A comprehensive review of the typical and atypical side effects of gabapentin.

BACKGROUND: Gabapentin, a widely prescribed medication for various neuropathic pain conditions, has demonstrated efficacy in managing diverse neurological disorders. While conventional side effects are well-documented, a growing body of evidence suggests the existence of atypical side effects, necessitating comprehensive exploration. This paper aims to systematically review and summarize the literature on the atypical side effects of gabapentin, shedding light on manifestations beyond the conventional spectrum. METHODS: A systematic review was conducted, encompassing peer-reviewed articles published up to the knowledge cutoff date in November 2023. Databases, specifically PubMed, were searched for relevant studies, focusing on atypical side effects such as myoclonus, ataxia, pediatric aggression, respiratory depression, pneumonia, pregnancy complications, sleep interference, encephalopathy, peripheral edema, suicidal ideation, dyskinesia, anorgasmia, and myopathy. Inclusion criteria comprised studies with a focus on gabapentin-related atypical side effects, published in recognized journals and involving human subjects. RESULTS: The review identified a spectrum of atypical side effects associated with gabapentin use, ranging from neurological manifestations like myoclonus and ataxia to behavioral changes such as pediatric aggression and suicidal ideation. Additionally, respiratory complications, pregnancy-related issues, sleep disturbances, and rare complications like encephalopathy and myopathy were observed. Literature synthesis provided insights into the incidence, clinical presentation, and potential mechanisms underlying these atypical side effects. CONCLUSION: This comprehensive review highlights the diverse range of atypical side effects associated with gabapentin use, expanding beyond conventional knowledge. Healthcare practitioners must be cognizant of these manifestations, recognizing their potential impact on patient well-being. As clinical decision-making relies on a thorough understanding of a medication's side effect profile, this review contributes to enhancing awareness and fostering informed practices in the prescription and management of gabapentin. Further research is warranted to elucidate the mechanisms and risk factors associated with these atypical side effects, refining our understanding of gabapentin's safety profile.

Use of Temporary Percutaneous Peripheral Nerve Stimulation in an Oncologic Population: A Retrospective Review.

OBJECTIVES: Patients with an underlying cancer diagnosis may experience pain from many sources. Temporary, percutaneous peripheral nerve stimulation (PNS) is a minimally invasive procedure that can control pain in those who have failed conservative management. The purpose of this retrospective review is to show the use of PNS in managing pain in the oncologic setting. MATERIALS AND METHODS: Temporary, percutaneous PNS was placed under fluoroscopic or ultrasound guidance for 15 patients at a cancer pain facility. Cases were grouped by subtypes of cancer pain (ie, tumor-related, treatment-related, cancer-associated conditions, and cancer-independent). Before PNS, patients were refractory to medical management or previous interventional treatments. Patients were observed with routine clinic visits to monitor pain levels via visual analog scale (VAS) and quality-of-life measures. PNS was removed after the indicated 60-day treatment period. RESULTS: This retrospective review presents ten successful cases of oncologic-related pain treated with PNS. Patients with subtypes of pain that were tumor related, from cancer-associated conditions, and cancer independent all experienced a similar degree of pain relief. However, patients with cancer-treatment-related pain experienced the least analgesia from PNS. We also present six cases in which PNS did not provide adequate pain relief. CONCLUSION: PNS is an emerging technology in neuromodulation that may be useful in managing pain, especially in the oncologic population. Patients with cancer-related and non-cancer-related pain localized to a specific nerve distribution should be considered appropriate candidates for PNS. Further research is needed to optimize patient selection and indications for PNS in the population with cancer.

Trends of opioid prescription in cancer patients utilizing telemedicine: a retrospective study.

Aim: Prescribing patterns among healthcare practitioners remain a recurring theme of interest in the opioid crisis. This study aims to provide insight on opioid prescribing patterns for cancer pain in telemedicine and in-person encounters during COVID-19. Materials & methods: A retrospective chart review of 1000 encounters (500 telemedicine and 500 in-person) at an academic tertiary care comprehensive cancer center. Results: On average, overall, significantly higher narcotics (in morphine milligram equivalents [MME]) prescribed for patients receiving telemedicine services. In-person encounters had a significantly higher proportion of narcotic (in MME) increases in subsequent visits. Conclusion: Our institution continues to adapt telehealth services as an additional care venue and deeper insight helps mitigate development of maladaptive opioid prescribing patterns.

