Steroid vs. Platelet-Rich Plasma in Ultrasound-Guided Sacroiliac Joint Injection for Chronic Low Back Pain

Abstract

INTRODUCTION
The sacroiliac joint (SIJ) has been implicated as the primary source of pain in 10% to 27% of patients.

Background: Despite widespread use of steroids to treat sacroiliac joint (SIJ) pain, their duration of pain reduction is short. Platelet-rich plasma (PRP) can potentially enhance tissue healing and may have a longer-lasting effect on pain.

Objectives: To assess the efficacy and safety of PRP compared with methylprednisolone in an ultrasound-guided SI injection for low back pain.

Study Design: Prospective randomized open-blinded end-point (PROBE) study

Methods: Forty patients with chronic low back pain diagnosed with SIJ pathology were randomly allocated into two groups. Group S received 1.5 mL of methylprednisolone (40 mg/mL) and 1.5 mL of 2% lidocaine with 0.5 mL of saline, while Group P received 3 mL of leukocyte-free PR with 0.5 mL of calcium chloride into ultrasound-guided SI. Address correspondence and reprint requests to: Varun Singla, MD, Senior Resident, Pain Management, Anaesthesia Office, 1st Floor, ABlock, SGPGI, Lucknow, Uttar Pradesh, India. E-mail: drvarunsingla@aol.com. IRB: NK/MD/1011/13442-443. Trial

Registration: 9154/PG 2Trg/2012/20886. Submitted: March 13, 2016; revised: August 10, 2016; revision accepted: August 25, 2016 DOl. 10.1111/papr.12526 2016 World Institute of Pain, 1530-7085/16/$15.00 Pain Practice, Volume so, Issue o 2016 • -06 injection Visual analog scale (VAS) scores, Modified Oswestry Disability Questionnaire (MODQ) scores, Short Form (SF-12) Health Survey scores, and complications (if any) were evaluated at 2 weeks, 4 weeks, 6 weeks, and 3 months.

Results: Intensity of pain was significantly lower in Group P at 6 weeks (median [interquartile range (IQR)] = 1 [1 to 1] vs. 3.5 [2 to 5]; P = 0.0004) and 3 months (median [IQR] = 1 [1 to 3] vs. 5 [3 to 5]; P = 0.0002) as compared to Group S. The efficacy of steroid injection was reduced to only 25% at 3 months in Group S, while it was 90% in Group P. A strong association was observed in patients receiving PRP and showing a reduction of VAS  50% from baseline when other factors were controlled. The MODQ and SF-12 scores improved initially for up to 4 weeks but deteriorated further at 3 months in Group S, while both scores improved gradually for up to 3 months in Group P. Conclusion: The intra-articular PRP injection is an effective treatment modality for low back pain involving SIJ.

Key Words: low back pain, methylprednisolone, platelet-rich plasma, sacroiliac joint injection, ultrasound-guided, prospective randomized open blinded endpoint study.

Varun Singla, MD*; Yatindra K. Batra, MDT; Neerja Bharti, DNBt; Vijay G. Goni, MS; Neelam Marwaha, MD “Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh; “Department of Anaesthesiology, Max Super Speciality Hospital, Mohali, Punjab; “Department of Anaesthesia and Intensive Care, Post Graduate Institute
of Medical Education and Research, Chandigarh; “Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh; “Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India

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