Some of the old black and white movies had scenes where a character would rub his lower back saying, "My sacroiliac is killing me!" Those scenes were played for the comedic effect as sacroiliac is a funny sounding word. Perhaps we have become more sophisticated as we rarely hear that "funny" word any more. We now hear of SI joint pain, and there is nothing funny about that.
Causes of SI Joint Pain
SI joints are located on both sides of the lower spine and connect the spine to the pelvis. Inflammation of either or both joints is called sacroiliitis and can cause severe pain with even slight movement of the spine. Many things can cause sacroiliitis or SI joint pain. An injury to the lower back, pregnancy which causes the pelvis to stretch for childbirth or any condition that changes the normal walking pattern places stress on the SI joints. But the most common cause of SI joint dysfunction is arthritis. Gout, rheumatoid arthritis, psoriatic arthritis and osteoarthritis are all forms of arthritis that can affect the SI joints. Additionally the chronic condition, ankylosing spondylitis, is an inflammatory condition that can affect the SI joints.
SI Joint Pain Treatments
As with all arthritic conditions, nonsteroidal anti-inflammatory drugs, NSAIDs, such as indomethan (Indocin) and naproxen (Aleve and Anaprox) are often recommended and prescribed on an as-needed or a continuous basis depending upon the situation. However, NSAIDs can have severe detrimental side effects such as indigestion, stomach bleeding, liver damage, kidney damage and high blood pressure. Alternatives to NSAIDs include oral corticosteroids, prednisone and prednisolone, and may be prescribed to help reduce the inflammation and pain. Corticosteroids also have serious side effects such as thinning of bones and susceptibility to infection. Physicians generally prescribe them for acute symptoms, not for long-term use.
Two other oral drugs groups are available to help with SI joint problems. Etanercept (Enbrel), adalimumab (Hummira) and infliximab (Remicade) are in a group of drugs called "tumor necrosis factor (TNF) inhibitors. These drugs block cytokine, which is a cell protein that acts as an inflammatory agent and may help reduce joint pain. TNF drugs are quite expensive and are generally not prescribed unless other treatments have not been satisfactory. Disease-modifying antirheumatic drugs (DMARDs), sulfasalazine (Azulfidine) and methotrexate (Rheumatrex) are prescribed to limit joint damage and slow the disease. These drugs probably would not provide any immediate pain relief, but may help prevent future problems.
A more invasive but effective treatment is to have the powerful anti-inflammatory drug, cortisone, injected directly into the SI joint. Cortisone injections can provide long-lasting pain relief and as a general guideline can be repeated three times a year. An anesthetic material is usually injected along with the cortisone, and that anesthetic serves as a diagnostic tool for if the pain disappears when the joint is numbed, it is a positive indication that the SI joint is the source of the problem. Although it is not common, surgery has been used when all else has failed. If the SI joint pain is the result of ankylosing spondylitis, the joint can become so damaged that pain relief can only be achieved by joint replacement.
Caution
Don't ignore chronic lower back pain. Although the root cause of the pain may be difficult to determine, a competent physician should be consulted. If the history and symptoms point to ankylosing spondylitis, more testing will be required. If left untreated, that condition may lead to serious complications such as breathing and heart problems.
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