Risk factors for surgical site infection in advanced neuromodulation pain procedures: a retrospective study.

Aim: To assess the effects of diabetes mellitus (DM) and related variables on surgical site infection (SSI) risk in neuromodulation. Methods: This retrospective study followed patients who underwent neuromodulation procedures for at least 9 months to identify postoperative infections. Demographics, clinical characteristics and surgical outcomes were compared. Results: Of 195 cases included, 5 (2.6%) resulted in SSIs. Median HbA1c was significantly higher for the cases with SSIs (8.2 vs 5.6%; p = 0.0044). The rate of SSI was significantly higher among patients with DM (17.9 vs 0%; p = 0.0005), HbA1c≥7% (37.5 vs 0%; p = 0.0009), and perioperative glucose ≥200 mg/dl (40 vs 2.3%; p = 0.0101). Conclusion: DM, elevated HbA1c and perioperative hyperglycemia may all contribute to increased risk of SSIs with neuromodulation procedures.

Infections are feared complications of surgery. It is important to identify factors that increase the risk of infection to prevent these complications. This study looked at the effects of diabetes and high blood sugar on the risk of infection associated with pain procedures. The researchers followed patients who had these procedures and looked for any infections that occurred afterward. They found that patients with diabetes and high blood sugar levels before surgery were more likely to develop infections after these procedures. More research can help establish blood sugar targets so that physicians can better manage this risk for their patients.

Dorsal root ganglion stimulation for chemotherapy-induced peripheral neuropathy.

BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) is a common consequence of cancer treatment that can be persistent and difficult to manage. Dorsal root ganglion stimulation (DRG-S) is a recently introduced but understudied treatment modality. This study explored the effect of DRG-S on pain and symptom burden associated with CIPN. METHODS: Patients with CIPN who underwent a DRG-S trial between January 2017 and August 2022 were identified through chart review after IRB approval was obtained. Demographic data, procedure details, pre-and postoperative scores, including the Numerical Rating Scale (NRS) and Edmonton Symptom Assessment System (ESAS), and duration of follow-up were recorded. Statistical analysis included descriptive statistics and paired t-tests to compare pre-and postoperative scores. RESULTS: Nine patients with an even mix of solid and hematologic malignancies underwent DRG-S trial and had a statistically significant decrease in NRS scores, with a mean reduction of 2.3 in their average pain (p = 0.014), 2.6 in worst pain (p = 0.023), and 2.1 in least pain (p = 0.018). Eight patients (88.9%) underwent permanent DRG-S implantation. Mean NRS scores remained lower than preoperative baselines through the first year of follow-up. Statistically significant reductions were noted at 3 months in average (2.1, p = 0.006) and least pain scores (1.9, p = 0.045), which further decreased after 6-12 months (average: 3.6, p = 0.049; least: 3.4, p = 0.023). Only the pain component of ESAS scores showed a significant reduction with DRG-S (2.0, p = 0.021). All patients endorsed improved sensation, 75% decreased their pain medication usage, and 37.5% reported complete pain relief by 2 years. CONCLUSION: Dorsal root ganglion stimulation can be an effective treatment for pain related to CIPN and deserves further investigation.

Peripheral Nerve Stimulation for Back Pain in Patients With Multiple Myeloma as Bridge Therapy to Radiation Treatment: A Case Series.

OBJECTIVES: Patients with spinal lesions or vertebral compression fractures from multiple myeloma often present with back pain that restricts their ability to lie flat and prevents them from undergoing cancer treatment. Temporary, percutaneous peripheral nerve stimulation (PNS) has been described for cancer pain secondary to oncologic surgery or neuropathy/radiculopathy from tumor invasion. The purpose of this case series is to show the use of PNS as an analgesic bridge therapy to treat myeloma-related back pain and allow patients to complete their course of radiation. MATERIALS AND METHODS: Temporary, percutaneous PNS was placed under fluoroscopic guidance for four patients with unremitting low back pain secondary to myelomatous spinal lesions. Before PNS, the patients had pain refractory to medical management and were unable to tolerate radiation mapping and treatment owing to low back pain while supine. Patients were followed with routine clinic visits to monitor pain and progression through cancer therapy. PNS was removed after approximately 60 days or after completion of radiation. RESULTS: This case series presents four successful cases of PNS to treat low back pain from myelomatous spinal lesions and associated vertebral compression fractures. PNS targeted the medial branch nerves to treat both nociceptive and neuropathic low back pain. All four patients successfully completed radiation therapy with PNS in place. CONCLUSIONS: PNS can effectively treat low back pain secondary to myeloma-related spinal lesions as a bridge therapy to radiation. The use of PNS is a promising option for back pain from other primary or metastatic tumors. Further research is needed into the use of PNS for cancer-related back pain.

