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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

Torstensson, Thomas MSc, RPT*; Lindgren, Anne RPT*; Kristiansson, Per MD, PhD†§

doi: 10.1097/BRS.0b013e3181b07eac
Randomized Trial

Study Design. 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.

Summary of Background Data. 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).

Conclusion. 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.

A clinical trial with corticosteroid injections to the ischial spine in women with long-lasting low back pain with onset during pregnancy. The treatment group had significantly reduced pain intensity, number of pain locations, and pain-provoking tests. The sacrospinous ligament of the pelvis is suggested 1 source of the pain.

From the *Department of Physiotherapy, Sundsvall Hospital, Sundsvall, Sweden; and †Department of Clinical Medicine, Umeå University, Umeå, Sweden.

Acknowledgment date: January 19, 2009. Revision date: March 20, 2009. Acceptance date: March 23, 2009.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

Institutional funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Supported by the Västernorrland County Council.

The trial was approved by the medical ethics committee at University of Umeå and the Medical Products Agency, Uppsala, Sweden.

Address correspondence and reprint requests to Thomas Torstensson, MSc, Department of Physiotherapy, Sundsvall Hospital, SE-851 86 Sundsvall, Sweden; E-mail: thomas.torstensson@lvn.se

© 2009 Lippincott Williams & Wilkins, Inc.