Sacroiliac Joint (SIJ) Disease is one of the major causes of lower back pain. The sacroiliac joint is located at the junction between the spine and the pelvis. The sacroiliac joint is a weight-bearing joint as the weight from the upper body is transmitted down the spine, through the sacroiliac joint and into the pelvis, hips, and lower extremities. The sacroiliac joint is supported by many muscle groups and ligaments that are richly innervated by free nerve endings and spinal nerve roots. When there is inflammation to the sacroiliac joint, the abundance of nerves become irritated and patients experience intense lower back pain. Patients typically complain that pain associated with sacroiliac joint worsens when sitting for long periods of time or performing twisting motions and will usually resolve with exercise.
Treatments
Sacroiliac Joint Steroid Injections: involve injecting a steroid into the joint space of the SIJ, where the irritated nerve roots are located. This injection includes both a long-lasting steroid and a local anesthetic (lidocaine, bupivacaine). The steroid reduces the inflammation and irritation and the anesthetic works to numb nerves in the area. The combination medicine then spreads throughout the joint and surrounding areas, reducing inflammation and irritation. The entire procedure usually takes less than 15 minutes.
SIJ Traumeel Injections: Traumeel is a homeopathic natural anti-inflammatory medication that has very few side-effects and can be injected into the SIJ when steroid medications are not desired.
Medial and Lateral Branch Blocks: The medial and lateral branches innervate (supply with nerves) the sacroiliac joint. Blocking these nerves is diagnostic and therapeutic. If your pain is better after the injections, than you may be a candidate for radiofrequency procedure.
Radiofrequency Ablation: The medial and lateral branches innervate (supply with nerves) the sacroiliac joint and can be destroyed with radiofrequency. The nerves typically grow back, but people report pain relief from ranging from three months to three years.
Spinal Cord Stimulation: A small electrode is typically placed in the epidural space and electrical current is directed through the electrode. If pain relief is attained, a permanent system with battery and electrodes can be placed under the skin.
Chiropractic Manipulation: The sacroiliac joint can sometimes be manipulated into place if it is believed to be out of alignment.
TENS unit: Electrical current is directed over the skin to the most painful area. The brain cannot perceive the pain it previously felt, but now feels the “tingling or buzzing” sensation that is commonly used to describe TENS therapy. TENS therapy may also cause the brain to release endorphin (the body’s natural pain fighters).
Physical Therapy: Is extremely important to increase range of motion and continue to maintain strength in a painful shoulder.
Acupuncture: Acupuncture is an alternative treatment that was originally started in China over 2000 years ago and is quickly gaining acceptance and popularity in Western Medicine for the treatment of many conditions (Facco 2007). Research continues to explore the use of acupuncture in the treatment of many chronic pain conditions.
Benefits
Chronic lower back pain is one of the most difficult conditions for physicians to treat. Commonly seen, the pain may go into remission with periods of decreased or absent symptoms. However, the pain frequently returns and causes a chronic pain syndrome in most people. Sacroiliac Joint Injections are a minimally invasive, low risk procedure that can cause a significant decrease in symptoms without disrupting your daily activities. In patients suffering from chronic sacroiliac joint pain, Sacroiliac Joint Injections are preferred to the more conventional methods of treatment (Pereira 2000).
Risks
SIJ injections are considered an appropriate non-surgical treatment for many patients who suffer from lower back pain. The associated risks, although rare, include nerve damage, bleeding, and infection. Some of the potential side effects of the corticosteroid may include elevated blood sugars, weight gain, arthritis, stomach ulcers, and transient decrease in the immune system.
Outcome
Patients have reported that Sacroiliac Joint Pain began spontaneously or had an insidious (slow) onset. Others recognize a specific event that triggered the occurrence of the pain. Frequently, the pain can be due to a traumatic injury to the spine resulting in residual sacroiliac joint inflammation. While conservative treatment, such as NSAID’s and physical therapy may be effective, Murakami and Tanaka reported in 2007 that the effect of periarticular injection (injections occurring around a joint) into the SIJ was 96% effective in pain improvement in patients with sacroiliac joint complaints, with minimal complications (2007 Murakami).
How We Can Help You
Arizona Pain Specialists is a Pain Center of Excellence and we realize the burden Sacroiliac Joint Pain can have on your life. We believe a compassionate patient-centered program integrating allopathic (alternative) and complementary treatments is the most effective method to obtain long-term pain relief.
During an initial visit, a pain physician will evaluate and diagnose your painful condition and build a customized treatment program that is specific for you. If you or someone you know could benefit from treatments we offer please contact Arizona Pain Specialists today.
Articles
- Sacroiliac Joint Injections – PainDoctor.com
- Murakami E, Tanaka Y, Aizawa T, Ishizuka M, Kokubun S. J Effect of periarticular and intraarticular lidocaine injections for sacroiliac joint pain: prospective comparative study. Orthop Sci. 2007 May;12(3):274-80. Epub 2007 May 31
- Pereira PL, Günaydin I, Duda SH, Trübenbach J, Rémy CT, Kötter I, Kastler B, Claussen CD. Corticosteroid injections of the sacroiliac joint during magnetic resonance: preliminary results J Radiol. 2000 Mar;81(3):223-6