Sacroiliac joint injections and radiofrequency ablation for pain management: A clinical review

Abstract

Sacroiliac (SI) joint pain is a widely prevalent, and frequent cause of chronic low back pain. Therefore, this review aimed to evaluate current evidence on the investigation and treatment of SI joint injections and radiofrequency ablation (RFA), outline the comparative effectiveness, and future treatments. Clinical studies were collected from databases, such as Scopus, MEDLINE, PubMed, EMBASE, Cochrane Library, Web of Science, Google Scholar, ClinicalTrials.gov, and CINAHL. Image-guided diagnostic injections are the reference standard for confirming the SI joint pain. Therapeutic steroid injections offer only temporary benefit, whereas RFA, in particular, cooled or bipolar methods offer longer-lasting benefit, lasting up to 6 months to 12 months. Comparative experimental studies showed better performance of RFA than injections in a well-selected population. There are fewer invasive options that include regenerative treatments, including using platelet-rich plasma and mesenchymal stem cells, which are on the horizon, but the evidence presented in the studies is limited. The pain in the SI joint ought to be managed in a multimodal and evidence-based pain management approach that focuses on the correct diagnosis. RFA remains the most widely supported intervention in offering long-term relief, and biologic and neuro-modulation therapies are areas where research can potentially improve in the future.

Keywords: Low back pain; Sacroiliac joint pain; Conventional radiofrequency ablation; Steroid injections; Intra-articular injection

Core Tip: This clinical review summarizes current evidence on diagnostic sacroiliac (SI) joint injections and therapeutic interventions, particularly steroid injections and radiofrequency ablation (RFA). Image-guided diagnostic injections remain the gold standard for confirming SI joint-related pain. While steroid injections may provide short-term relief, RFA-especially cooled or bipolar techniques-demonstrates more durable pain reduction lasting up to 6-12 months in appropriately selected patients. Emerging regenerative therapies such as platelet-rich plasma and mesenchymal stem cells show promise but require further high-quality clinical evidence to establish their effectiveness.