Diagnostic value of the posterior talofibular ligament area for chronic lateral ankle instability.

An injured posterior talofibular ligament (PTFL) is one of the reasons for chronic lateral ankle instability (CLAI). Previous researches have demonstrated that the PTFL thickness (PTFLT) is associated with chronic ligament injuries. However, ligament hypertrophy is different from ligament thickness. Thus, we created the PTFL cross-sectional area (PTFLCSA) as a diagnostic image parameter to assess the hypertrophy of the whole PTFL. We assumed that the PTFLCSA is a key morphological diagnostic parameter in CLAI. PTFL data were obtained from 15 subjects with CLAI and from 16 normal individuals. The T1-weighted axial ankle-MR (A-MR) images were acquired at the level of PTFL. We measured the PTFLT and PTFLCSA at the posterior aspect of the ankle using our imaging analysis program. The PTFLT was measured as the thickness between point of anterior and posterior fiber of PTFL. The PTFLCSA was calculated as the whole cross-sectional PTFL area. The average PTFLT was 3.43 ± 0.52 mm in the healthy group and 4.89 ± 0.80 mm in the CLAI group. The mean PTFLCSA was 41.06 ± 12.18 mm 2 in the healthy group and 80.41 ± 19.14 mm 2 in the CLAI group. CLAI patients had significantly greater PTFLT ( P < .001) and PTFLCSA ( P < .001) than the healthy group. A receiver operating characteristic curve analysis demonstrated that the optimal cutoff score of the PTFLT was 4.19 mm, with 93.3% sensitivity, 93.7% specificity, and an area under the curve of 0.97. The most suitable cutoff value of the PTFLCSA was 61.15 mm 2 , with 93.3% sensitivity, 100% specificity, and area under the curve of 0.99. Even though the PTFLT and PTFLCSA were both significantly associated with CLAI, the PTFLCSA was a more exact morphological measurement parameter.

Case report: use of high-intensity laser therapy for treatment of trigeminal neuralgia.

Trigeminal neuralgia represents a form of chronic facial pain that is characterized by its incapacitating nature. The current therapeutic approaches encompass pharmacological agents with carbamazepine or non-pharmacologic options including utilization of percutaneous rhizotomy, Gamma knife radiosurgery or microvascular decompression may be indicated in certain cases. While the interventions may be effective, medications have negative side effects and procedures are invasive which can pose challenges for patients with various comorbidities. High-intensity laser therapy (HILT) has demonstrated safety and efficacy for many types of chronic pain such as musculoskeletal, autoimmune and neuropathic. Herein, we demonstrate the benefits of HILT therapy in the management of trigeminal neuralgia in a 72 year-old patient with a complex history of facial surgery and radiation who had failed pharmacological treatments and denied any invasive procedures.

Trigeminal neuralgia causes severe facial pain, often requiring medications or invasive procedures. High-intensity laser therapy (HILT), known for treating many chronic pains, was explored for a 72 year-old patient with a complex medical history. Previous treatments had failed, and alternatives carried risks. HILT, a safe approach improving blood flow, was given for 3 days, targeting the painful area in the face. The patient experienced improved tissue oxygen supply and pain relief. The follow-up visit at 4 weeks showed sustained relief, enhanced jaw movement and no side effects. Although promising, further research is needed to confirm HILT's effectiveness for trigeminal neuralgia on a larger scale.

Methylene blue for intractable pain from oral mucositis related to cancer treatment: a randomized phase 2 clinical trial.

