INT-02 - The “Other” Back Pain: Sacroiliac Joint Pain

Sacroiliac joint related pain may have a prevalence of up to 16-30% among chronic low back pain patients. The sacroiliac joint is a large load bearing joint that is a common pain generator in patients with chronic low back pain. The sacroiliac joint is innervated by a complex web of sensory nerves and thus presenting pain patterns are often variable and shared by other concurrent pathologies. Diagnosis of sacroiliac joint dysfunction can times get overshadowed by more obvious diagnoses such as lumbar radiculopathy. Unless a clinician actively rules out sacroiliac joint pain it can easily be missed and forgotten during the workup for back pain. The topics introduced will help both interventional and non-interventional pain physicians understand sacroiliac joint dysfunction as a common pain generator in chronic low back pain. This first half of the presentation will review the anatomy and physiology of the sacroiliac joint. We will describe the diagnostic approach to sacroiliac joint dysfunction and update current treatment options. There will be an opportunity to include a live demonstration of the provocative diagnostic maneuvers that are utilized to diagnose SI joint pain. We will focus the second half of the presentation on current non-invasive and interventional treatment modalities for treating SI joint pain. This will include recent challenges in therapy adoption as in the case of radiofrequency ablation by insurance companies despite published data. There has been a rapid emergency of minimally invasive sacroiliac joint stabilization techniques. As part of this discussion, we will review the evidence related to the biomechanical studies that have been conducted associated with these therapies. We will explore the popular fusion techniques including the accompanying evidence and new billing codes. Will conclude the presentation with a review of treatment algorithm and best practices in workflow within a pain management practice.