European guidelines for the diagnosis and treatment of pelvic girdle pain

Abstract

A guideline on pelvic girdle pain (PGP) was developed by "Working Group 4" within the framework of the COST ACTION B13 "Low back pain: guidelines for its management", issued by the European Commission, Research Directorate-General, Department of Policy, Coordination and Strategy. To ensure an evidence-based approach, three subgroups were formed to explore: (a) basic information, (b) diagnostics and epidemiology, and (c) therapeutical interventions. The progress of the subgroups was discussed at each meeting and the final report is based on group consensus. A grading system was used to denote the strength of the evidence, based on the AHCPR Guidelines (1994) and levels of evidence recommended in the method guidelines of the Cochrane Back Review group. It is concluded that PGP is a specific form of low back pain (LBP) that can occur separately or in conjunction with LBP. PGP generally arises in relation to pregnancy, trauma, arthritis and/or osteoarthritis. Uniform definitions are proposed for PGP as well as for joint stability. The point prevalence of pregnant women suffering from PGP is about 20%. Risk factors for developing PGP during pregnancy are most probably a history of previous LBP, and previous trauma to the pelvis. There is agreement that non risk factors are: contraceptive pills, time interval since last pregnancy, height, weight, smoking, and most probably age. PGP can be diagnosed by pain provocation tests (P4/thigh thrust, Patrick's Faber, Gaenslen's test, and modified Trendelenburg's test) and pain palpation tests (long dorsal ligament test and palpation of the symphysis). As a functional test, the active straight leg raise (ASLR) test is recommended. Mobility (palpation) tests, X-rays, CT, scintigraphy, diagnostic injections and diagnostic external pelvic fixation are not recommended. MRI may be used to exclude ankylosing spondylitis and in the case of positive red flags. The recommended treatment includes adequate information and reassurance of the patient, individualized exercises for pregnant women and an individualized multifactorial treatment program for other patients. We recommend medication (excluding pregnant women), if necessary, for pain relief. Recommendations are made for future research on PGP.

Six-month outcomes from a randomized controlled trial of minimally invasive SI joint fusion with triangular titanium implants vs conservative management

“…Our randomized trial differed in design and intervention compared to a US randomized trial; in the US study, nonsurgical management included intraarticular SIJ steroid injections and radiofrequency (RF) ablation. Instead, our trial included only PT and adequate information and reassurance, consistent with European guidelines for pelvic girdle pain [29]. We note that although SIJ steroid injections and RF ablation are not commonly delivered in Europe, many trial participants had already undergone such treatments.…”

“…Conservative management was designed according to the European guidelines for the diagnosis and management of pelvic girdle pain [29]. CM consisted of (1) optimization of medical therapy, (2) individualized physical therapy (PT) that focused on mobilization and stabilization exercises for control and stability, and (3) adequate information and reassurance of the patient as part of a multifactorial treatment.…”

Women's experiences of low back pain during pregnancy

“…There were several reasons given for not seeking treatment: mild intensity or low frequency of pain, absence of health professional referral, believing that LBP is normal during pregnancy, use of other relief strategies and lack of awareness of possible treatments. However, physiotherapy is an effective treatment for LBP during pregnancy [13], and referral should be considered to prevent or reduce LBP and enhance the quality of life of pregnant women.…”

“…Massage therapy has been shown to be effective for reducing LBP and decreasing levels of anxiety [10]. Carr [11] indicated that the use of orthotheses such as sacroiliac belts can significantly reduce pain and lessen the effects on daily life; however, Vleeming et al [13] identified no evidence for the use of a pelvic belt as a stand-alone treatment. Transcutaneous electrical nerve stimulation can also be used, but tends to be the last treatment option, when other treatments are not effective [12].…”

Chiropractic Management of Pregnancy-Related Lumbopelvic Pain: A Case Study

“…1,2 Current terminology, pain topography, functional disabilities, and positive correlation of clinical testing have demarcated the classification of pregnancy-related lumbopelvic pain (PR LPP) into subgroups: pregnancy-related low back pain (PR LBP) and pregnancy-related pelvic girdle pain (PR PGP). [2][3][4] Careful observation of the clinical features of PR LPP can help distinguish the seriousness of the potential symptoms and prognosis. Pain has shown to influence pregnant women's daily lives and the challenges they encounter concerning their physical, psychological, occupational, and social function.…”