Category: sciatica

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SACROILIAC JOINT DYSFUNCTION AND THE MANY TREATMENTS AVAILABLE for THIS TYPE OF PAIN…

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As my readers know I have been suffering from bilateral sacroiliac joint dysfunction problems for quite some time and last year had some steroid injections into both sides which gave me some amazing pain-free time, although short-lived.

It was then decided that the next option was Radiofrequency Ablation which I had done on both sides 13 weeks ago.

My diary on my pain relief after the procedure went something like this –

DAY 3 MINIMAL PAIN – ONLY NEED PARACETAMOL.

ONE WEEK FROM THE PROCEDURE – JUST PARACETAMOL.

3 WEEKS FROM THE PROCEDURE – AFTER A LONG CAR JOURNEY SEVERE SPASMS AND LOW BACK PAIN NEED STRONGER PAINKILLERS.

STARTED WITH PHYSIOTHERAPIST ON WEEK 4 – GIVEN LOTS OF EXERCISES.

LOTS OF REGULAR VISITS TO PHYSIO AND ALSO GIVEN ACUPUNCTURE AND MASSAGE TO THE RIGHT SIDE OF LOW BACK TO HELP EASE SPASMS.

FROM WEEK 8 ONWARDS PAIN GRADUALLY CAME BACK INCLUDING PAIN AFTER WALKING/STANDING/VERY STIFF FIRST THING IN THE MORNING AND SITTING FOR A WHILE.

RESTLESS NIGHTS WITH PAIN IN BOTH HIPS WHEN I LIE ON THEM.

GOING UPSTAIRS SOMETIMES BRINGS THE PAIN ON AS WELL AS WALKING DOWNSTAIRS.

THE MAIN PAIN IS IN THE LOWER BACK, WHICH IS ACHING, SHARP AND DULL (LIKE TOOTHACHE) AND VERY PAINFUL TO TOUCH WITH A LOT OF NUMBNESS UNDER THE LEFT FOOT.

Obviously, I have been quite disappointed and felt quite low about the outcome especially as I also caught COVID on week 9 which completely knocked me sideways. The pain in my muscles was really severe.

I have now been back for my follow-up consultation with my Neurosurgeon who has come up with some options for me. First I am going to be booked in for a CT lumbar/including pelvis scan.

There is obviously a wait for this which is giving me time to think about the options available. Initially, I will continue with a conservative approach with oral analgesia. Then if things do not improve by the time I see my consultant again I will have hopefully decided to either consider a SI joint fusion or a spinal cord stimulation. Both are quite big things for me to decide upon so it is better that I have this time to see how I can manage without any further operative procedure as there are always risks involved in any type of surgery and no guarantee of complete pain relief.

In a fusion surgery, a bone graft and/or instruments are used to encourage bone growth over the sacroiliac joint and create one immobile unit. Joint fusion can effectively reduce pain and instability caused by sacroiliac joint dysfunction or inflammation (sacroiliitis).

Dysfunction in the sacroiliac joint (also called the SI joint) can produce significant lower back pain, as well as pelvic, groin, and hip pain. Sacroiliac joint dysfunction can be the result of too much motion, too little motion, or inflammation of the joint.

Spine Health writes that “Sacroiliac joint fusion is always an elective procedure, meaning it is the patient’s decision whether or not to have surgery. There are many factors to consider when deciding to have surgery, including the effectiveness of nonsurgical treatments, if fusion surgery is likely to improve one’s quality of life, and the recovery process necessary after surgery.”

Spinal Cord Stimulation is an advanced pain-relief procedure that is often recommended for an increasing number of medical conditions such as complex regional pain syndrome, neuropathy, cervical and lumbar radiculitis.

A neurosurgeon will implant the spinal cord stimulator in the patient’s back. It consists of a small battery pack which is surgically inserted beneath the skin and is connected to a lead placed near the spinal cord. The battery sends electric signals to the lead in the epidural space next to the spinal cord altering the long-standing pain signals often reducing the perception of pain and subsequently improving the patient’s quality of life.

A spinal cord stimulator can be trialled for a few weeks to assess its effectiveness or fully inserted at the first sitting. The trial system allows patients to have a test run before committing to a full system but can involve additional delays and further surgical procedures. The decision on the most appropriate for each patient is made on an individual basis by a multidisciplinary team and will be discussed before committing to any procedure.

