A Randomized, Placebo-Controlled Study to Assess the Efficacy of Lateral Branch Neurotomy for Chronic Sacroiliac Joint Pain: Letter to EditorDear Editor: We read with interest this article by Patel et al. [1] (A Randomized, Placebo-Controlled Study to Assess the Effi- cacy of Lateral Branch Neurotomy for Chronic Sacroiliac Joint Pain, Pain Med. 2012 Feb 2. doi: 10.1111/j.1526- 4637.2012.01328.x. Epub ahead of print). The authors have compared the efficacy of lateral branch neurotomy using cooled radiofrequency (RF) with a sham intervention for sacroiliac (SI) joint pain. We have some comments. 1. It is not very apparent from the inclusion criteria whether there was any specific reason to omit the clinical tests as screening criteria. Studies and meta- analysis have found that three or more positive provocation tests resulted in a specificity between 79% and 85%, and sensitivity between 78% and 94%, respec- tively [2–5]. This might have probably avoided the unnecessary injections, at least in some patients. 2. Figure 1 seems incomplete. It does not mention about the number of subjects that underwent first diagnostic block, and out of them, how many returned for the second diagnostic block. This could have better revealed the utility of clinical assessment and/or diagnostic blocks in diagnosing SI joint pain precisely. 3. A C-arm fluoroscopy photograph or even a schematic diagram could have been provided in the article showing the final needle position(s) for lateral branch blocks/RF. Figure 7 seems unnecessary as the same message has been conveyed by Figure 6 (RF equipment brochure; Baylis Medical Company Inc.; Montreal, QC, Canada, H4T 1A1) with a different presentation. CHINMOY ROY, MD, FIPP (WIP) Institute of Neurosciences Kolkata— Pain Management, Kolkata, India References 1 Patel N, Gross A, Brown L, Gekht G. A randomized, placebo-controlled study to assess the efficacy of lateral branch neurotomy for chronic sacroiliac joint pain. Pain Med 2012;13(3):383–398. 2 Laslett M, Aprill CN, McDonald B, Young SB. Diagnosis of sacroiliac joint pain: Validity of individual provocation tests and composites of tests. Man Ther 2005;10(3): 207–18. 3 van der Wurff P, Buijs EJ, Groen GJ. A multitest regimen of pain provocation tests as an aid to reduce unnecessary minimally invasive sacroiliac joint procedure. Arch Phys Med Rehabil 2006;87(1):10–4. 4 Szadek KM, van der Wurff P, van Tulder MW, Zuur- mond WW, Perez RS. Diagnostic validity of criteria for sacroiliac joint pain: A systematic review. J Pain 2009;10(4):354–68. 5 Young S, Aprill C, Laslett M. Correlation of clinical examination characteristics with three sources of chronic low back pain. Spine J 2003;3(6):460–5. Pain Medicine 2012; 13: 980 Wiley Periodicals, Inc. 980

A Randomized, Placebo-Controlled Study to Assess the Efficacy of Lateral Branch Neurotomy for Chronic Sacroiliac Joint Pain: Letter to Editor

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Page 1: A Randomized, Placebo-Controlled Study to Assess the Efficacy of Lateral Branch Neurotomy for Chronic Sacroiliac Joint Pain: Letter to Editor

A Randomized, Placebo-Controlled Studyto Assess the Efficacy of Lateral BranchNeurotomy for Chronic Sacroiliac Joint Pain:Letter to Editorpme_1388 980

Dear Editor:

We read with interest this article by Patel et al. [1] (ARandomized, Placebo-Controlled Study to Assess the Effi-cacy of Lateral Branch Neurotomy for Chronic SacroiliacJoint Pain, Pain Med. 2012 Feb 2. doi: 10.1111/j.1526-4637.2012.01328.x. Epub ahead of print). The authorshave compared the efficacy of lateral branch neurotomyusing cooled radiofrequency (RF) with a sham interventionfor sacroiliac (SI) joint pain. We have some comments.

1. It is not very apparent from the inclusion criteriawhether there was any specific reason to omit theclinical tests as screening criteria. Studies and meta-analysis have found that three or more positive provo-cation tests resulted in a specificity between 79% and85%, and sensitivity between 78% and 94%, respec-tively [2–5]. This might have probably avoided theunnecessary injections, at least in some patients.

2. Figure 1 seems incomplete. It does not mention aboutthe number of subjects that underwent first diagnosticblock, and out of them, how many returned forthe second diagnostic block. This could have betterrevealed the utility of clinical assessment and/or diag-nostic blocks in diagnosing SI joint pain precisely.

3. A C-arm fluoroscopy photograph or even a schematicdiagram could have been provided in the articleshowing the final needle position(s) for lateral branchblocks/RF. Figure 7 seems unnecessary as thesame message has been conveyed by Figure 6 (RFequipment brochure; Baylis Medical Company Inc.;

Montreal, QC, Canada, H4T 1A1) with a differentpresentation.

CHINMOY ROY, MD, FIPP (WIP)Institute of Neurosciences Kolkata—

Pain Management, Kolkata, India

References1 Patel N, Gross A, Brown L, Gekht G. A randomized,

placebo-controlled study to assess the efficacy oflateral branch neurotomy for chronic sacroiliac jointpain. Pain Med 2012;13(3):383–398.

2 Laslett M, Aprill CN, McDonald B, Young SB. Diagnosisof sacroiliac joint pain: Validity of individual provocationtests and composites of tests. Man Ther 2005;10(3):207–18.

3 van der Wurff P, Buijs EJ, Groen GJ. A multitest regimenof pain provocation tests as an aid to reduce unneces-sary minimally invasive sacroiliac joint procedure. ArchPhys Med Rehabil 2006;87(1):10–4.

4 Szadek KM, van der Wurff P, van Tulder MW, Zuur-mond WW, Perez RS. Diagnostic validity of criteriafor sacroiliac joint pain: A systematic review. J Pain2009;10(4):354–68.

5 Young S, Aprill C, Laslett M. Correlation of clinicalexamination characteristics with three sources ofchronic low back pain. Spine J 2003;3(6):460–5.

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Pain Medicine 2012; 13: 980Wiley Periodicals, Inc.

980