Clinical Effectiveness of Botulinum Toxin A Compared to a Mixture of Steroid and Local Anesthetics as a Treatment for Sacroiliac Joint Pain

• Published in: Pain medicine (Malden, Mass.) Vol. 11; no. 5; pp. 692 - 700
• Main Authors: Lee, Jung H., Lee, Sang-Ho, Song, Sun H.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01-05-2010
• Subjects: Adult; Anesthetics, Local - therapeutic use; Anti-Dyskinesia Agents - therapeutic use; Anti-Inflammatory Agents - therapeutic use; Arthralgia - drug therapy; Botulinum Toxin; Botulinum Toxins, Type A - therapeutic use; Case-Control Studies; Disability Evaluation; Female; Humans; Local Anesthetics; Low Back Pain - drug therapy; Male; Middle Aged; Pain Measurement; Prospective Studies; Sacroiliac Joint - physiopathology; Sacroiliac Joint Pain; Steroid; Steroids - therapeutic use; Treatment Outcome; Triamcinolone - therapeutic use
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1111/j.1526-4637.2010.00838.x

Objective.  The sacroiliac joint (SIJ) is one of the sources of low back pain and referred pain to the lower limb. Steroid injections have been used to treat SIJ pain, but this frequently necessitates repeated injections. Botulinum toxin (BT) type A has been shown to provide significant reduction of joint pain, and functional improvements. This study investigated the efficacy of BT for reducing SIJ pain and maintaining a clinical effect, compared with steroid injections.
Design.  Prospective case control study.
Setting.  Spine hospital.
Patients.  Patients who were diagnosed with SIJ syndrome based on physical examination and diagnostic SIJ injection were selected.
Interventions.  Either Dysport® (BT group) or a mixture of triamcinolone and lidocaine (triamcinolone and local anesthetics [TA] group) was injected into the posterior sacroiliac ligaments under C‐arm fluoroscopy.
Outcome Measures.  Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI) were used for evaluation at pretreatment, 1 month, 2 months, and 3 months after treatment.
Results.  At 1 month, the BT and TA group showed no significant differences in NRS or ODI. However, at 2 and 3 months, the BT group had significantly lower scores in NRS and ODI than did the TA group.
Conclusion.  BT shows clinical usefulness in pain reduction and for functional improvement in patients with SIJ pain. This effect was maintained for 3 months following the injection, by which time the effects of TA had diminished.