Pain in the lower back in some patients may be due to problems at the sacroiliac joint. This joint is where the pelvis meets the sacrum of the spine.
Persons affected may have mild to severe low back pain. Other symptoms include pain in the buttocks, hip and back of thigh. Stiffness of the lower back may be felt. Some activities that worsen the pain include walking, prolonged sitting, twisting, stooping, turning in bed, getting up from sitting, climbing stairs, coughing and sneezing.
Pain in this joint may be due to various diseases; degeneration or wear and tear being the commonest. Other causes include injury, inflammation, osteoarthritis and ankylosing spondylitis. Pain originating in the surrounding ligaments and muscles may mimic sacroiliac joint dysfunction.
A good medical history and a physical examination by a trained physician will usually clinch the diagnosis. X-rays of the back may help to detect degenerative changes in the sacroiliac joint and rule out fractures and bone tumours. Depending on the severity, MRI, CT scans or bone scans may be ordered by the physician.
Pain physicians at the Pain Management Centre can give an injection of local anaesthetic into the sacroiliac joints or relevant nerve blocks with continuous X-ray (fluoroscopic) guidance. This can be a very accurate method for diagnosing sacroiliac joint disease. If the patient obtains relief, further treatment of the joint may proceed with greater confidence.
Treatment depends upon the cause of the pain. Any underlying condition would receive treatment specific for that disease.
Medications such as non-steroidal anti-inflammatory drugs and other pain medications may be prescribed. Topical non-steroidal anti-inflammatory preparations may also be prescribed. Physiotherapy referral for controlled exercises and heat/ultrasound treatment will also be offered. Activity modification may be advised.
At the SGH Pain Management Centre, there is the additional option of acupuncture as this can also help alleviate symptoms.
When the above conservative measures fail to control pain, pain specialists at the Pain Management Centre can perform sacroiliac joint injections with very small doses of steroids. Alternatively, they can also inject the nerves to the joint and block the pain messages from these nerves that supply the affected joint.
Radiofrequency ablation of these nerves subsequently, using a special machine we have can provide longer relief.
The patient is assessed for other medical problems and contraindications for the procedure. The procedure is explained to the patient and a formal consent is obtained. The patient needs to fast for 6 hrs before the procedure but plain water is allowed up to 2 hrs before the procedure.
The patient is taken into an operating room at the Pain Management Centre and positioned prone on the stomach. Using x-ray guidance, the relevant sacroiliac joint or nerve is localised accurately. Sedation may be given if necessary. The skin on the back is cleaned with a disinfectant. Following this the physician numbs a small area of skin with numbing medicine (local anaesthetic). Then a small needle is passed close to the nerve/ joint under x-ray guidance. Once the needles are in the correct position, a small mixture of numbing medicine (local anaesthetic) and anti-inflammatory steroid is injected. There is very minimal pain and discomfort. The procedure will take 15-30 minutes.
If radiofrequency ablation is performed, the procedure is similar but will take longer. A small electrical current will pass through the needle once it is next to the correct nerve. A mild tingling sensation will be felt. Once the needle is in the correct place, the radiofrequency machine will heat the nerve. A strange sensation may be felt in the area corresponding to usual pain but it should not be painful. The procedure may be repeated for more nerves.
Sometimes these procedures may cause an increase in pain in the following days before a beneficial effect is felt. This is normal and the patient should rest and take pain medications. When pain relief is felt, the patient should take the opportunity to gradually increase activity. The physical therapist can guide in this.
After the procedure, you will be monitored to ensure safety before discharge in about 1 to 2 hours.
Many individuals with sacroiliac joint pain will recover and return to normal activities. Proper posture, proper body mechanics, and certain exercises should be maintained in order to ensure ongoing back health. Elderly patients and those with severe disease may get only partial benefit with joint or nerve injections and medications may need to be continued but at much lower doses. Injections may be repeated safely if required after an acceptable interval.
Your pain physicians and physical therapists that deal with people with sacroiliac joint pain can help outline an individualized treatment program.