BACKGROUND: Oral mucositis (OM) in patients receiving cancer therapy is thus far not well managed with standard approaches. We aimed to assess the safety and effectiveness of methylene blue (MB) oral rinse for OM pain in patients receiving cancer therapy. METHODS: In this randomized, single-blind phase 2 clinical trial, patients were randomized to one of four arms: MB 0.025%+conventional therapy (CTx) (n = 15), MB 0.05%+CTx (n = 14), MB 0.1%+CTx (n = 15), or CTx alone (n = 16). Intervention groups received MB oral rinse every 6 h for 2 days with outcomes measured at days 1-2; safety was evaluated up to 30 days. The primary outcome measured change in the pain numeric rating scale (0-10) from baseline to day 2. Secondary outcome measured change in oral function burden scores from baseline to day 2, World Health Organization OM grades, morphine equivalent daily doses, and adverse events. The trial was registered with ClinicalTrials.gov ID: NCT03469284. RESULTS: Sixty patients (mean age 43, range 22-62 years) completed the study. Compared with those who received CTx alone, those who received MB had a significant reduction of pain scores at day 2 of treatment (mean ± SD); 0.025%: 5.2 ± 2.9, 0.05%: 4.5 ± 2.9, 0.1%: 5.15 ± 2.6) and reduction of oral function burden scores (0.025%: 2.5 ± 1.55, 0.05%: 2.8 ± 1.7, 0.1%: 2.9 ± 1.60). No serious adverse events were noted, but eight patients reported burning sensation of the oral cavity with the first dose, and this caused one patient to discontinue therapy. CONCLUSIONS: MB oral rinse showed significant pain reduction and improved oral functioning with minimal adverse effects. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03469284.

Clinical practice guidelines for the management of patients with complex regional pain syndrome: a systematic appraisal using the AGREE II instrument.

Aim: Complex regional pain syndrome (CRPS) is a debilitating, painful condition of limbs that often arises after an injury and is associated with significant morbidity. Materials & methods: The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument, used to assess the quality of clinical practice guidelines (CPGs), was used to evaluate seven CRPS management guideline. Results: Out of the seven CPGs evaluated using the AGREE II instrument, only one from Royal College of Physicians was found to have high-quality consensus guidelines for diagnosis and management of CRPS. Conclusion: Future CPGs should be backed by systematic literature searches, focus on guidelines clinical translation into clinical practice and applicability to the desired patient population.

Non-Invasive Pelvic Floor Rehabilitation in Cancer Population: An Incomplete Cohort.

BACKGROUND: Pelvic floor dysfunction and its associated symptoms are a common clinical challenge in the cancer population. Despite the noninvasive nature of pelvic floor rehabilitation (PFR) for this condition and the promising clinical results observed with its use, PFR appears to be an underused therapy. OBJECTIVES: The purpose of this study was to quantify the association between physical therapy of the pelvic floor and its effect on pain relief and the associated symptoms in cancer patients with pelvic floor dysfunction. STUDY DESIGN: Retrospective cohort study. METHODS: With the use of an electronic database in our pain medicine department, we retrospectively quantified the pain relief and symptom improvement in patients diagnosed as having chronic pelvic floor dysfunction who had undergone PFR. RESULTS: Of the 68 patients available for analysis, 49 met the inclusion criteria. Baseline characteristics of included patients were generally similar. The duration of pelvic pain before PFR was 53.7 months (mean) (SD, 182.5 months; median, 12 months). Of the 49 study patients, 23 (47%) had bladder dysfunction, 24 (49%) had dyspareunia, 2 (4%) had erectile dysfunction, and one (2%) had rectal dysfunction. Most symptoms associated with pelvic floor dysfunction resolved after PFR. LIMITATIONS: Single-center, small data, retrospective study. CONCLUSIONS: PFR is an effective tool for treating the pain associated with pelvic floor dysfunction and its related symptoms. This conservative approach can contribute to lowering the use of opiate analgesics.

Case report: Use of peripheral nerve stimulation for treatment of pain from vertebral plana fracture.

Vertebral plana fractures are a severe form of compression fractures that can cause significant morbidity due to incapacitating pain. Due to the flattening of the vertebrae in a plana fracture, accessing the vertebral body transpedicularly can be difficult, making traditional vertebral augmentation treatment dangerous. These injuries also typically occur in elderly patients with contraindications to invasive procedures. Peripheral nerve stimulation is a relatively new and minimally invasive treatment that uses electrical stimulation to inhibit pain signals from reaching the somatosensory cortex. Our case describes an 80 Year old female with multiple comorbidities and refractory pain due to a vertebral planar fracture successfully treated with a 60 day course of peripheral nerve stimulation as evidenced by over 50% reduction in symptoms and discontinuation of opioid pain medication use.

