. Pulsed radiofrequency treatment of the lumbar dorsal root ganglion in patients with chronic lumbar radicular pain: a randomized, placebo-controlled pilot study. J Pain Res 2014; 7:47-55. [PMID: 24453500 PMCID: PMC3894138 DOI: 10.2147/jpr.s55749] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background No proof of efficacy, in the form of a randomized controlled trial (RCT), exists to support pulsed radiofrequency (PRF) treatment of the dorsal root ganglion (DRG) for chronic lumbar radicular (CLR) pain. We determined the feasibility of a larger trial (primary objective), and also explored the efficacy of PRF in decreasing pain on a visual analog scale (VAS) and improving the Oswestry Disability Index. Methods This was a single-center, placebo-controlled, triple-blinded RCT. Patients were randomized to a placebo group (needle placement) or a treatment group (PRF at 42°C for 120 seconds to the DRG). Patients were followed up for 3 months post procedure. Outcomes with regard to pain, Oswestry Disability Index score, and side effects were analyzed on an intention-to-treat basis. Results Over 15 months, 350 potential patients were identified and 56 were assessed for eligibility. Fifteen of them did not meet the selection criteria. Of the 41 eligible patients, 32 (78%) were recruited. One patient opted out before intervention. Three patients were lost to follow-up at 3 months. Mean VAS differences were not significantly different at 4 weeks (−0.36, 95% confidence interval [CI], −2.29, 1.57) or at 3 months (−0.76, 95% CI, −3.14, 1.61). The difference in mean Oswestry Disability Index score was also not significantly different at 4 weeks (−2%, 95% CI, −14%, 10%) or 3 months (−7%, 95% CI, −21%, 6%). There were no major side effects. Six of 16 patients in the PRF group and three of 15 in the placebo group showed a >50% decrease in VAS score. Conclusion The recruitment rate was partially successful. At 3 months, the relative success of PRF-DRG was small. A large-scale trial to establish efficacy is not practically feasible considering the small effect size, which would necessitate recruitment of a challengingly large number of participants over a number of years. Until clear parameters for application of PRF are established, clinicians will need to use their individual judgment regarding its clinical applicability, given the present evidence.
Collapse
Affiliation(s)
- Harsha Shanthanna
- Department of Anesthesia, St Joseph's Hospital, McMaster University, Hamilton, ON, Canada
| | - Philip Chan
- Department of Anesthesia, St Joseph's Hospital, McMaster University, Hamilton, ON, Canada
| | - James McChesney
- Department of Anesthesia, St Joseph's Hospital, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, St Joseph's Hospital, McMaster University, Hamilton, ON, Canada
| | - James Paul
- Department of Anesthesia, St Joseph's Hospital, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
6
|
Freundt MIE, Ritter M, Al-Zghloul M, Groden C, Kerl HU. Laser-guided cervical selective nerve root block with the Dyna-CT: initial experience of three-dimensional puncture planning with an ex-vivo model. PLoS One 2013; 8:e69311. [PMID: 23894448 PMCID: PMC3716595 DOI: 10.1371/journal.pone.0069311] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 06/12/2013] [Indexed: 12/19/2022] Open
Abstract
Background Cervical selective nerve root block (CSNRB) is a well-established, minimally invasive procedure to treat radicular cervical pain. However, the procedure is technically challenging and might lead to major complications. The objective of this study was to evaluate the feasibility of a three-dimensional puncture planning and two-dimensional laser-guidance system for CSNRB in an ex-vivo model. Methods Dyna-CT of the cervical spine of an ex-vivo lamb model was performed with the Artis Zee® Ceiling (Siemens Medical Solutions, Erlangen, Germany) to acquire multiplanar reconstruction images. 15 cervical nerve root punctures were planned and conducted with the syngo iGuide® laser-guidance system. Needle tip location and contrast dye distribution were analyzed by two independent investigators. Procedural, planning, and fluoroscopic time, tract length, and dose area product (DAP) were acquired for each puncture. Results All 15 punctures were rated as successful with 12 punctures on the first attempt. Total procedural time was approximately 5 minutes. Mean planning time for the puncture was 2.03 (±0.39) min. Mean puncture time was 2.16 (±0.32) min, while mean fluoroscopy time was 0.17 (±0.06) min. Mean tract length was 2.68 (±0.23) cm. Mean total DAP was 397.45 (±15.63) µGy m2. Conclusion CSNRB performed with Dyna-CT and the tested laser guidance system is feasible. 3D pre-puncture planning is easy and fast and the laser-guiding system ensures very accurate and intuitive puncture control.
