Ketorolac Versus Corticosteroid Injections for Sacroiliac Joint Pain

NCT ID: NCT06081101

Last Updated: 2024-11-20

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

EARLY_PHASE1

Total Enrollment

20 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-01-31

Study Completion Date

2026-06-30

Brief Summary

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This study will contribute to the current literature that have compared joint injections with steroid versus ketorolac providing evidence for the use of ketorolac for SI joint pain. Currently steroid is the clinical standard for joint injections, however with repetitive use, steroid injections can damage the joint. Ketorolac is an alternative anti-inflammatory medication that does not cause the same joint damage and at a cheaper cost than steroid. The investigators hypothesize that ultrasound guided SI joint injections utilizing ketorolac provide the same pain relief as corticosteroid SI joint injections measured at 2, 6 and 12 weeks post injection. This would allow more frequent injections to control pain at a decreased cost to the healthcare system.

Detailed Description

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The majority of people will suffer from low back pain at some point in their life with 15-25% of axial low back pain originating at the sacroiliac (SI) joint. This pain is thought to be due to inflammation of the SI joint capsule, ligaments or bone. Following conservative management strategies such as mobility work, core strengthening and physiotherapy, as well as pharmacologic management, an SI joint injection would be the next treatment modality. Corticosteroid injections are currently the standard of care for joint injections. The corticosteroid minimizes pain by interrupting the bodies inflammatory cascade primarily by inhibiting the phospholipase A2 enzyme. However, with repetitive use, steroids can cause cartilaginous damage of the joint. With chondrocyte dysfunction being a key part of early osteoarthritis, these injections may expedite the arthritic joint changes. Due to this damage, physicians try to spread out joint injections as far as possible to reduce this risk even if the patient begins to experience more severe joint pain.

One possible alternative to steroids is the use of ketorolac, an non-steroidal anti-inflammatory drug (NSAID). Ketorolac joint injections have been shown to have similar pain reducing effects to steroids when used for shoulder, knee, hip and carpometacarpal joint pain. They have also been used widely in the National Football League to treat musculoskeletal injuries and in the post-operative phase to reduce opioid usage to manage pain. NSAIDS provide analgesia by inhibiting the cyclooxygenase (COX) family of enzymes that are involved with formation of prostaglandins. These prostaglandins are inflammatory mediators that promote inflammation and activates nociceptive neurotransmitters. Although there are known side effects of NSAIDs including increasing propensity for GI bleeds, kidney and liver disease, joint injections may have less systemic side effects compared to their oral counterparts. Another benefit of Ketorolac is the fact it is significantly cheaper than steroids. With less chondrotoxic effects, perhaps Ketorolac injections could be administered more frequently, not allowing the patient to have increasing pain levels, at less cost to the health care system even with more frequent administration.

Conditions

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Sacro-iliac Joint Pain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Corticosteroid

Patients will receive ultrasound guided corticosteroid injection to see pain relief after injection

Group Type ACTIVE_COMPARATOR

Methylprednisolone Injection

Intervention Type DRUG

Medication will be injected into SI joint under ultrasound guidance

Ketorolac

Patients will receive ultrasound guided ketorolac injection to see pain relief after injection

Group Type ACTIVE_COMPARATOR

Ketorolac Injection

Intervention Type DRUG

Medication will be injected into SI joint under ultrasound guidance

Interventions

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Methylprednisolone Injection

Medication will be injected into SI joint under ultrasound guidance

Intervention Type DRUG

Ketorolac Injection

Medication will be injected into SI joint under ultrasound guidance

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* SI joint pain for at least 3 months
* Age greater than 18
* Must have at least 3 special tests positive for SI joint pain on physical exam

Exclusion Criteria

* Previous back surgery
* Radicular leg pain
* Discogenic pain
* Myofascial pain syndrome
* Depression
* Systemic infection or localized infection at anticipated needle entry sites
* Cognitive impairment preventing informed consent or accurate collection of data
* Patient allergic to medication used
* NSAID contraindications including:
* Gastrointestinal bleeds
* Renal failure
* Symptomatic congestive heart failure
* Cirrhosis
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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McMaster University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Michael G. DeGroote Pain Clinic

Hamilton, Ontario, Canada

Site Status

Countries

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Canada

Central Contacts

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Akil Siva, MD

Role: CONTACT

905-521-2100 ext. 44621

Michael Lee, MD

Role: CONTACT

Facility Contacts

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Rebecca Leone

Role: primary

905-521-2100 ext. 44621

References

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Park KD, Kim TK, Bae BW, Ahn J, Lee WY, Park Y. Ultrasound guided intra-articular ketorolac versus corticosteroid injection in osteoarthritis of the hip: a retrospective comparative study. Skeletal Radiol. 2015 Sep;44(9):1333-40. doi: 10.1007/s00256-015-2174-9. Epub 2015 Jun 3.

Reference Type BACKGROUND
PMID: 26031217 (View on PubMed)

Aranke M, McCrudy G, Rooney K, Patel K, Lee CA, Hasoon J, Kaye AD. Minimally Invasive and Conservative Interventions for the Treatment of Sacroiliac Joint Pain: A Review of Recent Literature. Orthop Rev (Pavia). 2022 May 31;14(4):34098. doi: 10.52965/001c.34098. eCollection 2022.

Reference Type BACKGROUND
PMID: 35769646 (View on PubMed)

Koh SH, Lee SC, Lee WY, Kim J, Park Y. Ultrasound-guided intra-articular injection of hyaluronic acid and ketorolac for osteoarthritis of the carpometacarpal joint of the thumb: A retrospective comparative study. Medicine (Baltimore). 2019 May;98(19):e15506. doi: 10.1097/MD.0000000000015506.

