Few things are as frustrating as undergoing a medical procedure you believe will help you feel better, only to find out days later that you don’t. This is often the case with sacroiliac injections. But here is the good news: any increase in pain following the procedure is only temporary. Relief will kick in, at least in most cases.
Diagnosis and Therapy Options
Weatherford, Texas-based LoneStarPainMedicine.com explains that sacroiliac injection (SI) is somewhat unique among pain medicine therapies in that it can be used for two different purposes: diagnosis and treatment. In a diagnostic setting, the doctor relies on the procedure to isolate a particular joint that is causing a patient pain.
It’s used primarily to diagnose back pain. Because of the number of joints in the spine and the way the nerves are arranged in the spinal column, pain in one area of the back doesn’t necessarily mean the issue is located in the same area. Back pain can radiate. So SI can help doctors figure out which joint is actually causing the problem.
In a therapeutic setting, the procedure can actually be utilized to offer long-term pain relief. This is accomplished through a combination of anesthesia and corticosteroids. Yet some patients experience a return of their pain within a few hours of the injection. The question is: why?
What SI Is Designed to Do
When utilized as a pain relief treatment, SI is designed to reduce inflammation. Doing so takes the pressure from the affected nerves, thereby offering some measure of relief. Furthermore, it is the corticosteroids that address inflammation. The problem is that they do not work instantly.
Short Term Pain Relief
The short-term pain relief experienced with SI is the result of the anesthesia. Doctors include a local anesthetic in the injected material in order to reduce the pain and discomfort of the procedure itself. But its effects begin to wear off within a few hours. After about six hours, the anesthetic has completely worn off.
Unfortunately, the patient’s original back pain returns. But in addition, there may be pain resulting from the procedure. Remember that SI is an injection therapy. But it is not as simple as a vaccination injection.
To ensure the medication is delivered correctly, a doctor normally uses some sort of medical imaging – usually fluoroscopy. A fluoroscope is utilized to ensure that the needle injects the medication into the right location. So unfortunately, a doctor may have to move the needle a few times to get it right.
The Steroid Lag
Corticosteroids are very effective at reducing inflammation. But there is a lag between the moment of injection and when inflammation really starts to go down. How long is that lag? For most patients, it is 2 to 7 days. Therein lies the explanation of why back pain may temporarily return after SI.
Pain medicine doctors tend to refer to this period of returned pain as ‘the hole’. It is so named because patients feel like they are right back where they started before the treatment. In some cases, they are even more uncomfortable because of the combination of the original pain and the pain of the procedure.
The good news is that relief comes as the corticosteroids kick in. Relief tends to last from 2 to 6 months, with doctors recommending treatments 3 to 4 times per year. It is also worth noting that many patients are candidates for other treatments if SI proves successful.
When pain returns following sacroiliac injection, it’s normal. Relief from the procedure takes a few days to really set in. It truly is nothing to worry about.
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