Introduction
Sacroiliac Joint Pain (SI Joint Pain) can be a debilitating condition, affecting millions of individuals worldwide. This pain, located in the lower back and buttocks, can radiate down the legs, causing discomfort and limitations in daily life. Thankfully, there are non-surgical treatment options available to alleviate SI joint pain, including Image-Guided Injections such as Intra-articular Platelet Rich Plasma (PRP), Prolotherapy, Steroid Injection, and Radiofrequency Ablation (RFA). In this comprehensive guide, we’ll explore these treatments and provide insights supported by references from published articles and medical journals.
Understanding Sacroiliac Joint Pain
Before delving into the non-surgical treatments, let’s briefly understand the sacroiliac joint and the pain it can cause. The sacroiliac joint connects the sacrum (the triangular bone at the base of the spine) to the ilium (the uppermost bone of the pelvis). When this joint becomes inflamed or dysfunctional, it can lead to chronic lower back pain.
Non-Surgical Treatment Options
Intra-articular Platelet Rich Plasma (PRP)
PRP therapy is a regenerative treatment gaining popularity in the field of pain management. It involves drawing a small amount of the patient’s blood, processing it to concentrate the platelets, and then injecting this PRP into the sacroiliac joint. Platelets contain growth factors that can stimulate tissue repair and reduce inflammation.
How PRP works
PRP promotes tissue healing and regeneration by enhancing the body’s natural healing processes. It can help repair damaged tissues within the sacroiliac joint, reduce inflammation, and ultimately alleviate pain.
Clinical Evidence
A study published in the Journal of Back and Musculoskeletal Rehabilitation (2019) demonstrated that PRP injections in the sacroiliac joint significantly reduced pain and improved function in patients with chronic SI joint pain.
Prolotherapy
Needle Location used for injection of the sacroiiac ligaments. Trigger point of ligaments: (IL) Iliolumbar; (LS) Lumbosacral-supra and interspinus; (A,B,C,D,) Posterior sacroiliac; (SS) Sacroapinus; (ST) Sacrotuberus;(SC) Sacrococcygeal;(H) Hip-Articular; (SN) Sciatic nerve (from G.S. Hackett, Ligament and Tendon Relaxation. Charles C. Thomas Co., 1958)
Sacroiliac joint prolotherapy is sometimes used to treat sacroiliac joint pain. Protocols vary for thisProlotherapy, also known as “proliferative therapy” or “regenerative injection therapy,” is another non-surgical option for SI joint pain. This treatment involves injecting a solution (usually dextrose or other irritants) into the ligaments and tendons around the sacroiliac joint.
How Prolotherapy works
The irritant solution stimulates the body’s natural healing response, causing the ligaments and tendons to strengthen and tighten. This can stabilize the SI joint, reducing pain and improving joint function.
Clinical Evidence
A systematic review published in the journal “Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders” (2017) reported that Prolotherapy can be an effective treatment for chronic sacroiliac joint pain, with improvement seen in pain scores and function.
Steroid Injection
Steroid injections into the sacroiliac joint can provide temporary relief from inflammation and pain. A corticosteroid, such as triamcinolone or methylprednisolone, is often used for this purpose.
How Steroid Injections work
Corticosteroids have potent anti-inflammatory properties. When injected into the sacroiliac joint, they can reduce inflammation, alleviate pain, and improve mobility.
Clinical Evidence
A randomized controlled trial published in the journal Pain Physician (2013) found that steroid injections provided significant pain relief in patients with chronic sacroiliac joint pain. However, the duration of pain relief varied among individuals.
Radiofrequency Ablation (RFA)
right sacroiliac joint target lesion sites. On the right side, L5 dorsal ramus, 2,4:30 and 6 o’clock for S1 and S2, while S3 only 2, 4:30 o’clock were targeted.Radiofrequency Ablation is a minimally invasive procedure that uses heat generated by radiofrequency waves to disrupt the nerves that transmit pain signals from the sacroiliac joint to the brain.
How RFA works
During the procedure, a specialized needle with a heating element at the tip is guided into the sacroiliac joint using fluoroscopy or ultrasound. The nerves responsible for transmitting pain signals are then heated and destroyed, providing long-lasting pain relief.
Clinical Evidence
A study published in the “Journal of Vascular and Interventional Radiology” (2014) reported that radiofrequency ablation of the sacroiliac joint nerves resulted in significant pain relief and improved functional outcomes in patients with chronic sacroiliac joint pain.
Conclusion
Sacroiliac joint pain can be a challenging condition to manage, but non-surgical treatments such as Intra-articular Platelet Rich Plasma (PRP), Prolotherapy, Steroid Injections, and Radiofrequency Ablation (RFA) offer promising options for relief. These treatments aim to reduce inflammation, promote tissue healing, and disrupt pain signals, ultimately improving the quality of life for individuals suffering from SI joint pain.
It’s important to consult with a qualified pain management specialist such as At Alleviate Pain Clinic to determine the most suitable treatment option based on individual needs and medical history. These non-surgical interventions have demonstrated efficacy in numerous clinical studies, making them valuable choices for those seeking relief from sacroiliac joint pain without resorting to surgery.
References
- Cohen SP. Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment. Anesth Analg. 2005;101(5):1440-1453.
- Hauser RA, Lackner JB, Steilen-Matias D, Harris DK. A systematic review of dextrose prolotherapy for chronic musculoskeletal pain. Clin Med Insights Arthritis Musculoskelet Disord. 2016;9:139-159.
- Hansen H, Manchikanti L, Simopoulos TT, et al. A systematic evaluation of the therapeutic effectiveness of sacroiliac joint interventions. Pain Physician. 2012;15(3):E247-E278.
- Hansen HC, McKenzie-Brown AM, Cohen SP, et al. Sacroiliac joint interventions: a systematic review. Pain Physician. 2007;10(1):165-184.
- Chowdhury B, Siddiqui F, Armstrong K, et al. Safety and Efficacy of Thermal Annular Procedures in Clinical Practice: A Review. Pain Physician. 2020;23(2):E123-E136.
- Patel N, Gross A, Brown L, et al. A randomized, placebo-controlled study to assess the efficacy of lateral branch neurotomy for chronic sacroiliac joint pain. Pain Med. 2012;13(3):383-398.
- Kennedy DJ, Engel A, Kreiner DS, Nampiaparampil D, Duszynski B, MacVicar J. Fluoroscopically guided diagnostic and therapeutic intra-articular sacroiliac joint injections: a systematic review. Pain Med. 2015;16(8):1500-1518.
- Ashkenazi E, Ifergane G, Sheffer D, et al. Radiofrequency treatment for refractory sacroiliac joint dysfunction: short-term outcome. J Anesth. 2003;17(3):194-196.
- Hasan S, Smith R, Brismée JM, Simpson KN, George SZ. What are the costs of nonoperative care for sacroiliac joint-related pain? J Pain Res. 2016;9:1007-1018.
- Image taken from https://bmcmusculoskeletdisord.biomedcentral.com/ articles/ 10.1186/ s12891-023-06344-7/ figures/ 2
