Abstract
Purpose And Background: In patients with chronic low back pain (LBP), selective injection procedures (provocative discography, medial branch, facet and sacroiliac joint blocks) have shown the pain source to be the intervertebral disc in 40%, the sacroiliac joint in 13–19% and the facet joints in 15–40%. No individual features in the history or examination are of consistent discriminatory value in diagnosis.
This study aimed to assess whether patients with different pain sources could be differentiated using the Oswestry Disability Index (ODI) (a validated patient questionnaire scoring ten different aspects of pain and function in patients with LBP; higher scores correlating with greater disability).
Methods And Results: ODI scores were recorded from 67 patients (46 female, age 17–82) whose source of LBP was subsequently confirmed by selective injection. The scores for each section of the ODI were compared between patients grouped according to pain origin; disc (n=11), sacroiliac (n=31) or facet (n=25).
Patients with disc pain had significantly greater overall disability and scored higher for sitting, sleeping and social activity than those with facet or sacroiliac pain as judged by the 95% confidence limits of the median (p< 0.05). Patients with facet pain scored higher for walking and standing compared to those with sacroiliac pain.
For disc pain scores were higher for sitting and standing than for walking, and for facet pain scores were higher for standing than for sitting or walking.
Conclusion: Although the ODI is not a diagnostic tool, analysis of its components reveals characteristic pain and disability patterns in patients sub-grouped according to pain source.
Correspondence should be addressed to Ms Alison McGregor, c/o BOA, SBPR at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
