Comparing the Treatment Outcomes of Two Interventional Pain Procedures in Chronic Coccygodynia
Comparison of Treatment Outcomes in Chronic Coccygodynia Patients Treated With Ganglion Impar Blockade Versus Caudal Epidural Steroid Injection: A Prospective Randomized Comparison Study
Coccygodynia is a disabling pain in the coccyx exacerbated by sitting or rising from sitting. The pain is often pulling or lancinating in quality, may radiate to the sacrum or buttock, and may coexist with lower back pain. Contributing of many physiologic and psychological factors to its etiology, it may be traumatic or idiopathic in origin. Many risk factors are known such as trauma, female gender and obesity. Despite the identification of chronic coccygeal pain hundreds of years ago, its treatment can be difficult and sometimes controversial because of the multifactorial nature of coccygeal pain. Most cases of coccygodynia resolve within weeks to months with or without conservative treatment, but for a few patients, the pain can become chronic and debilitating. First-line treatment options include analgesic drugs, cushion, sit baths, and manuel therapy. Interventional procedures for pain management can be applied to patients who have no response to other conservative modalities. Ganglion impar block and caudal epidural steroid injection are two treatment options for chronic coccygodynia and both of them can be applied by guidance of fluoroscopy and ultrasonography. Radiofrequency ablation is the other option for treatment and eventually, surgical intervention can be done for patients who have refractory pain despite other treatments.
Although efficacy of two interventional procedure for chronic coccygodynia, ganglion impar block and caudal epidural steroid injection, has been well known, no study is exist comparing the efficacy of them. We aimed to compare the efficacy of ganglion impar block and caudal epidural steroid injection in chronic coccygodynia.
研究概览
地位
详细说明
研究类型
注册 (实际的)
阶段
- 不适用
联系人和位置
学习地点
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Istanbul、火鸡、34899
- Marmara University School of Medicine Department of Physical Medicine and Rehabilitation
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
Inclusion Criteria:
- Patients diagnosed with chronic coccygodynia between the ages of 18 and 65
- Intractable pain over the coccyx despite conservative treatment
Exclusion Criteria:
- History of ganglion impar blockade and/or caudal epidural steroid injection carried out in the last 3 months
- History of lumbar surgery
- Systemic and/or local infections
- Malignancy
- Bleeding diathesis
- Acute fracture
- Known allergy to contrast material and/or local anesthetic substances
- Known history of any psychiatric disorder
- History of pregnancy
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:双倍的
武器和干预
参与者组/臂 |
干预/治疗 |
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有源比较器:Ganglion impar block group
Fluoroscopy-guided ganglion impar block is applied to patients in this group.
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Fluoroscopy guidance is used for correct visualization of injection site, and so obtained more successful results.
Patients are placed in the prone position.
Injection site is cleaned thrice with povidone iodine %10 solution and covered with sterile drapes.
Being most commonly used technic, transsacrococcygeal technique, a 22-gauge, 1.5-inch spinal needle is advanced through the sacrococcygeal disk and positioned carefully anterior to the sacrococcygeal junction.
Injection of contrast results in a classical comma sign.
A mixture of steroid and local anesthetic is given.
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有源比较器:Caudal epidural steroid injection group
Fluoroscopy-guided caudal epidural steroid injection is applied to patients in this group.
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Fluoroscopy guidance is used for correct visualization of injection site, and so obtained more successful results.
Patients are placed in the prone position.
Injection site is cleaned thrice with povidone iodine %10 solution and covered with sterile drapes.
An 18-gauge epidural needle (Tuohy) is advanced at an angle of 45° to the skin until a 'give-way' sensation is felt and position of the needle is confirmed by lateral and anteroposterior fluoroscopic images.
Then 5 ml of iohexol solution is injected through it to confirm the position.
A properly placed needle would produce a classical 'inverted fern tree' appearance in anteroposterior view after dye injection or a 'filling defect'.
The needle is introduced up to S3 level for proper spread of the drug.
A mixture of steroid and local anesthetics is given.
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
---|---|---|
Change in pain severity of patients from baseline to each checkpoints
大体时间:from pre-interventional time to post-interventional 1st hour, 3rd week, 3rd month
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Defining the change in Numeric Rating Scale (NRS) score
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from pre-interventional time to post-interventional 1st hour, 3rd week, 3rd month
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
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Change in number of patients with neuropathic pain from baseline to each checkpoints
大体时间:from pre-interventional time to post-interventional 3rd week, 3rd month
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Defining the change in number of patients with neuropathic pain using Leeds Assessment of Neuropathic Symptoms and Signs Scale (LANSS)
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from pre-interventional time to post-interventional 3rd week, 3rd month
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Change the patient reported quality of life assessment from baseline to each checkpoints
大体时间:from pre-interventional time to post-interventional 3rd week, 3rd month
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Defining the change in quality of life scores of patients using Short Form 12 Health Survey (SF-12)
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from pre-interventional time to post-interventional 3rd week, 3rd month
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合作者和调查者
调查人员
- 首席研究员:Savaş Şencan, MD、Marmara University
研究记录日期
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学习开始 (实际的)
初级完成 (实际的)
研究完成 (实际的)
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首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
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与本研究相关的术语
其他研究编号
- 09.2019.395
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