Reference Type BACKGROUND
PMID: 31083191 (View on PubMed)

Shapiro PS, Rohde RS, Froimson MI, Lash RH, Postak P, Greenwald AS. The effect of local corticosteroid or ketorolac exposure on histologic and biomechanical properties of rabbit tendon and cartilage. Hand (N Y). 2007 Dec;2(4):165-72. doi: 10.1007/s11552-007-9042-6. Epub 2007 May 5.

Reference Type BACKGROUND
PMID: 18780047 (View on PubMed)

Beitzel K, McCarthy MB, Cote MP, Apostolakos J, Russell RP, Bradley J, ElAttrache NS, Romeo AA, Arciero RA, Mazzocca AD. The effect of ketorolac tromethamine, methylprednisolone, and platelet-rich plasma on human chondrocyte and tenocyte viability. Arthroscopy. 2013 Jul;29(7):1164-74. doi: 10.1016/j.arthro.2013.04.006.

Reference Type BACKGROUND
PMID: 23809450 (View on PubMed)

Cooke C, Osborne J, Jackson N, Keating P, Flynn J, Markel D, Chen C, Lemos S. Acetaminophen, bupivacaine, Duramorph, and Toradol: A comparison of chondrocyte viability and gene expression changes in osteoarthritic human chondrocytes. Knee. 2020 Dec;27(6):1746-1752. doi: 10.1016/j.knee.2020.10.019. Epub 2020 Nov 13.

Reference Type BACKGROUND
PMID: 33197813 (View on PubMed)

Xu J, Qu Y, Li H, Jiang T, Zheng C, Wang B, Shen P. Effect of ketorolac in intra-articular injection analgesia for postoperative pain in patients undergoing shoulder arthroscopy: a pilot-controlled clinical study. J Pain Res. 2019 Jan 17;12:417-422. doi: 10.2147/JPR.S178413. eCollection 2019.

Reference Type BACKGROUND
PMID: 30705607 (View on PubMed)

Taheri P, Dehghan F, Mousavi S, Solouki R. Comparison of Subacromial Ketorolac Injection versus Corticosteroid Injection in the Treatment of Shoulder Impingement Syndrome. J Res Pharm Pract. 2017 Oct-Dec;6(4):223-227. doi: 10.4103/jrpp.JRPP_17_57.

Reference Type BACKGROUND
PMID: 29417082 (View on PubMed)

Matava M, Brater DC, Gritter N, Heyer R, Rollins D, Schlegel T, Toto R, Yates A. Recommendations of the national football league physician society task force on the use of toradol((R)) ketorolac in the national football league. Sports Health. 2012 Sep;4(5):377-83. doi: 10.1177/1941738112457154.

Reference Type BACKGROUND
PMID: 23016110 (View on PubMed)

Barkho JO, Li YK, Duku E, Thoma A. Ketorolac May Increase Hematoma Risk in Reduction Mammaplasty: A Case-control Study. Plast Reconstr Surg Glob Open. 2018 Mar 19;6(3):e1699. doi: 10.1097/GOX.0000000000001699. eCollection 2018 Mar.

Reference Type BACKGROUND
PMID: 29707458 (View on PubMed)

Jurgensmeier K, Jurgensmeier D, Kunz DE, Fuerst PG, Warth LC, Daines SB. Intra-articular Injections of the Hip and Knee With Triamcinolone vs Ketorolac: A Randomized Controlled Trial. J Arthroplasty. 2021 Feb;36(2):416-422. doi: 10.1016/j.arth.2020.08.036. Epub 2020 Aug 22.

Reference Type BACKGROUND
PMID: 32950343 (View on PubMed)

Piuzzi NS, Ng M, Kantor A, Ng K, Kha S, Mont MA, Muschler GF. What Is the Price and Claimed Efficacy of Platelet-Rich Plasma Injections for the Treatment of Knee Osteoarthritis in the United States? J Knee Surg. 2019 Sep;32(9):879-885. doi: 10.1055/s-0038-1669953. Epub 2018 Sep 6.

Reference Type BACKGROUND
PMID: 30189436 (View on PubMed)

Bellamy JL, Goff BJ, Sayeed SA. Economic Impact of Ketorolac vs Corticosteroid Intra-Articular Knee Injections for Osteoarthritis: A Randomized, Double-Blind, Prospective Study. J Arthroplasty. 2016 Sep;31(9 Suppl):293-7. doi: 10.1016/j.arth.2016.05.015. Epub 2016 May 18.

Reference Type BACKGROUND
PMID: 27402605 (View on PubMed)

D'Arcy Y, Mantyh P, Yaksh T, Donevan S, Hall J, Sadrarhami M, Viktrup L. Treating osteoarthritis pain: mechanisms of action of acetaminophen, nonsteroidal anti-inflammatory drugs, opioids, and nerve growth factor antibodies. Postgrad Med. 2021 Nov;133(8):879-894. doi: 10.1080/00325481.2021.1949199. Epub 2021 Jul 12.

Reference Type BACKGROUND
PMID: 34252357 (View on PubMed)

Chiarotto A, Maxwell LJ, Ostelo RW, Boers M, Tugwell P, Terwee CB. Measurement Properties of Visual Analogue Scale, Numeric Rating Scale, and Pain Severity Subscale of the Brief Pain Inventory in Patients With Low Back Pain: A Systematic Review. J Pain. 2019 Mar;20(3):245-263. doi: 10.1016/j.jpain.2018.07.009. Epub 2018 Aug 10.

Reference Type BACKGROUND
PMID: 30099210 (View on PubMed)

Other Identifiers

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McMaster_University_KVC

Identifier Type: -

Identifier Source: org_study_id

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