I went to a pain clinic yesterday for the first time. I’ve been having months and months of sacroiliac joint pain that hasn’t responded to anything I’ve tried. The doctor wants me to take an antidepressant. She says it’s not because I’m depressed, but because it might help as a nerve moderator. I don’t want to take drugs. Are there any other choices?

Over the years, there’s been a lot of debate about the source of pain felt in the sacroiliac joint (SIJ). Is it coming from the joint itself? From outside the joint? Or both? Studies show that it’s possible for soft tissue structures surrounding the joint to generate the same pain pattern as the joint itself.

One way to treat this is with physical therapy. The therapist works with patients to restore normal posture and biomechanics. This can help you regain normal movement patterns and stop the pain cycle. But in some cases, when the problem has been there for months (or longer), there are possible changes in how the pain is perpetuated (kept going).

Instead of being just a local problem of pinched soft tissues, misalignment of the bones, or an imbalance in the general body mechanics, the central nervous system has gotten in the act. Now there are central messages going from the spinal nerves up the spinal cord to the brain. This can set up a faulty, but permanent, neural pathway.

Using an anti-depressant as a neuromodulator helps reduce and possibly even eliminate the pain messages that don’t respond to any other outside treatment modalities. Usually, this type of approach is short-term (until the central nervous system is no longer part of the feedback loop).

When patients don’t want to use prescription drugs, there are other possible alternatives to change the way pain messages are processed and perceived. These are referred to as complementary and alternative medicine (CAM), energy medicine, or integrative medicine. There are many possible choices including reiki, acupuncture, naturopathy/homeopathy, BodyTalk, craniosacral therapy, and chiropractic or osteopathic care (to name a few).

You may find a center in your area that offers a variety of these energy medicines. It’s possible the pain center you went to has one or more alternative energy medicine practitioners on staff. Check with your doctor (or the pain clinic staff) first to find out what’s available. Explain your desire to explore other alternative treatment options. If nothing else works for you, you can always come back to the idea of trying an antidepressant for this purpose.