Subanesthetic ketamine in the ambulatory setting for refractory cancer pain: a 6-year retrospective at a cancer center.

Pain is common in advanced cancer is often refractory to standard treatment. Ketamine has shown promise as an effective adjuvant despite conflicting reports. The aim of this retrospective was to analyze the efficacy of subanesthetic ketamine infusion in the ambulatory setting over an extended follow-up period of 3 months for symptoms related to refractory cancer pain. Forty seven patients treated with intravenous ketamine infusion for refractory cancer pain at a tertiary referral cancer center. Patients demonstrated improvement from baseline in worst, mean, current and least pain immediately after treatment (p < 0.05), worst pain 1 month after treatment (p = 0.003), and current pain (p = 0.036) and worst pain (p = 0.002) 3 months after treatment. Symptoms of quality of life were followed 1 month after treatment.

Predictors of response to medial branch block, radiofrequency ablation or facet joint injections: a retrospective study.

Aim: Low back pain is a leading cause of patient disability in the USA. Our goal was to determine association between patient characteristics and their response to lumbar medial branch block, radiofrequency ablation of medial nerves or lumbar facet joint injections. Materials & methods: Medical records for the first 100 patients who underwent lumbar medial branch block, radiofrequency ablation of lumbar medial nerves or lumbar facet joint injections between 1 September 2019 and 31 March 2020 were reviewed and demographic data were recorded. Results: At the 3-month post-procedure visit, positive responders were significantly more likely to be non obese patients (BMI <30) and those with pain <5-years. Conclusion: Obesity and chronicity of pain certainly are found to be predictors of response to the above mentioned procedures.

Mirogabalin: could it be the next generation gabapentin or pregabalin?

Except for carbamazepine for trigeminal neuralgia, gabapentinoid anticonvulsants have been the standard for the treatment of neuropathic pain. Pregabalin, which followed gabapentin, was developed with the benefit of rapid peak blood concentration and better bioavailability. Mirogabalin besylate (DS-5565, Tarlige®) shows greater sustained analgesia due to a high affinity to, and slow dissociation from, the α2δ-1 subunits in the dorsal root ganglion (DRG). Additionally, it produces a lower level of central nervous system-specific adverse drug reactions (ADRs), due to a low affinity to, and rapid dissociation from, the α2δ-2 subunits in the cerebellum. Maximum plasma concentration is achieved in less than 1 hour, compared to 1 hour for pregabalin and 3 hours for gabapentin. The plasma protein binding is relatively low, at less than 25%. As with all gabapentinoids, it is also largely excreted via the kidneys in an unchanged form, and so the administration dose should also be adjusted according to renal function. The equianalgesic daily dose for 30 mg of mirogabalin is 600 mg of pregabalin and over 1,200 mg of gabapentin. The initial adult dose starts at 5 mg, given orally twice a day, and is gradually increased by 5 mg at an interval of at least a week, to 15 mg. In conclusion, mirogabalin is anticipated to be a novel, safe gabapentinoid anticonvulsant with a greater therapeutic effect for neuropathic pain in the DRG and lower ADRs in the cerebellum.

All about pain pharmacology: what pain physicians should know.

From the perspective of the definition of pain, pain can be divided into emotional and sensory components, which originate from potential and actual tissue damage, respectively. The pharmacologic treatment of the emotional pain component includes antianxiety drugs, antidepressants, and antipsychotics. The anti-anxiety drugs have anti-anxious, sedative, and somnolent effects. The antipsychotics are effective in patients with positive symptoms of psychosis. On the other hand, the sensory pain component can be divided into nociceptive and neuropathic pain. Non-steroidal anti-inflammatory drugs (NSAIDs) and opioids are usually applied for somatic and visceral nociceptive pain, respectively; anticonvulsants and antidepressants are administered for the treatment of neuropathic pain with positive and negative symptoms, respectively. The NSAIDs, which inhibit the cyclo-oxygenase pathway, exhibit anti-inflammatory, antipyretic, and analgesic effects; however, they have a therapeutic ceiling. The adverse reactions (ADRs) of the NSAIDs include gastrointestinal problems, generalized edema, and increased bleeding tendency. The opioids, which bind to the opioid receptors, present an analgesic effect only, without anti-inflammatory, antipyretic, or ceiling effects. The ADRs of the opioids start from itching and nausea/vomiting to cardiovascular and respiratory depression, as well as constipation. The anticonvulsants include carbamazepine, related to sodium channel blockade, and gabapentin and pregabalin, related to calcium blockade. The antidepressants show their analgesic actions mainly through inhibiting the reuptake of serotonin or norepinephrine. Most drugs, except NSAIDs, need an updose titration period. The principle of polypharmacy for analgesia in case of mixed components of pain is increasing therapeutic effects while reducing ADRs, based on the origin of the pain.

