Ultrasound Guided Posterior Sacroiliac Ligament Corticosteroid Injection in Pregnancy-Related Pelvic Girdle Pain

NCT ID: NCT02044991

Last Updated: 2018-08-08

Study Results

Results available

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE2

Total Enrollment

2 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-10-24

Study Completion Date

2017-02-22

Brief Summary

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The purpose of this study is to see if pelvic girdle pain can be more effectively treated with the use of injectable anti-inflammatory medication plus physical therapy compared with physical therapy and a saline injection.

Detailed Description

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Pelvic girdle pain (PGP) in pregnancy is common with prevalence estimates of 45%.1 It is defined as pain experienced between the posterior iliac crest and the gluteal fold, particularly in the region of the sacroiliac joint.2 Pain may radiate in the posterior thigh and can also occur in conjunction with/or separately in the symphysis. In PGP, the endurance capacity for standing, walking and sitting is diminished. The diagnosis of PGP can be reached after exclusion of lumbar causes and must be reproducible by specific clinical tests. While various pain mechanisms including mechanical, hormonal, inflammatory, and neural have been proposed in the development of PGP, the etiology and pathogenesis is poorly understood. It is possible that musculoskeletal changes influenced by hormonal (Relaxin) elevation in pregnancy predispose pregnant women to acute musculoskeletal injury presenting clinically as PGP. An inflammatory response in other acute musculoskeletal injuries has been well described3 and may also occur in pregnancy related PGP particularly given the musculoskeletal vulnerability during this time. Though PGP is common in pregnancy, no study to date has investigated the efficacy of anti-inflammatory treatment in pregnancy related PGP in order to better establish the contribution of inflammation in the etiology of pregnancy related PGP.

Conditions

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Pelvic Girdle Pain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Participants are assigned to receive either an injection of methylprednisolone acetate plus lidocaine or to receive an injection of saline with lidocaine using a randomized block design with a 1:1 allocation.
Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Treatment

Participants randomized to this arm will receive a corticosteroid. This is 40mg of a non-fluorinated injectable glucocorticoid, methylprednisolone acetate (1cc) combined with 1cc of 1% Lidocaine

Group Type ACTIVE_COMPARATOR

Corticosteroid

Intervention Type DRUG

40mg of a non-fluorinated injectable glucocorticoid, methylprednisolone acetate (1cc) combined with 1cc of 1% Lidocaine

Placebo

Participant's randomized to this condition will receive a placebo injection once weekly

Group Type PLACEBO_COMPARATOR

Placebo Injection

Intervention Type DRUG

A placebo injection

Interventions

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Corticosteroid

40mg of a non-fluorinated injectable glucocorticoid, methylprednisolone acetate (1cc) combined with 1cc of 1% Lidocaine

Intervention Type DRUG

Placebo Injection

A placebo injection

Intervention Type DRUG

Other Intervention Names

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Medrol Saline

Eligibility Criteria

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Inclusion Criteria

* Women who are not doing other therapies for pain (physical therapy, chiropractic management, pool)
* Women between age 21 and 50 who plan to deliver at Loyola or Gottlieb
* Pain Numeric Rating Scale (NRS) on average of greater than or equal to 5/10 at Visit 1
* Pain must be between the upper level of the iliac crests and the gluteal folds in conjunction with or separately from pain in the pubic symphysis and influenced by position and locomotion
* 2/4 positive physical examination tests on the symptomatic side including the P4 test, the LDL test, pubic symphysis palpation and the acute straight leg rise (ASLR)

Exclusion Criteria

* Women presenting with PGP in the first or third trimester (\<13 weeks gestation or \>28 weeks gestation)
* Women with pubic symphysis (anterior) pain alone
* Women who do not plan to deliver a baby at Loyola or Gottlieb
* Pain above the upper level of the iliac crest
* History of lumbar or pelvic fracture, neoplasm, inflammatory disease, active urogenital infection or active gastrointestinal illness, current physical therapy or other therapies for PGP, or previous surgery of the lumbar spine, pelvic girdle, hip joint or femur
* History or signs of radiculopathy or other systemic neurologic disease
* Women with diabetes or gestational diabetes
Minimum Eligible Age

21 Years

Maximum Eligible Age

50 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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American Academy of Physical Medicine and Rehabilitation

OTHER

Sponsor Role collaborator

Loyola University

OTHER

Sponsor Role lead

Responsible Party

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Colleen Fitzgerald

M.D., Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Colleen Fitzgerald, MD

Role: PRINCIPAL_INVESTIGATOR

Loyola Univ Med Cntr-

Locations

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Loyola University Health System

Maywood, Illinois, United States

Site Status

Countries

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United States

References

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Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

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205418

Identifier Type: -

Identifier Source: org_study_id

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