Spinal cord stimulation is a therapy that has been used for over 40 years to help relieve chronic pain and improve quality of life.

It is a bit of a waiting game for me now.

Source: Spine Health Leeds NHS

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ONE WEEK ON FROM MY RADIOFREQUENCY ABLATION PROCEDURE TO MY SACROILIAC JOINTS…

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It is now a week since I had my Radiofrequency Ablation procedure for the pain in my sacroiliac joints.

Most sites said the average time for the pain relief to kick in is about two weeks or sooner.

My pain lifted on Day 7.

On Day 6 it was very hot so we decided to go to the beach as I had been in isolation for a week after the surgery. I did check with the nurse if going to the beach would be ok and she said it was fine. She said it is more to stop me from mixing in crowds more than anything else.

I found it quite uncomfortable on the lounger on the beach but my wound was still sore and bruised so it didn’t surprise me but I enjoyed getting out into the fresh air.

I have been doing my exercises every day and I can feel I am getting stronger. My physiotherapist said it was essential for me to build up my core after this procedure.

Not needing lots of medication is absolutely brilliant. I am still taking paracetamol and nortryptyline but if it continues as good as this I should be able to cut down on those as well.

The one thing I am really struggling with the most is fatigue. I have had an afternoon rest for years and years as this was part of my pacing technique which I know has always helped me but that nap isn’t hitting my fatigue at all at the moment.

I am sure the hot weather does not help but I am waking up after a good night’s sleep feeling exhausted and even if I sleep a couple of hours in the afternoon I do not feel any better.

I am very excited about the fact that this procedure has worked so far and I hope this will encourage others in this sort of pain to look into having the radiofrequency ablation technique.

Some of the best sites to look into this procedure include Spine Universe, NHS, Med

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MY NEXT TYPE OF INJECTION FOR PAIN IS BILATERAL SACROILIAC JOINT RADIOFREQUENCY ABLATION…

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I am going back to the hospital next week for a different type of injection for the pain in my sacroiliac joints called radiofrequency ablation which I am having in both sacroiliac joints.

I have previously had facet joint injections, trigger points, and nerve blocks to name a few but radiofrequency ablation is quite different from any of these.

A radiofrequency ablation (RFA) of the sacroiliac joint (SI joint) is a procedure that uses radio waves to heat and destroys the nerves. These nerves carry pain signals from the injured sacroiliac joint to the brain. Radiofrequency ablation of the sacroiliac joint is often recommended for patients who have received short-term pain relief after injecting the SI joint with numbing/steroid medicine but have had unsuccessful results with later therapy.

The best pain relief I have ever had was my after my SI joint steroid injections last December. I had not felt such pain relief for years so my consultant knew that we had hit the right spot and hoped it would last a long time. Unfortunately, the pain relief only lasted for a couple of months but because it had worked initially it meant my next procedure would be the radiofrequency ablation procedure.

The sacroiliac joint is a large joint in the lower back joining the iliac bone to the sacrum. You have two joints, one on each side. Inflammation or arthritic changes in these joints can cause pain, either in the back, or referred areas around the back, side in the buttocks or lower limbs.

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.
  • 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 to 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.
  • After each lesion, the area is injected with a mixture of local anaesthetic and steroid, to help reduce discomfort afterwards.
  • I am being put to sleep for this procedure but with a heavy sedative and not a general anaesthetic. Some patients just have a mild sedative.

Of course, no surgery comes without possible risks but at only 1% it is well worth giving this a try.

The risks include:
• Allergic reaction to the medication
• Nerve damage
• Bleeding and bruising at the injection site
• Pain at the injection site or during the injection
• Infection
• Injection of medication into a blood vessel
• No improvement or worsening of your pain in some cases

I have been told that on the day after the procedure, I can cautiously return to my regular activities, but most require an additional 2 days of rest. My back and buttock will usually be very sore during the next few days. The pain will slowly improve over several weeks. This pain is usually caused by muscle spasms and irritability while the targeted nerves are dying from the heat lesion. Pain relief usually is not experienced until about 2-3 weeks after the procedure when the nerves have completely died. My back may feel odd or slightly weak for several weeks after the procedure. There is a rare chance (less than 5%) that you may have increased nerve pain following the procedure for 1-3 months.

The nerves can grow back over a period of months eventually causing the pain to return. If this happens the procedure can usually be repeated or another alternative is to have your sacroiliac joints fused.

Source: Spine Universe, NHS, Med