What if SI Joint Injections Don’t Work?

Have you been calling in sick due to persistent back pain? It’s not just you. Around the world, backache is the most common cause of employee absenteeism. Sacroiliac joint (SIJ) disorder could be the cause of lower joint pain. Each year, this disorder is identified in between 15 and 30 % of people who experience lower back discomfort. However, you might be saved by a therapeutic sacroiliac joint injection. Lower back pain that originates in the sacroiliac joint is diagnosed or treated with a sacroiliac joint injection. The connection between your spine and pelvis is made at this joint. 

To relieve the pain during the treatment, your doctor or nurse will inject anesthetics combined with corticosteroid medication right into the joint. The sedative is intended to relieve pain immediately, while the anti-inflammatory corticosteroid is used to ease pain over the long term by lowering inflammation. However, in most cases, after the anesthetic wears off, your discomfort could return briefly. This may frequently indicate that the SI joint injection did not work. If the intravenous administration is ineffective, more drugs, follow-up shots, and more invasive surgeries may be recommended. 

However, it is crucial to understand more about SI joint pain, the treatment available, different types of injections, and its benefits, before heading forward with the question of the hour on “what you should do if the SI joint injection fails”.

What triggers SI Joint Pain?

The body utilizes the spine for a variety of reasons. While you’re sitting, strolling, or running, it supports your upper body by keeping your back straight and firm, supporting your head by connecting to your shoulder and hips, and helping you lift your upper body.

Your spine and your hips are joined by two ligaments in the pelvis. The sacroiliac joints are referred to as these joints. When you move, jog, or stand up, they support the upper half of your body through your lower back. Your spine, groin, and calves might become stiff when one or both of your sacroiliac (SI) joints become strained. 

SI joint dysfunction has many underlying causes. The most frequent reason is intense pressure or movement in the joint, which causes the muscles and tissues to stretch or compress.

Additional factors include:

  • Issues with your gait
  • Gestation or recent motherhood
  • Lower back surgery done in the past
  • Engaging in repetitive muscle movement activities
  • Ankylosing spondylitis
  • Arthritis

The majority of people are most susceptible to developing SI joint dysfunction when they routinely pressure their lower spine, whether intentionally or mistakenly.

Your lower body, thighs, and legs may experience SI joint dysfunction complaints. Considering that your pelvis and each side of your lower back are connected by a SI joint, symptoms can occasionally just affect one part of your body.

Treatment available for SI Joint Pain

Sacroiliac joint dysfunction (SI joint pain) treatment options mainly concentrate on reducing discomfort and restoring the joint’s flexibility and range of motion. The majority of SI joint pain situations can be properly treated without surgery.

The following are some common primary therapies for sacroiliac joint pain:

Time of brief repose:

One to two days of relaxation may be suggested. Resting for more than a few days is not advised because it can aggravate tightness, increase pain, and lead to overall muscle atrophy.

Applying heat or ice:

Ice helps reduce swelling and ease pain and discomfort when administered to the hips and upper back. By easing muscle tension or cramps, heat applied around the joint may aid in pain relief.

Narcotics for pain: 

For mild to moderate pain treatment, over-the-counter painkillers such as Tylenol and NSAIDs, such as aspirin or ibuprofen, may be prescribed. During instances of really excruciating pain, prescription drugs such as powerful painkillers or anti-inflammatory medications may be administered. These drugs need to be used carefully because they can have serious negative effects and are very strong.

Manual intervention:

If sacroiliac joint pain is brought on by insufficient movement, manual manipulation administered by chiropractic, naturopathic physician, or other trained health practitioners can be quite beneficial (hypomobility). The purpose of this therapy is to lessen joint rigidity and muscle spasms while reinstating the normal range of motion. Manual techniques are used on the SI joint and lower back. 

Collars and other supports: 

A sacral corset can be wrapped around the waist and pulled securely to stabilize the SI joint if it is very loose. When the joint is sore and inflamed, pelvic support, which is about the size of a wide belt, can be beneficial.

Facet  Joint Injections and Sacroiliac Joint Injections: 

To lower inflammation and aid in pain relief, an anti-inflammatory drug, such as a corticosteroid, is injected along with a local anesthetic, such as lidocaine or bupivacaine. A joint injection’s ability to relieve pain might reduce discomfort experienced when beginning a physical treatment regimen and boost functional abilities. Sacroiliac Joint Injections are the most extensively used treatments among others, and thus it is crucial to know more about them.

What are SI Joint Injections, and How does it help you with pain relief?

A sacroiliac joint injection, sometimes referred to as a sacroiliac joint block, is frequently used to identify or cure low back discomfort and/or sciatica symptoms that are typically brought on by SI Joint dysfunction. An injection into the sacroiliac joint has two functions. The first step is identifying the cause of the pain, and the second is offering therapeutic pain treatment.

Diagnostic SI Joint Injection: 

A diagnostic SI joint injection, also known as a SI joint diagnostic block, serves as a mild anesthetic in addition to aiding in the confirmation of a diagnosis. A local anesthetic (a small numbing drug) is used in diagnostic SI joint injections. Depending on the drug, the joint will be numbed for anywhere between 2 and 12 hours. To ensure the injection is given precisely into the joint, it is performed under fluoroscopic or MRI guidance.

