• Reference Number: HEY-538/2023
• Departments: Pain Medicine
• Last Updated: 29 September 2023

Introduction

This leaflet has been produced to give you general information about your treatment. Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for further discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is a sacroiliac joint injection?

Sacroiliac joint injections may be used to diagnose and treat certain types of lower back pain.  A mixture of local anaesthetic and steroid is used for the injection. This has the effect of reducing both the pain in the joint and any surrounding inflammation.

The sacrum is the large bony part at the bottom of the spine.  It feels like one bone but is actually five bones that have grown together. The hip bone is called the ileum and the area where it joins the sacrum at the back is known as the sacroiliac joint.

Why do I need a sacroiliac injection?

A sacroiliac injection is administered in order to relieve pain which is thought to be coming from the sacroiliac joint.

Can there be any complications or risks?

Some patients experience mild local tenderness at the site of the injection. This usually settles over the next few days.

Very rarely, the local anaesthetic may spread causing some numbness in your legs and other areas. This is temporary and will resolve within 4 to 6 hours.

The steroid drug used in the injection can occasionally cause such problems as diarrhoea and abdominal pain; this will usually resolve after a period of up to a week, however if it continues consult your doctor. The steroid can also cause flushing and redness to the face, which also will pass after a short period of time.

Advice to be read before having a pain relief procedure

The following information has been produced to ensure that you are able to have your pain relief procedure. It is essential that you read and follow the advice given below before you come to the hospital. If you do not follow this advice you may not be able to have your treatment.

Please contact the Pain Clinic if any of the following apply to you:

• You have recently had an admission to hospital.
• You have tested positive for Methicillin-resistant Staphylococcus aureus (MRSA).
• You have an infection and are currently taking antibiotics.
• You think you may be pregnant.
• You are diabetic and take medication to control your diabetes.

Continue your other regular medications including your pain relief. However, if you take any of the anticoagulants listed below, please notify the Pain Clinic at least 10 days before your appointment. You will need to stop taking these drugs at least 1 week prior to the procedure unless your doctor has advised against this.

• Warfarin (Marevan)
• Clopidogrel (Plavix)
• Dipyridamole (Persantin Retard)
• Phenindione
• Pradaxa
• Xarelto
• Sinthrome
• Asasantin Retard

Your stay may last between 2 to 4 hours so please bring something to read or to keep yourself occupied.

Please leave any valuables or jewellery at home. It is essential that after the procedure you arrange for a friend or relative to collect you by car or taxi. You will not be able to use the bus or train to travel home.

Hospital transport may be available if there is a medical need. If you think you may be eligible please contact your doctor’s surgery.

Advice for diabetic patients only

If you are diabetic and are booked to attend treatment in the morning, you should not have breakfast or take your morning medication but bring the drugs for your diabetes with you.

If you are booked for treatment in the afternoon please have your breakfast and take regular medications before 7.00 am.  Thereafter only drink water (not milk) for up to two hours before the procedure.  Please inform the clinic staff as soon as you arrive that you are diabetic, the staff will then assess your diabetes and if necessary take appropriate action to monitor and control your blood sugar while you are in our care.

What happens before the procedure?

You will be admitted by the nursing staff; they will ask for and record some information about you.  Your blood pressure will be checked and you will be given a gown to put on.  The doctor will explain the procedure and ask you to sign a consent form.   Please make sure you have understood what has been said and feel free to ask any questions.

What to expect during the procedure

As a precautionary measure, a thin plastic tube (cannula) may be inserted into a vein in your arm or hand.  Once you are lying in the correct position the doctor will clean your back with an antiseptic solution which can feel very cold.

The procedure will be carried out under X-ray screening. This allows the doctor to identify the specific level of joints to be treated. Needles are then inserted under X-ray control into the correct position.  You may feel a pushing sensation or some discomfort at this stage.   Once the needles are in the correct position local anaesthetic is injected and a feeling of tightness may be felt. You should let the doctor know if you feel pain.

What happens after the procedure?

You will be taken on the trolley to the recovery area where the nurse will check your blood pressure and pulse.  You will be asked to rest for about an hour.  After that you will be able to get up, but please check with the nurse before you do so.

Once you are mobile, you will able to go home, accompanied by a friend or relative.

Please ensure that you have arranged for someone to accompany you home after this procedure. Failure to do so will result in your procedure being cancelled.

If you have had sedation, arrange for someone to stay with you overnight and do not drive for 24 hours.

Try to undertake only light activities for a few days after the injection but gradually build up your activities. You should continue to take all your usual pain relief medication as the pain may be slightly worse until the injections start to work.

Some people find that they get relief from their pain but, after a couple of months this wears off.  Others may experience complete relief.  However there is a chance that the pain will not improve, not change or will get worse.

During the pain-free period 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 and strengthen your back. The best way is to increase your activity slowly.

Try not to overdo things on a good day as this may result in you experiencing more pain the following day.

How long will the pain relief last?

This is highly variable between individuals.  Some might notice immediate pain relief where in others it may take up to one to two weeks.  Pain relief may last from a few days to several months.  Some patients do not get any pain relief from this injection.

Follow Up

A letter will be sent to your doctor and you will be reviewed either by telephone or seen at the Pain Clinic in due course.

Points to remember

• You will need to arrange for someone to drive you home after this procedure.
• Please bring your glasses if you need them for reading.
• Always bring a list of all current medication.
• Continue taking all your usual medication on treatment day.
• If there is any possibility you may be pregnant please inform the doctor or nurse.

Additional information

If you experience unusual symptoms such as a marked increase in pain or swelling around an injection site, fever, severe headache, new symptoms of pins and needles, new muscle weakness in your arms, or you are very concerned about how you feel after the procedure, please contact your doctor.

In the event of an emergency and outside normal working hours (9.00am – 4.00pm) of the Pain Clinic please contact your own doctor, Local Walk in Clinic / Minor Injuries Unit

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Pain Service, Outpatients Department, East Riding Community Hospital, Beverley Pain Service (01482) 478868

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.