Sacroiliac joint pain affects millions of Americans. It is estimated that between 12 and 25% of low back pain is actually coming from a problem in one of the SI joints. These joints have cartilage just like other weight-bearing joints, and are subject to arthritis degeneration similarly.
Chronic pain due to an SI joint arthritis problem does not have a good surgical answer. There is a procedure that has been developed which fuses the joint, but there are no long-term studies available showing its effectiveness. So the best way to treat SI joint pain is conservatively with pain management options, and here are what those entail.
Initial treatment should consist of over-the-counter medications including Tylenol and anti-inflammatories such as ibuprofen or naproxen. These have very low risk when taken according to the manufacturer’s recommended dosing, and may help significantly with mild to moderate pain emanating from the SI joint.
When it comes to prescription medications such as narcotics and muscle relaxers, those may be indicated on a short-term basis during an acute exacerbation phase of the SI joint pain. These should not be taken on a chronic basis, as the risks of those medications begins to outweigh the benefits.
Chiropractic treatment can help significantly with SI joint pain. Spinal manipulations can relieve pain significantly for weeks at a time, but it’s usually not a permanent solution. Additional treatments with the chiropractor may include physical rehabilitation, electrical stimulation, ultrasound, ice and heat, and maybe trigger point therapy.
Physical therapy can also work well for pain coming from an SI joint. This includes stretching and strengthening which can help relieve pressure off of the joint. This is similar to when you have arthritis in a hip joint, strengthening those muscles around the joint can take pressure off of the arthritic painful area.
When it comes to interventional pain management, there are a few procedures that could help for sacroiliitis. Steroid injections directly into an SI joint can work well similar to other arthritic joints like the hip or the knee. With the sacroiliac joint being a long, jagged joint, it can be difficult to gain appropriate entry to place the steroid. Therefore, fluoroscopy is recommended and entering the joint in different areas may be necessary to get the steroid in the proper amount and areas. Relief from a few weeks to a few months should be expected in over half of treated patients. Injections may be repeated every few months.
There is an injection around the SI joint that can help which is called a lateral branch block. In the lumbar spine this is actually called a medial branch block, but sensation to the sacroiliac joint comes from the other side and therefore numbing medicine is placed around these tiny little nerve endings. This injection may provide relief for a few weeks to a few months as well, and also confirms for the pain doctor that the SI joint is the source of the patient’s pain if it provides pain relief. if that injection wears off, it may be repeated or the patient may move on to a radiofrequency ablation. Radiofrequency ablation has a decent history now in the cervical and lumbar spine, and is gaining immense popularity in the sacrum due to numerous studies showing its effectiveness. Basically what it does is deaden the tiny little nerve endings supplying sensation to the joint, and may provide substantial pain relief for over six months.
If you’re experiencing low back pain or sacroiliac joint pain in Florida, let the Florida Pain Network help you. The Network has pain clinics listed in the directory around the state, which accept a lot of different insurances and some accept self-pay patients. Clinics include pain management Orlando practices, Port St. Lucie pain management, pain management Boca Raton clinics, Tampa pain management and many more.
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