Collapse
Affiliation(s)
- Miriam I E Freundt
- University of Heidelberg, Medical Faculty Mannheim, Department of Neuroradiology, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
| | | | | | | | | |
Collapse
|
7
|
Vanelderen P, Van Boxem K, Van Zundert J. Epiduroscopy: the missing link connecting diagnosis and treatment? Pain Pract 2012; 12:499-501. [PMID: 22891852 DOI: 10.1111/j.1533-2500.2012.00587.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
8
|
van Boxem K, Joosten EA, van Kleef M, Patijn J, van Zundert J. Pulsed radiofrequency treatment for radicular pain: where do we stand and where to go? PAIN MEDICINE 2012; 13:351-4. [PMID: 22360848 DOI: 10.1111/j.1526-4637.2012.01338.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
9
|
Kim SH, Yoon KB, Yoon DM, Choi SA, Kim EM. An Analysis of Location of Needle Entry Point and Palpated PSIS in S1 Nerve Root Block. Korean J Pain 2011; 23:242-6. [PMID: 21217887 PMCID: PMC3000620 DOI: 10.3344/kjp.2010.23.4.242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 10/12/2010] [Accepted: 10/18/2010] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The first sacral nerve root block (S1NRB) is a common procedure in pain clinic for patients complaining of low back pain with radiating pain. It can be performed in the office based setting without C-arm. The previously suggested method of locating the needle entry point begins with identifying the posterior superior iliac spine (PSIS). Then a line is drawn between two points, one of which is 1.5 cm medial to the PSIS, and the other of which is 1.5 cm lateral and cephalad to the ipsilateral cornu. After that, one point on the line, which is 1.5 cm cephalad to the level of the PSIS, is considered as the needle entry point. The purpose of this study was to analyze the location of needle entry point and palpated PSIS in S1NRB. METHODS Fifty patients undergoing C-arm guided S1NRB in the prone position were examined. The surface anatomical relationships between the palpated PSIS and the needle entry point were assessed. RESULTS The analysis revealed that the transverse and vertical distance between the needle entry point and PSIS were 28.7 ± 8.8 mm medially and 3.5 ± 14.0 mm caudally, respectively. The transverse distance was 27.8 ± 8.3 mm medially for male and 29.5 ± 9.3 mm medially for female. The vertical distance was 1.0 ± 14.1 mm cranially for male and 8.1 ± 12.7 mm caudally for female. CONCLUSIONS The needle entry point in S1NRB is located on the same line or in the caudal direction from the PSIS in a considerable number of cases. Therefore previous recommended methods cannot be applied to many cases.
Collapse
Affiliation(s)
- Shin Hyung Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | | | | | | | | |
Collapse
|
10
|
Benedetti EM, Siriwetchadarak R. Selective nerve root blocks as predictors of surgical outcome: Fact or fiction? ACTA ACUST UNITED AC 2011. [DOI: 10.1053/j.trap.2011.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
11
|
Insausti Valdivia J. [Non-specific lower back pain: In search of the origin of pain]. REUMATOLOGIA CLINICA 2009; 5 Suppl 2:19-26. [PMID: 21794654 DOI: 10.1016/j.reuma.2009.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2009] [Accepted: 04/08/2009] [Indexed: 05/31/2023]
Abstract
Lower back pain is a condition considered benign and with a specific cause determined only in 15% of patients. In the past years this concept has varied, because many papers have described no benign condition leading to back pain, citing their capacity to cause disability. Through many different diagnostic techniques it is possible to identify the structures capable of producing back pain. This identification, and the level of evidence of the interventional techniques, is the aim of this paper.
