The results of this review demonstrate that tests do exist that change the probability of the disc or SIJ ( but not the facet joint ) as the source of low back pain .
Clinical practice guidelines state that the tissue source of low back pain can not be specified in the majority of patients .
However , there has been no systematic review of the accuracy of diagnostic tests used to identify the source of low back pain .
The aim of this systematic review was therefore to determine the diagnostic accuracy of tests available to clinicians to identify the disc , facet joint or sacroiliac joint ( SIJ ) as the source of low back pain .
Capacity of the Clinical Picture to Characterize Low Back Pain Relieved by Facet Joint Anesthesia: Proposed Criteria to Identify Patients With Painful Facet Joints
Study Design . Prospect i ve r and omized study to compare the efficacy of facet joint injection with lidocaine and facet joint injection with saline in two groups of patients with low back pain , with and without clinical criteria that were determined in a previous study to implicate the facet joint as the primary source of the pain . Objectives . To assess the efficacy of single facet joint anesthesia versus placebo ( saline injections ) and to determine clinical criteria that are predictive of significant relief of LBP after injection . Summary of Background Data . There is no syndrome that discriminates between lower back pain caused by facet joint and that caused by other structures . Single or double facet joint anesthesia , and single photon emission computed tomography are expensive and time‐consuming procedures for selecting patients in controlled clinical trials with large population s. Methods . Results of a previous study showed that seven clinical characteristics were more frequent in patients who responded to facet joint anesthesia than in those who did not . In the current study , a group of 43 patients with lower back pain who met at least five criteria were compared with 37 patients who met fewer criteria . Patients r and omly received injection of either lidocaine or saline into the lower facet joints . The result was considered positive if more than 75 % pain relief was determined by visual analog scale . The patient , the radiologist , and the investigator were blinded . An analysis of variance was used to seek an interaction between clinical group effect and injection effect , and logistic regression analysis to select the best set of variables that would be predictive of minimum pain relief of 75 % after the injection . Results . There was a significant interaction between clinical group and injection effect ( P= 0.003 ) . In patients with back pain , lidocaine  provided greater lower‐back pain relief than saline ( P = 0.01 ) . Lidocaine also‐provided greater pain relief in the back pain group than in the the nonpain group ( P = 0.02 ) . The presence of five among seven variables ( age greater than 65 years and pain that was not exacerbated by coughing , not worsened by hyperextension , not worsened by forward flexion , not worsened when rising from flexion , not worsened by extension‐rotation , and well‐relieved by recumbency ) , always including the last item , distinquished 92 % of patients responding to lidocaine injection and 80 % of those not responding in the lidocaine group . Conclusions . A set of five clinical characteristics can be used in r and omized studies to select lower back pain that will be well relieved by facet joint anesthesia . These characteristics should not , however , be considered as definite diagnostic criteria of lower back pain originating from facet joints
The results of this review demonstrate that tests do exist that change the probability of the disc or SIJ ( but not the facet joint ) as the source of low back pain .
Clinical practice guidelines state that the tissue source of low back pain can not be specified in the majority of patients .
However , there has been no systematic review of the accuracy of diagnostic tests used to identify the source of low back pain .
The aim of this systematic review was therefore to determine the diagnostic accuracy of tests available to clinicians to identify the disc , facet joint or sacroiliac joint ( SIJ ) as the source of low back pain .