From the Guidelines
Iliac pain in adults is typically managed with a combination of rest, pain medication, and physical therapy, prioritizing the reduction of morbidity, mortality, and improvement of quality of life. For acute pain, start with over-the-counter NSAIDs like ibuprofen (400-600mg every 6-8 hours) or naproxen (220-440mg twice daily) for up to 10 days, as these have been shown to be effective in managing pain with minimal side effects 1. Apply ice for 15-20 minutes several times daily during the first 48 hours, then switch to heat therapy. If pain persists, consult a healthcare provider who may prescribe muscle relaxants like cyclobenzaprine (5-10mg three times daily) or stronger pain medications.
Causes and Management
Iliac pain often stems from inflammation or strain of muscles attaching to the iliac crest, sacroiliac joint dysfunction, or hip-related issues. Maintaining proper posture, avoiding prolonged sitting, and using ergonomic support can prevent recurrence. The management of iliac pain should also consider the potential for underlying conditions such as iliac artery occlusive disease, which may present as claudication or rest pain, and can be diagnosed through Doppler vascular ultrasound, CT angiography, or MR angiography 1.
Diagnostic Approach
The diagnostic approach to iliac pain should be guided by the clinical presentation, with a focus on identifying potential causes that may require urgent attention, such as sigmoid volvulus or acute limb ischemia 1. In cases where the diagnosis is unclear, imaging studies such as plain abdominal radiographs or CT scans may be necessary to confirm the diagnosis and guide treatment.
Treatment Options
Treatment options for iliac pain depend on the underlying cause, but may include supportive care, anticoagulation, thrombolytic therapy, surgical or catheter-directed mechanical thrombectomy, and surgical bypass for acute thrombotic cases, and supportive measures such as behavior modification, a supervised exercise program, adjunctive treatment with anticoagulation and antiplatelet medications, angioplasty, stent placement, stent-graft placement, surgical or catheter-directed endarterectomy or plaque excision, and surgical bypass for atherosclerotic disease 1.
Key Considerations
If pain is accompanied by fever, unexplained weight loss, or radiates down the leg, seek immediate medical attention as these may indicate more serious conditions requiring specialized treatment. The management of iliac pain should prioritize the reduction of morbidity, mortality, and improvement of quality of life, and should be guided by the most recent and highest quality evidence available 1.
From the Research
Iliac Pain in Adults
- Iliac pain is a common presenting complaint to general surgery, with a wide range of differential diagnoses, particularly in the elderly 2.
- The use of imaging modalities, such as computed tomography (CT) and ultrasound, can help identify the cause of iliac pain and guide management.
Causes of Iliac Pain
- Appendicitis is a common cause of iliac pain, particularly in younger adults 3, 4.
- Other causes of iliac pain include neoplasia, non-specific abdominal pain, and acute colonic diverticulitis 2.
- Gynaecological pathology, such as ovarian cysts, can also cause iliac pain in women 3, 4.
Diagnostic Imaging
- CT scanning is often used in the evaluation of iliac pain, particularly in older adults, and has a high sensitivity for detecting appendicitis and other causes of iliac pain 2.
- Ultrasound is also a useful imaging modality, particularly in women of reproductive age, and can help identify gynaecological pathology and appendicitis 3, 4.
- The use of ultrasound can help reduce the need for CT scanning and other imaging modalities, and can be used as an adjunct to clinical evaluation 4.
Management of Iliac Pain
- The management of iliac pain depends on the underlying cause, and may involve surgical or medical treatment 2, 4.
- In some cases, iliac pain may be caused by musculoskeletal disorders, such as hip osteoarthritis, and may be managed with ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs) 5.
- US-guided musculoskeletal interventions, such as anesthetic and corticosteroid injections, may also be used to manage hip pain 6.