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.


METHODS
Prospective, observational study.


METHODS
Hospital setting.


METHODS
Sixty patients with chronic low back pain.


METHODS
Not applicable.


METHODS
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.
van der Wurff
Peter
P
Division of Perioperative Medicine and Emergency Medicine, Department of Anesthesiology and Pain Treatment, University Medical Centre Utrecht, Utrecht, The Netherlands. P.vanderWurff@ok.azu.nl
Buijs
Evert J
EJ
Groen
Gerbrand J
GJ
D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002908:Chronic Disease; D003955:Diagnostic Tests, Routine; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D017116:Low Back Pain / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D018579:Patient Selection; D010808:Physical Examination; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012446:Sacroiliac Joint / Q000187:drug effects* / Q000503:physiopathology; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome; D019564:Unnecessary Procedures
D000779:Anesthetics, Local