Original article
A Multitest Regimen of Pain Provocation Tests as an Aid to Reduce Unnecessary Minimally Invasive Sacroiliac Joint Procedures

https://doi.org/10.1016/j.apmr.2005.09.023Get rights and content

Abstract

van der Wurff P, Buijs EJ, Groen GJ. A multitest regimen of pain provocation tests as an aid to reduce unnecessary minimally invasive sacroiliac joint procedures.

Objective

To compare the diagnostic accuracy of a multitest regimen of 5 sacroiliac joint (SIJ) pain provocation tests with fluoroscopically controlled double SIJ blocks using a short- and long-acting local anesthetic in order to reduce the exposure of patients to unnecessary invasive SIJ procedures.

Design

Prospective, observational study.

Setting

Hospital setting.

Participants

Sixty patients with chronic low back pain.

Interventions

Not applicable.

Main Outcome Measures

Visual analog scale score and receiver operating characteristic (ROC) curve.

Results

Twenty-seven patients responded positively to the blocks, of whom 23 were found positive after the multitest regimen and 4 were negative. For the nonresponders (n=33), these figures were 7 positive and 26 negative. The calculated sensitivity and specificity were .85 (95% confidence interval [CI], .72–.99) and .79 (95% CI, .65–.93), respectively. Positive and negative predictive values were .77 (95% CI, .62–.92) and .87 (95% CI, .74–.99), respectively. The positive likelihood ratio was 4.02 (95% CI, 2.04–7.89); the negative likelihood ratio was .19 (95% CI, .07–.47). The area under the ROC curve was .799.

Conclusions

The test regimen with 3 or more positive tests is indicative of SIJ pain. It can be used in early clinical decision making to reduce the number of unnecessary minimally invasive diagnostic SIJ 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%

References (25)

  • P. Dreyfuss et al.

    The value of medical history and physical examination in diagnosing sacroiliac joint pain

    Spine

    (1996)
  • H. Elgafy et al.

    Computed tomography findings in patients with sacroiliac pain

    Clin Orthop

    (2001)
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    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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