Do Sacroiliac Joint Injections and Steroid Injections Overlap in Effectiveness?

Is the injection of proliferative agents into the sacroiliac joint mutually exclusive with steroid injections into the sacral hiatus?

Hello, the patient is 67 years old.
[Symptoms]: Since undergoing knee surgery last August, pain in the right hip and coccyx has gradually increased and worsened.
There are tender points upon palpation, especially with a tearing pain while sitting.
The pain has persisted for 10 months.
It has now spread to the groin and near the anus, causing cramping pain and a sensation of needing to have a bowel movement.
The left hip has also started to hurt for the past three months (with a burning sensation in the left foot for 10 months), and there is pain in the hip while lying down.
[Medical History]: The patient has undergone lumbar MRI, cervical MRI, and pelvic MRI, multiple X-rays, and a nuclear medicine bone scan last September, which indicated no significant issues.
The patient has also had three lumbar nerve block procedures (between L5 and S3), with the most recent on July 3rd.
Additionally, the patient received 15% dextrose prolotherapy and 5% dextrose neural gliding injections a total of seven times, has been taking neuropathic pain medications and NSAIDs, and received a third steroid injection in the right hip (diagnosed as calcific tendonitis).
On June 19th, the patient had one shockwave therapy session, but none of these treatments have been effective.
The patient has also received PRP injections in the knee twice and hyaluronic acid injections twice, but continues to experience pain.
[Current Situation and Concerns]: Two doctors have provided different diagnoses, and the patient trusts both.
An appointment was made for a sacroiliac joint dextrose prolotherapy injection on October 2nd; another appointment is scheduled for October 6th for a steroid injection at the sacral hiatus along the dura mater to L4.
My question is whether the steroid injection site will overlap with the previous prolotherapy injection at the sacroiliac joint, potentially affecting the efficacy of the prolotherapy treatment?

Peng Ren, 60~69 year old female. Ask Date: 2020/10/04

Dr. Wang Zhaomin reply Rehabilitation

In general, sacral hiatus steroid injections do not easily spread to the sacroiliac joint, but this may vary depending on the injection technique, anatomical structures, or other treatments.
Please discuss your current condition with your treating physician.

Reply Date: 2020/10/04

More Info

The question you posed regarding the overlap in effectiveness between sacroiliac joint injections and steroid injections is quite pertinent, especially given your complex medical history and ongoing pain issues.
To begin with, sacroiliac joint injections are typically performed to alleviate pain originating from the sacroiliac joint, which connects the lower spine to the pelvis. These injections can contain a local anesthetic, a steroid, or a combination of both. The primary goal is to reduce inflammation and provide pain relief, which can help improve mobility and quality of life.

On the other hand, steroid injections, particularly those administered via the caudal epidural route (as you mentioned), are aimed at reducing inflammation and pain in the lower back and legs. These injections can target the nerve roots that may be inflamed or compressed, providing relief from pain that radiates down the legs.

Now, regarding your concern about whether the steroid injection will overlap with the sacroiliac joint injection and potentially affect its efficacy, it is essential to understand how these injections work. While both types of injections aim to reduce inflammation and pain, they target different anatomical structures. The sacroiliac joint injection focuses on the joint itself, while the steroid injection via the caudal route targets the nerve roots and surrounding tissues.

In general, there is no direct interference between the two types of injections, as they serve different purposes. However, the timing and the specific medications used can influence the overall effectiveness of your treatment plan. For instance, if you receive a steroid injection shortly after a sacroiliac joint injection, the systemic effects of the steroid may provide additional pain relief, but they could also mask the localized effects of the sacroiliac injection. This masking effect might make it challenging to assess the true efficacy of the sacroiliac injection alone.

Moreover, it is crucial to consider the cumulative effects of multiple injections. Repeated steroid injections can lead to side effects, including potential weakening of the surrounding tissues, which may affect the long-term outcomes of your treatment. Therefore, it is advisable to space out these injections appropriately and discuss with your healthcare provider the best timing for each procedure.

Given your ongoing pain and the various treatments you have undergone, it is also essential to explore other avenues of pain management. This could include physical therapy, which may help strengthen the muscles around the affected areas, improve flexibility, and reduce pain. Additionally, alternative therapies such as acupuncture or chiropractic care may provide relief for some individuals.

In conclusion, while sacroiliac joint injections and steroid injections do not directly overlap in their mechanisms, careful consideration of their timing and the overall treatment plan is crucial. It is always best to have an open dialogue with your healthcare providers about your concerns and treatment options. They can help tailor a plan that addresses your specific needs and maximizes the potential for pain relief while minimizing risks.

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