title: A multitest regimen of pain provocation tests as an aid to reduce unnecessary minimally invasive sacroiliac joint procedures.
abstract: 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.
authors.affiliation: 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
authors.forename: Peter
authors.initials: P
authors.lastname: van der Wurff
authors.forename: Evert J
authors.initials: EJ
authors.lastname: Buijs
authors.forename: Gerbrand J
authors.initials: GJ
authors.lastname: Groen
mesh_terms: 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
chemical_list: D000779:Anesthetics, Local