The next question is- “What should you anticipate following a diagnostic SI joint injection?” The answer is, that if the injection significantly lessens your discomfort in the SI joint, the SI joint is most likely the source of your pain. However, even after receiving the diagnostic injection, if your pain does not significantly decrease, there may be more causes for your problems that your physician should explore further.  When SI joint dysfunction is diagnosed, non-surgical SI joint treatment, which may entail therapeutic SI joint injections, is the likely next step.

Therapeutic SI Joint Injection:

 In contrast to diagnostic injections, therapeutic SI joint injections aim to relieve pain for a limited period of time (weeks to months). Local anesthetic and corticosteroids are used in a therapeutic SI joint injection. The anesthetic is meant to relieve pain right away, and the anti-inflammatory corticosteroid is meant to provide therapeutic benefits over a longer period of time by lowering inflammation.

Each individual will experience pain alleviation for a unique time period. It may endure for months in some circumstances, while in others, it may only last for a few weeks or perhaps just a few days. Over the course of several years, some people may require repeated therapeutic SI joint injections, and the length of treatment may get shorter until, at last, the injections only offer minimal or no comfort. Let us now look at the benefits of SI Joint Injections.

Benefits of SI Joint Injections

SI joint injections can be performed during a straightforward outpatient visit to a pain clinic. They are reasonably rapid, have a low risk of adverse effects, and normally produce little to no discomfort during the actual injection. Within a few days, patients typically see a considerable reduction in SI joint pain and an improvement in their quality of life. SI joint injections may offer sufficient comfort to enable a patient to undergo physical treatment and develop a higher tolerance for exercise and activities. We know that regular exercise helps to control chronic pain and aspects like mood and sleep that are related to it.

Additionally, SI joint injections make it easier for people to get back to their regular activities or jobs. Furthermore, SI joint injections typically contain both painkillers and anti-inflammatory drugs, which can help minimize inflammation and pain and lower the number of pain antibiotics consumed.

What If SI Joint Injections Don’t Work?

A prevalent cause of shoulder pain, neck pain, and groin pain is SI joint dysfunction. Additionally, injections of medicine can effectively relieve pain in the SI joints when one or both of these big joints become irritated owing to conditions including surgeries, distress, osteoarthritis, or childbirth. However, this does not preclude the use of SI joint injections as a valuable component of a person’s pain management strategy. For many people, these injections are insufficient to produce persistent and positive effects on their own. 

Today, stabilization of the sacroiliac joint is noninvasive and warrants consideration as an initial treatment, but there is no evidence for its efficacy.  Furthermore, there is also no satisfactory response in the research in regards to the effectiveness and diagnostic validity of general anesthetic or corticosteroid injections. 

Thus, in the event that the SI joint injections don’t work, your doctor may prescribe you further anti-inflammatory drugs and advice to adjust your activities and/or lifestyle. 

Further, your physician may also advise you of new minimally invasive fusion approaches that help reduce the morbidity of open surgeries.  SIJ fusion appears to be developing as a viable treatment for patients with difficult-to-treat SIJ dysfunction when conservative treatments fail. With at least comparable results, new minimally invasive fusion approaches appear to reduce the morbidity of invasive surgeries. Because of its improved safety profile compared to open spinal surgery, and minimally invasive spinal procedures, SI arthrodesis fusion surgery may be recommended as a first-line surgical treatment. Open spinal fusion should only be performed in the event of failed surgery, bone fractures, and abnormal physiology.

The most effective non-invasive line of treatment is Si joint thermolysis, which involves destroying the nerves.

Another treatment option in case of failure of injections is Prolotherapy and radiofrequency ablation, which may offer potential benefits as therapeutic modalities.

Prolotherapy: 

A non-surgical treatment option for SI pain is prolotherapy injections. This injectable therapy promotes the healing of soft tissues including tendons and ligaments. It triggers a minor autoimmune response that starts an immunological reaction. This is similar to how the body heals soft tissue injuries.

Radiofrequency Ablation: 

A minimally invasive treatment called Bipolar Radiofrequency Neurotomy (or Radiofrequency Ablation) is used to treat and relieve SI joint pain symptoms. It blocks and disables particular sciatic nerve branches from delivering pain signals to the brain using a noninvasive procedure. Bipolar radiofrequency is a modified kind of Radiofrequency Therapy (RT), commonly known as Radiofrequency Ablation (RFA).

Bottom Line

Today, SI injections are excellent prospective treatments for chronic pain, but according to studies and patient experiences,  multidisciplinary pain therapy has the best chance of bringing about long-lasting relief. Several factors contribute to this:

  • Injections for the SI joint often provide relatively brief pain control, ranging from a few days to a few months.
  • In order to control pain in between injections, patients should get alternative pain management modalities from their doctors, as SI joint injections can require more than one try to operate effectively.
  • A person’s treatment for chronic back pain and discomfort must change as their healthcare, and underlying issues do since chronic pain is a highly individualized and ongoing process.

Thus, when an SI joint injection and other non-surgical options like physical therapy, pain medications, and steroid injections fail, alternative treatments like chiropractic care and other effective treatments must be advised by the pain specialist. 

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