Rheumatology 2001; 40: 478
© 2001 British Society for Rheumatology
Letters to the Editor |
Sclerosant injections for low back pain
Oving Clinic, Church Lane, Oving, Chichester PO20 6DG, UK
SIR, The recent trial of sclerosant injections was indeed an excellent attempt to illuminate a grey area in musculoskeletal practice. Thompson's trial [1] removed the rehabilitation element that confounded the results of the two previous trials [2, 3] and was unable to show any benefit. Curiously, there was no placebo effect at all, which raises other questions. Unfortunately, all three controlled trials to date have failed to be sufficiently selective in their inclusion criteria. In answer to Thompson's invitation [4] for help in identifying a potential subgroup of lower back pain (LBP) patients who might respond, I would suggest the following criteria: (i) the patient describes acute symptoms of LBP on trivial movements, or episodes of ‘locking’ against a background of chronic aching, i.e. `clinical instability syndrome’; (ii) intolerance of static strain, i.e. prolonged sitting, standing or flexed postures; (iii) hypermobility generally, or in particular, on local palpation of lumbar segments and sacroiliac joints; and (iv) tenderness confined to supra-/interspinous ligaments, iliolumbar ligament attachment to iliac crest, sacral sulcus—not widespread hyperalgesic areas (see Klein's subgroup [3]). All four of these criteria should be fulfilled.
Minor grades I/II spondylolisthesis would usefully be included. Signs of radicular irritation and disc syndrome should be excluded, along with features of abnormal illness and pain behaviour.
Hurst [5] correctly states the need for a larger, more specific study to evaluate a treatment method that has been in use for nearly half a century and has many advocates amongst doctors and patients on both sides of the Atlantic.
References
- Dechow E, Davies RK, Carr AJ, Thompson PW. A randomized, double-blind, placebo-controlled trial of sclerosing injections in patients with chronic low back pain. Rheumatology1999; 38:1255–9.
[Abstract/Free Full Text] - Ongley MJ, Klein RG, Dorman TA, Eek BC, Hubert LJ. A new approach to the treatment of chronic low back pain. Lancet, 1987; 2:143–6.[Web of Science][Medline]
- Klein RG, Eek BC, DeLong B, Mooney V. A randomised, double-blind trial of dextrose–glycerine–phenol injections for chronic low back pain. J Spinal Disord1993;6:23–33.[Web of Science][Medline]
- Thompson PW. Reply. Rheumatology2000;39:925.
[Free Full Text] - Hurst NP. Sclerosing injections in patients with chronic low back pain. Rheumatology2000;39:925.
[Free Full Text]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||