Normal Saline Trigger Point Injections vs Conventional Active Drug Mix for Myofascial Pain Syndromes.

BACKGROUND: Myofascial pain syndrome (MPS) originates in the muscle and fascia. MPS presents with referred pain specific for each muscle and a trigger point that reproduces the symptoms. Trigger-point-injection (TPI) is an effective approach to treating MPS. Some TPI agents, however, are associated with systemic and local side effects. OBJECTIVE: The aim of this study was to evaluate the effectiveness of TPI with a conventional active drug mixture (CADM) vs. that with normal saline solution (NS) alone in patients with MPS presenting to the emergency department (ED). METHODS: Adults with MPS diagnosed in the ED, participants were randomly assigned to receive TPI with NS or with CADM. Pain intensity was scored using a 0-10 numeric rating scale prior to and after TPI, before discharge and 2 weeks after TPI. RESULTS: Among 48 patients analyzed, 23 received TPI with NS. The mean pain scores were as follows: immediately before TPI, 7.59 (NS) and 7.44 (CADM); immediately after TPI, 2.22 (NS) and 1.76 (CADM); prior to discharge, 1.52 (NS) and 1.76 (CADM). At 2-week follow up, the mean pain scores were 4.29 (NS) and 4.14 (CADM). Pain was significantly reduced after TPI in both groups. At 2 weeks, the mean pain scores were similar between the groups. No adverse events were reported. CONCLUSION: In cases of MPS in the ED, pain can be controlled with TPI independent of the injectate. TPI with NS may be preferred over CADM because of its lower cost and more favorable side effect profile.

Recurrence of complex regional pain syndrome after administration of adenosine.

Background: The effects of adenosine in acute chronic pain are not clear. Literature supports both a pronociceptive/inflammatory role of the A2aR/A2bR and antihyperalgesia/allodynia with A1Rs/A3Rs. Adenosine could participate in the reactivation of chronic regional pain syndrome (CRPS) through inflammatory pathways and via A2Rs. Plastic changes in the brain CRPS-related overlap with those seen in systemic inflammation and persist even after symptoms of CRPS resolve. Aim: To illustrate the hypothesis that intravenous adenosine can reactivate dormant CRPS. Case report: An individual with successfully treated CRPS developed supraventricular tachycardia, he was treated with intravenous adenosine. Shortly after a second dose, he developed severe pain at a lower limb from relapsed CRPS. Treatment included lumbar sympathetic block, physical therapy and pharmacological agents. Conclusion: Intravenous adenosine can reactivate dormant CRPS. Its potential pronociceptive role in CRPS calls for further studies to better elucidate the underlying mechanisms.

Sacroiliac joint pain following iliac-bone marrow aspiration and biopsy: a cohort study.

Background: Sacroiliac joint (SIJ) pain is a common source of lower back pain; the factors associated have not been studied in cancer patients. Observing patients with bone marrow aspiration and biopsy (BMAB) who subsequently developed SIJ-pain led to this investigation. Aim: To investigate this possible relationship. Methods: A cohort study of cancer patients diagnosed with SIJ pain. The association of BMAB with SIJ pain was evaluated, as were variables that differed between the groups. Results: The prevalence of SIJ pain was 4.95% (231/4669). Among 231 patients with SIJ pain, 34% (78/231) did not have prior history of lower back pain and had undergone BMAB prior to their diagnosis of SIJ pain. A statistically significant association between BMAB-SIJ-pain was found (p < 0.01). Conclusion: We found linear correlation between BMAB and subsequent SIJ pain.