Lower back pain is a very common complaint in the Chronic Pain Clinic. Its etiology is nonspecific in 85% of the cases. In 1957, Strong and Davila reported that the superior cluneal nerves (SCNs) and middle cluneal nerves (MCNs) can be entrapped around the iliac crest, suggesting a causal relationship between this entrapment (SCN-Entrapment, SCN-E) and low back pain symptom. This is known today as "cluneal syndrome". Cluneal syndrome remains poorly investigated and is currently a diagnostic challenge. Various types of lumbar movements exacerbate its occurence. The most common theory regarding the origin of this pain evokes that is primarily due to a mechanical cause linked to stenosis or adhesions of fibrous tissue around the cluneal nerves causing distress. The hypothesis is that the investigator can reduce the pain related to the syndrome of superior cluneal origin thanks to a "volume effect" which aims to detach adhesions and/or aponeurotic stenoses that cause a distress of cluneal nerves. The aim of this study is to assess the effectiveness of the cluneal nerve block using theThomas Dahl Nielsen ultrasound based technique in patients with chronic low-back pain related to SCN-E. To this end, the investigator will compare physiological serum injection versus local anaesthetic injection, with the aim of reducing short-term pain and improving quality of life.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
The patients will receive 15 ml of Ropivacaine 0.375 % on each side.
The patients will receive 15 ml of physiological serum (NaCl 0.9 %) on each side.
Reduction of pain intensity in the acute phase of the treatment.
The pain intensity will be assessed using the numeric analogue scale (NAS) at 5 minutes, 30 minutes, 60 minutes and will be compared with (the pain intensity at) the baseline. The patient rate the pain from 0 to 10 (0 = no pain; 10 = worst pain imaginable)
Time frame: up to 1 hour post-infiltration
Reduction of pain in the late phase of the treatment.
The pain intensity will be assessed with the numeric analogue scale (NAS) at 15 days, 1 month, 3 month post-infiltration and will be compared with the pain intensity at the baseline. The patient rate the pain from 0 to 10 (0 = no pain; 10 = worst pain imaginable)
Time frame: up to 3 months post-infiltration
Impact of Pain on daily life
Impact of pain on daily life will be evaluated according to the Dallas Pain Questionnaire (DPQ). The Dallas Pain Questionnaire (DPQ) is 16-item visual analog tool for evaluating how the chronic pain affects the daily activities (The higher the score, the greater the impact of low back pain on quality of life). The impact on daily life will be evaluated before infiltration, 15 days, 1 month, 3 months after infiltration.
Time frame: up to 3 months post-infiltration
Incidence of Side effects
Side effects will be collected such that the intolerance to the technique and/or injected product, traumatic complications
Time frame: up to 3 months post-infiltration
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.