Corticosteroid injection treatment to the ischiadic spine reduced pain in women with long-lasting sacral low back pain with onset during pregnancy: a randomized, double blind, controlled trial.
METHODS
Randomized double blind controlled clinical trial.


OBJECTIVE
To evaluate the pain relief effect of locally injected corticosteroid treatment in women with long-lasting sacral low back pain with onset during pregnancy.


BACKGROUND
Pregnancy-related low back pain is a global problem. Almost 1 of 10 women still experienced disabling daily back pain 2 years after childbirth with high impact on the individual, family, and society. On spite of this, the sources of pain and effective treatment are uncertain.


METHODS
Thirty-six women were allocated to injection treatment, with slow-release triamcinolone and lidocaine or saline and lidocaine, given at the sacrospinous ligament insertion on the ischiadic spine bilaterally with 4 weeks follow-up time. Primary outcome measure was reported pain intensity on visual analogue scale and secondary outcome measures number of pain-drawing locations and pain-provoking test results. RESULTS.: The triamcinolone treatment group had significantly reduced pain intensity, number of pain locations, and pain-provoking test results between baseline and follow-up as compared with the saline treatment group. The absolute median change of visual analogue scale score in the triamcinolone treatment group was -24 mm and in the saline group +4.5 mm (P < 0.05). A reduced number of pain drawing locations was reported by 16 of 18 women in the triamcinolone group as compared with 10 of 18 in the saline group (P < 0.05). In the triamcinolone treatment group, 17 of 18 women had an improved pain provocation test result as compared with 9 of 18 in the saline treatment group (P < 0.01).


CONCLUSIONS
The anatomic region around the sacrospinous ligament insertion on the ischial spine is suggested to be one source of long-lasting sacral low back pain with onset during pregnancy. The pain was relieved by slow-release corticosteroid injection treatment to the ischial spine.
Torstensson
Thomas
T
Department of Physiotherapy, Sundsvall Hospital, Sundsvall, Sweden. thomas.torstensson@lvn.se
Lindgren
Anne
A
Kristiansson
Per
P
D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage; D003692:Delayed-Action Preparations; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007278:Injections, Spinal; D008012:Lidocaine / Q000008:administration & dosage; D017116:Low Back Pain / Q000188:drug therapy* / Q000503:physiopathology; D008161:Lumbosacral Region; D010147:Pain Measurement / Q000379:methods; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage*
D000779:Anesthetics, Local; D003692:Delayed-Action Preparations; D004338:Drug Combinations; D005938:Glucocorticoids; D014221:Triamcinolone; D008012:Lidocaine