ARE STEROID INJECTIONS FOR SIJ ARTHRITIS THE BEST TREATMENT?…

As I have written before I am having big problems with pain in my SIJ due to arthritis with referred pain into my hip causing bursitis.

Last November I had steroid into both hips for the bursitis and a further CT guided steroid injection into my SIJ. I found they both helped with the pain but four months later the pain all started coming back again. My left sacroiliac joint has been terrible for some time now. It wakes me up when I turn over in bed. It’s painful to lie on my side and sit in a certain position and I cannot stand for long in one spot so I was keen to get another injection as soon as possible.

My insurance company had told me last time that they would not cover me for any more injections and with lockdown pain management appointments are a long way off so I decided to go back and pay for one myself. After a quick examination my consultant offered me another steroid injection into my bursa which was again inflamed and offered me another SIJ injection for my sacroiliac joints were causing significant pain when he checked me out.

He said he would arrange for me to have another CT guided steroid injection into my left SIJ but pointed out that it is not something I can keep having done. The two other options he talked about were bilateral sacroiliac joint radiofrequency ablation which I will cover in this post or if this did not work then I could have fusion surgery to my sacroiliac joints, but I have said time and time again that surgery was not something I wanted to go through again.

I looked into the radiofrequency ablation and on an NHS website it explained what this type of treatment is for and what happens during the treatment.

Each of the sacroiliac joints has its own nerve supply, the lateral branch nerve, which normally carries information about the state of the joint to your brain e.g. pain caused by inflammation, joint position etc. These nerves can be numbed / blocked by your doctor using a local anaesthetic to assess if they are transmitting pain signals (Diagnostic). Radiofrequency denervation, which is the burning of these nerves, is then performed at a later stage in order to interrupt the nerve supply and pain messages for a significantly log time. This prevents the passage of pain signals to the rest of the nervous system. The aim of this treatment is to interrupt the nerve supply to the affected sacroiliac joints.

The treatment involves –

• A small needle is placed in the back of your hand for sedation or emergency drugs.
• SIJ RFD is performed lying face down.
• Your back is cleaned. The skin is numbed with some local anaesthetic is injected which stings a little.
• A special X-ray and a radiofrequency generator machine will be used by the doctor to identify the location of the nerve.
• Electrical tests will enable the tip of the specially designed needle get close to the nerve. The final electrical test is done to make sure that the needle tip is well away from the main spinal nerve to your leg, thereby improving the safety of the procedure.
• When the doctor is happy with the needle position, local anaesthetic is injected before a high frequency (radiofrequency) electrical signal is passed down the needle for 90 seconds.
• You may feel discomfort at this stage.
• After each lesion, the area is injected with a mixture of local anaesthetic and steroid, to help reduce discomfort afterwards.
• Depending on the technicality of the procedure and your medical condition, you may be offered a pain killer or sedative as agreed with your doctor.

There are of course a few complications that could arise but that applies to any type of treatment even with the steroid injections.

In an article on the Spine-Health website it says that the success rate has conflicting results. Success usually depends on the accuracy of diagnosis, variations in the anatomy of the nerve, and the type of technique used. Some patients have reported up to 100% reduction in pain from RFA. Research suggests:

• RFA performed for the facet joint may provide pain relief in 45% to 60% of patients.
• RFA performed for the sacroiliac joint may provide pain relief in 75% to 86% of patients.

Typically, if effective, RFA may provide pain relief lasting 6 months up to 2 years. However, some studies have shown patients experiencing pain relief up to 3 years. During or after this period of time, however, the nerve usually regenerates, and the pain may or may not return. The pain relief from this treatment is usually more significant when performed on the facet joints as compared to the sacroiliac joints. Some patients may not experience any relief from pain after this procedure.

I have now been passed onto the NHS pain team who have been in touch and need to refer me to a special triage service who will chat with me then refer me onto the appropriate person to chat about whether this is something I should or should not think about having done. In the meantime the steroid in my hip has helped and my SIJ injection is due at the end of the month.

I understand I cannot keep having steroid injections as there is concern and some evidence that frequent shots can cause damage to the tissue and cartilage within the joints. I guess I have to leave it to the experts to advice me.