Overview

The sacroiliac joints are each side of your spine, at the bottom, and attach it to your pelvis. They allow movement and stabilise the spine. ‘Wear and tear’, inflammation and injury can cause pain for some people.

To treat this localised pain, if simpler measures have not helped, you might have an injection into the sacroiliac joint. It might reduce some of the pain signals from the joint to your brain. Pain relief is usually short-term. Although some people get long-term pain relief from these injections, they are not a cure.

The injections contain local anaesthetic, often with a small amount of steroid. The injection is usually done alongside other treatments, such as physiotherapy.

These injections can also be used to diagnose and treat certain types of back pain.

Other treatment options

The decision about treatment is shared between you and your doctor. If there are any other treatment options available, your doctor will discuss these with you. Your doctor can give you up-to-date information about the chances of this being a successful treatment for you, and how it fits into the best pathway of care.

If you are undecided about treatment, more advice and information can be provided. Please speak to your doctor about this.

Side effects

As with any procedure, you can have side effects. However, these are usually minor and there is little risk of serious harm. Not everyone will get them, but possible side effects include the following.

Common side effects

• Mild tenderness or bruising at the injection sites, that usually settles over the first few days.

Rare side effects

• Infection that might require antibiotic treatment. Seek medical help if there is warmth, redness or tenderness at the injection site, or you feel hot and unwell.
• Numbness or weakness in your legs or other areas. Sometimes the local anaesthetic spreads. If this happens, the effect is temporary and will quickly get better in minutes or perhaps hours.

Extremely rare

• Serious nerve damage (less than 1 in 10,000 cases).

Asking for your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This states that you agree to have the treatment and you understand what it involves.

If you would like more information about our consent process, please speak to a member of staff caring for you.

Before treatment

If your health has changed, it is important to let your doctor know if you:

• have an infection in your body or on the skin of your back (your doctor will delay the treatment until the infection is cleared)
• take anti-retroviral medicines (these can interact with the steroids used)
• suffer from diabetes (the use of steroids during injections can cause your blood sugar to change, needing monitoring and adjustment of your diabetic medicines)
• have any allergies

You must also tell the doctor if there is any chance that you could be pregnant.

If you are planning to fly or travel abroad within 2 weeks after the injections, please let your doctor know, as it might be best to change the date of the injections.

Make sure that you have made arrangements for someone to collect you after the procedure. If you do not, your procedure will probably be cancelled. It is unsafe for you to drive immediately after the procedure. If you do, your motor insurance will not be valid.

Bring a list of all of your current medicines, including any you buy from a pharmacy or shop, and any herbal or homeopathic remedies.

Continue to take your medicines as usual on the treatment day (unless your nurse or doctor has told you otherwise). Please contact us at least 2 weeks before your injections if you have an infection or are taking antibiotics.

During the treatment

Doctors give these injections in slightly different ways, but this is generally what will happen.

• Observations, such as blood pressure and pulse rate, might be taken.
• A small needle (cannula) might be placed in the back of your hand.
• You will be carefully positioned and the skin around the injection sites will be cleaned with an antiseptic solution or spray. This can feel very cold.
• An X-ray machine (or another form of image guidance) will be used to make sure we inject you accurately.
• You will feel a stinging sensation as local anaesthetic is injected to numb the skin and surrounding tissues. Your doctor will warn you of this first. If you are having sedation (medicine to make you sleep through the procedure) this will not apply.
• The doctor will direct the needles to the areas suspected to be a source of pain.
• When the injections are given, you might feel pressure, tightness or a pushing sensation. If there is any discomfort, let the doctor know.

After the treatment

You will be taken to a recovery ward where nursing staff will observe and monitor you. You will be told when you can get dressed, and be given help to make sure that you can stand safely after the procedure.

Your pain will be assessed at rest and during daily activities, such as walking and moving your back, to find out how much pain relief you have immediately after the injections. This will help assess how much of your pain is coming from the sacroiliac joints, and also help plan future treatments. You will be given more advice before you leave.

Leaving hospital

You can usually leave hospital within a few hours after the injections, and sometimes much sooner. This will depend on how long your doctor or nurse wants you to stay for in recovery.

You should arrange for someone to travel home with you, and stay with you for 24 hours after treatment. If that is not possible, you should at least have access to a phone. You should not:

• drive
• operate machinery
• sign legal documents
• provide childcare unsupervised
• drink alcohol

If you are unsure, please discuss these issues with your doctor.

Before you go home, you will be given information about who to contact outside office hours. If it is an emergency, go to your nearest emergency department (A&E) or call 999.

For a few days after the injections, you might get some soreness or aching at the injection sites.

Keep the injection sites dry for 24 hours after the procedure.

Do not worry if your pain feels worse for a few days, as this sometimes happens. Take your regular painkillers and medicines as normal and this should settle down. Try to move about the house, but avoid anything too strenuous.

As your pain decreases, you should try to gently increase your exercise. Simple activities, like a daily walk, using an exercise bike or swimming on your back, will help to improve your muscle tone.

It is best to increase your activities gradually. If you are unsure, or you find exercising is getting more difficult, contact your GP or the pain team and discuss a referral to physiotherapy.

Returning to work

This will be different for everyone, and might depend on the nature of your work. It is difficult to give general advice, so you should discuss this with your doctor.

Follow-up appointments

You will be contacted for a phone call or clinic appointment with a nurse specialist or a consultant. If you have not heard from us within 10 weeks after the procedure, please contact us, phone 020 7188 8877, Monday to Friday, 9am to 5pm.

Acknowledgements

Adapted from information from the Faculty of Pain Medicine of the Royal College of Anaesthetists, and includes contributions from Addenbrooke's Pain Management Unit, the Chronic Pain Service at St Georges Hospital London, Newcastle Pain Management Unit, and the Interventional Specialist Interest of the British Pain Society.