Collapse
|
12
|
Puljak L, Kojundzic SL, Hogan QH, Sapunar D. Lidocaine injection into the rat dorsal root ganglion causes neuroinflammation. Anesth Analg 2009; 108:1021-6. [PMID: 19224819 DOI: 10.1213/ane.0b013e318193873e] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Injury of a spinal nerve or dorsal root ganglion (DRG) during selective spinal nerve blocks is a potentially serious complication that has not been adequately investigated. Our hypothesis was that local anesthetic injection into these structures may result in an inflammatory response and hyperalgesia. METHODS We evaluated inflammatory and behavioral responses after injection of 4 microL lidocaine or saline into the L5 spinal nerve or DRG of rats after partial laminectomy. Behavioral testing was performed before and after surgery to examine hyperalgesia in response to nociceptive mechanical stimulation of the foot. DRGs were harvested and stained, and rings of immunoreactive glial cells around neurons were counted. RESULTS Animals demonstrated hyperalgesia on the ipsilateral paw up to 4 days after lidocaine injection into the DRG but not after injection into the spinal nerve. The number of glial fibrillary acid protein immunopositive glial cell rings, which represent activation of satellite cells, significantly increased in DRGs after injection of lidocaine into either the DRG or the spinal nerve. The number of glial fibrillary acid protein-positive cells in the lidocaine-injected group was significantly larger than in the saline-injected group. Sporadic OX-42 immunopositive cells, which represent activated microglia, were also seen in lidocaine-injected DRGs. Testing for Pan-T expression, which labels activated T lymphocytes, showed no positive cells. CONCLUSIONS Lidocaine injection into the DRG may produce hyperalgesia, possibly due to activation of resident satellite glial cells. In a clinical setting, local anesthetic injection into the DRG should be avoided during selective spinal nerve blocks.
Collapse
Affiliation(s)
- Livia Puljak
- Department of Histology and Embryology, University of Split School of Medicine, Soltanska 2, 21000 Split, Croatia.
| | | | | | | |
Collapse
|
13
|
Heran MKS, Smith AD, Legiehn GM. Spinal injection procedures: a review of concepts, controversies, and complications. Radiol Clin North Am 2008; 46:487-514, v-vi. [PMID: 18707959 DOI: 10.1016/j.rcl.2008.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The field of spinal injection procedures is growing at a tremendous rate. Many disciplines are involved, including radiology, anesthesiology, orthopedics, physiatry and rehabilitation medicine, as well as other specialties. However, there remains tremendous variability in the assessment of patients receiving these therapies, methods for evaluation of outcome, and in the understanding of where these procedures belong in the triaging of those who require surgery. In this article, we attempt to highlight the biologic concepts on which these therapies are based, controversies that have arisen with their increasing use, and a description of complications that have been reported.
Collapse
Affiliation(s)
- Manraj K S Heran
- Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, 899 West 12th Avenue, Vancouver, BC, Canada.
| | | | | |
Collapse
|
14
|
van der Wurff P, Buijs EJ, Groen GJ. Intensity mapping of pain referral areas in sacroiliac joint pain patients. J Manipulative Physiol Ther 2006; 29:190-5. [PMID: 16584942 DOI: 10.1016/j.jmpt.2006.01.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Revised: 09/11/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify differences in pain referral areas, using intensity maps, between responders and nonresponders to a double diagnostic sacroiliac joint injection with a short- and long-acting local anesthetic in patients with chronic low back pain. METHODS From a group of 140 consecutive patients with chronic low back pain, 60 patients who met clinical criteria were included in the study. Twenty-seven demonstrated a positive response to a double diagnostic fluoroscopically guided intra-articular sacroiliac joint block and were compared with 33 patients with a negative response. Each patient's preinjection pain diagram was used to determine areas of pain referral. The summation of these pain referral zones for both groups was used to construct intensity maps. RESULTS No major differences were observed between responders and nonresponders with regard to mean size and distribution of referral pain areas. Intensity maps, however, showed differences in pain referral at the buttock in the areas overlying the sacroiliac joint (100% of the responders vs 80% of the nonresponders) and the ischial tuberosity (10% of the responders vs 100% of the nonresponders). CONCLUSIONS Overall referred pain maps appeared not to be useful to discriminate patients with an identified sacroiliac joint pain from chronic low back pain patients with pain from other sources. Differences were only found using intensity maps. By implementing these data, it could be concluded that patients with sacroiliac joint pain are less likely to experience pain in both the 'Fortin' and 'tuber' areas. This knowledge can be used as additional selection criterion for putative sacroiliac joint patients, next to sacroiliac joint pain provocation tests.
Collapse
Affiliation(s)
- Peter van der Wurff
- Division of Perioperative Medicine and Emergency Care, Department of Anesthesiology and Pain Treatment, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands.
| | | | | |
Collapse
|
15
|
Wolff AP, Groen GJ, Wilder-Smith OHG. Diagnosis of chronic radiating lower back pain without overt focal neurologic deficits: what is the value of segmental nerve blocks? ACTA ACUST UNITED AC 2005. [DOI: 10.2217/14750708.2.4.577] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|