Chronic Low Back Pain
Conditions
Keywords
Backache, F-18 Sodium Fluoride PET/CT, Pain Palliation, Facet Joint Pain, Chronic low backache, Sacroiliac Joint Pain, Chronic Low back pain
Brief summary
The goal of this open-label randomized controlled trial explored the efficacy of ultrasound guided versus F-18 Sodium Fluoride PET/CT guided local anesthetic and steroid injections in managing chronic low back pain caused by lumbar facet and sacroiliac joint arthritis.. The main questions it aims to answer are: 1. To Compare the reduction in pain intensity between PET/CT guided and Ultrasound Guided facet joint injections using the Visual Analog Scale (VAS) at predefined follow up intervals. 2. To compare functional improvement and disability outcomes between two study arms using Oswestry Disability Index (ODI) and Low Back Outcome Score (LBOS). 3. To compare association of PET/CT associated parameters with post intervention clinical response associated parameters. Patients fulfilling the inclusion criteria will be randomly allocated to one of two groups. Randomization will be conducted using a computer-generated random sequence, ensuring a 1:1 allocation ratio between the two treatment groups 1. Group A: Patients receiving F-18 sodium fluoride PET/CT-guided corticosteroid plus local anesthetic injection. 2. Group B: Patients receiving Ultrasound-guided corticosteroid plus local anesthetic injection
Interventions
PROCEDUREintra-articular injection
• A combination of steroids (80 mg methylprednisolone acetate) and 0.5% bupivacaine will be injected into the intra-articular and periarticular regions of the targeted LFJ(lumbar facet Joint) or SIJ(sacroiliac Joint) under F-18 sodium fluoride PET/CT guidance, with doses equally divided for multiple joints, if required
Sponsors
Post Graduate Institute of Medical Education and Research, Chandigarh
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients with a chronic nociceptive low backache attending the orthopaedic department who do not get adequate relief with conservative treatments for more than three months will be recruited in the study. * Patients who are ready to give informed consent
Exclusion criteria
* Pregnant and lactating females * Patients with active infection and febrile illness * Patients with acute spine trauma * Spinal pathologies requiring surgical interventions such as significant spinal stenosis , spondylolisthesis or disc herniation. * Patients with corticosteroid injection within six weeks before the study * Patients who refused to give written informed consent * MRI showing the neuropathic cause or nerve root compression * Patients with deranged coagulation profile * Systemic conditions affecting joints (eg ankylosing spondylitis , rheumatoid arthritis) * Uncontrolled diabetes
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Visual Analog Scale (VAS) Score | From date of intervention to follow up at 20 weeks. | Change in pain intensity from baseline to follow-up as measured using the Visual Analog Scale (VAS). The VAS is a 10-point scale ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Lower scores indicate less pain. |
| Change in Oswestry Disability Index (ODI) | From date of intervention to the follow up at 20 weeks | Change in disability from baseline to follow-up as measured using the Oswestry Disability Index (ODI). The ODI is scored from 0% to 100%, with higher scores indicating greater disability and poorer functional status. Lower scores indicate improvement in disability. |
| Change in Low Back Outcome Score (LBOS) | From date of intervention to follow up at 20 weeks | Change in functional outcome from baseline to follow-up as measured using the Low Back Outcome Score (LBOS). The LBOS ranges from 0 to 75 points, with higher scores indicating better functional outcome and lower levels of disability. Higher scores indicate improvement in functional status. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Correlation between baseline SUVmax and improvement in Visual Analog Scale (VAS) score | From baseline F-18 Sodium fluoride PET/CT to follow up PET/CT and clinical assessment at 20 weeks | Correlation between baseline maximum standardized uptake value (SUVmax) measured on PET/CT and change in pain severity assessed using the Visual Analog Scale (VAS; 0-10 points). Improvement will be calculated as the difference between baseline and follow-up VAS scores. Correlation analysis will be performed using Pearson's or Spearman's correlation coefficient, as appropriate. |
| Correlation between baseline SUVmax and improvement in Oswestry Disability Index (ODI) score | From baseline F-18 sodium fluoride PET/CT to follow up PET/CT and clinical assessment at 20 weeks | Correlation between baseline maximum standardized uptake value (SUVmax) measured on PET/CT and change in disability assessed using the Oswestry Disability Index (ODI; 0-100%). Improvement will be calculated as the difference between baseline and follow-up ODI scores. Correlation analysis will be performed using Pearson's or Spearman's correlation coefficient, as appropriate. |
| Correlation between baseline SUVmax and improvement in Low Back Outcome Score (LBOS) | From baseline F-18 sodium fluoride PET/CT to follow up PET/CT and clinical assessment at 20 weeks | Correlation between baseline maximum standardized uptake value (SUVmax) measured on PET/CT and change in functional outcome assessed using the Low Back Outcome Score (LBOS; 0-75 points). Improvement will be calculated as the difference between baseline and follow-up LBOS scores. Correlation analysis will be performed using Pearson's or Spearman's correlation coefficient, as appropriate. |
Countries
India
Outcome results
None listed