Original articleA Multitest Regimen of Pain Provocation Tests as an Aid to Reduce Unnecessary Minimally Invasive Sacroiliac Joint Procedures
Section snippets
Methods
The Medical Ethical Approval Committee of the Gelre Hospital Apeldoorn, the Netherlands, approved this study. The nature of this prospective, observational study and the potential hazards of the diagnostic procedures were explained and informed consent was obtained from all patients before their participation.
Patients for this study were selected from among those with chronic LBP (CLBP) referred to the pain clinic of the Gelre Hospital Apeldoorn for further invasive diagnostic and therapeutic
Results
Between January 2001 and April 2002, a total number of 140 patients with CLBP visited the pain clinic of the Gelre Hospital Apeldoorn, The Netherlands. Sixty patients entered the study. The characteristics of the study population, sex, age, duration of complaints, ODI score, SCL-90 score, and VAS score are shown in table 1. There were no statistically significant differences between 27 positive (45%) and 33 negative responders (55%) to the diagnostic SIJ blocks.
Leakage of the anesthetic fluid,
Discussion
An evident correlation was found between the outcome of 3 or more positive SIJ pain provocation tests and the outcome of double intra-articular SIJ blocks. For 3 or more positive tests, the ROC curve shows optimal results for sensitivity (85%), specificity (79%), negative (87%) and positive (77%) predictive values, and likelihood ratios. The sensitivity and specificity values are in the range of being acceptable. Sensitivity and specificity rates cannot be used to quantify the shift in
Conclusions
This study, designed to determine the relevance of a multitest regimen of SIJ provocation tests, shows that application of this regimen may be useful in reducing unnecessary intra-articular SIJ blocks in the early stage of clinical decision making. When 3 or more provocation tests are positive, the probability is between 65% and 93% that the pain is related to the SIJ, in which case confirming SIJ blocks are required. With fewer than 3 provocation tests positive, the probability is between 72%
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