What is the role of sacroiliac joint injections in the treatment of low back pain (LBP)?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Answer

Pain relief from intra-articular sacroiliac joint (SIJ) injections of local anesthetics and corticosteroids is considered short-term if lasting less than 6 weeks and long-term after 6 weeks. These injections are moderately useful in terms of diagnostic accuracy. The evidence for any benefit from intra-articular SIJ injections is limited for both short- and long-term relief. In the diagnostic phase, a patient may receive 2 SIJ injections at intervals shorter than 1 week or, preferably, 2 weeks. In the therapeutic phase (which begins on completion of the diagnostic phase), the suggested frequency would be every 2 months or longer, provided that 50% relief is obtained for 6 weeks from each injection session. In this phase, these procedures should be limited to 4-6 applications of local anesthetic and corticosteroids over a period of 1 year in each region. [136]

The evidence resulting from RF neurotomy of a painful SIJ is limited and is considered short-term when lasting less than 3 months, and long-term when lasting 3 months or longer. Relief of pain by injecting this joint tells the physician that this is a pain generator that would best be treated in physical therapy rather than surgically. Physical therapy should always be considered an adjunctive requisite for SIJ blocks or RF neurotomy. The suggested frequency of SIJ RF neurotomy is once every 3 months or longer (for a maximum of 3 times/y), provided that >50% relief is obtained for 10-12 weeks. [136]


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