Intensity mapping of pain referral areas in sacroiliac joint pain patients

Wurff, Peter van der; Buijs, Evert J.; Groen, Gerbrand J.

doi:10.1016/j.jmpt.2006.01.007

Cited by 73 publications

(21 citation statements)

References 25 publications

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“…Results are presented in Additional file 7. Four studies [32, 44–46] from the Hancock review and three studies [47–49] from our updated search were included (Table 2). …”

Section: Resultsmentioning

confidence: 99%

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Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews

Petersen¹,

Laslett²,

Juhl

2017

BMC Musculoskelet Disord

142

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BackgroundClinical examination findings are used in primary care to give an initial diagnosis to patients with low back pain and related leg symptoms. The purpose of this study was to develop best evidence Clinical Diagnostic Rules (CDR] for the identification of the most common patho-anatomical disorders in the lumbar spine; i.e. intervertebral discs, sacroiliac joints, facet joints, bone, muscles, nerve roots, muscles, peripheral nerve tissue, and central nervous system sensitization.MethodsA sensitive electronic search strategy using MEDLINE, EMBASE and CINAHL databases was combined with hand searching and citation tracking to identify eligible studies. Criteria for inclusion were: persons with low back pain with or without related leg symptoms, history or physical examination findings suitable for use in primary care, comparison with acceptable reference standards, and statistical reporting permitting calculation of diagnostic value. Quality assessments were made independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies tool. Clinical examination findings that were investigated by at least two studies were included and results that met our predefined threshold of positive likelihood ratio ≥ 2 or negative likelihood ratio ≤ 0.5 were considered for the CDR.ResultsSixty-four studies satisfied our eligible criteria. We were able to construct promising CDRs for symptomatic intervertebral disc, sacroiliac joint, spondylolisthesis, disc herniation with nerve root involvement, and spinal stenosis. Single clinical test appear not to be as useful as clusters of tests that are more closely in line with clinical decision making.ConclusionsThis is the first comprehensive systematic review of diagnostic accuracy studies that evaluate clinical examination findings for their ability to identify the most common patho-anatomical disorders in the lumbar spine. In some diagnostic categories we have sufficient evidence to recommend a CDR. In others, we have only preliminary evidence that needs testing in future studies. Most findings were tested in secondary or tertiary care. Thus, the accuracy of the findings in a primary care setting has yet to be confirmed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1549-6) contains supplementary material, which is available to authorized users.

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“…Results are presented in Additional file 7. Four studies [32, 44–46] from the Hancock review and three studies [47–49] from our updated search were included (Table 2). …”

Section: Resultsmentioning

confidence: 99%

“…This finding was only investigated in one study using the double block standard [49]. However, the usefulness is supported by the fact that all included studies comprised patients with pain location in the PSIS area and it is a logical assumption that a strict interpretation of pain location; i.e.…”

Section: Resultsmentioning

confidence: 99%

Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews

Petersen¹,

Laslett²,

Juhl

2017

BMC Musculoskelet Disord

142

View full text Add to dashboard Cite

show abstract

“…The second article differentiated pain referral areas between responders and nonresponders in the same patient population . All patients who had at least 50% relief from comparative blocks and 80% of nonresponders had pain at Fortin's area, just inferior to the posterior superior iliac spine.…”

Section: Resultsmentioning

confidence: 99%

Fluoroscopically Guided Diagnostic and Therapeutic Intra-Articular Sacroiliac Joint Injections: A Systematic Review

Kennedy

Engel

Kreiner³

et al. 2015

Pain Med

106

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Objective. To assess the validity of fluoroscopically guided diagnostic intra-articular injections of local anesthetic and effectiveness of intra-articular steroid injections in treating sacroiliac joint (SIJ) pain.Design. Systematic review. Interventions.Ten reviewers independently assessed 45 publications on diagnostic validity or effectiveness of fluoroscopically guided intraarticular SIJ injections.Outcome Measures. For diagnostic injections, the primary outcome was validity; for therapeutic injections, analgesia. Secondary outcomes were also described.Results. Of 45 articles reviewed, 39 yielded diagnostic data on physical exam findings, provocation tests, and SIJ injections for diagnosing SIJ pain, and 15 addressed therapeutic effectiveness. When confirmed by comparative local anesthetic blocks with a high degree of pain relief, no single physical exam maneuver predicts response to diagnostic injections. When at least three physical exam findings are present, sensitivity, and specificity increases significantly. The prevalence of SIJ pain is likely 20-30% among patients that have suspected SIJ pain based on history and physical examination. This estimate may be higher in certain subgroups such as the elderly and fusion patients. Two randomized controlled trials and multiple observational studies supported the effectiveness of therapeutic sacroiliac joint injections.Conclusions. Based on this literature, it is unclear whether image-guided intra-articular diagnostic injections of local anesthetic predict positive responses to therapeutic agents. The overall quality of evidence is moderate for the effectiveness of therapeutic SIJ injections.

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“…For sacroiliac joint pain referral, note the zones of anterior and posterior hip pain as well as the extension of pain past the knee to the ankle (See: Figure 4[33]).…”

Section: Discussionmentioning

confidence: 99%

What is different about spinal pain?

Vernon

2012

Chiropr Man Therap

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Intensity mapping of pain referral areas in sacroiliac joint pain patients

Cited by 73 publications

References 25 publications

Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews

Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews

Fluoroscopically Guided Diagnostic and Therapeutic Intra-Articular Sacroiliac Joint Injections: A Systematic Review

What is different about spinal pain?

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