The pain clinic I’m going to for my low back pain has finally figured out it’s coming from my sacroiliac joint. They have suggested doing radiofrequency ablation on the nerves that are causing the pain. How well does this treatment work?

Pain from the sacroiliac joint can be referred to the low back pain, leg, sacrum, pelvis, or buttocks. It can be difficult to trace and even more problematic getting rid ot it.

For the last 10 years, radiofrequency denervation (using radio waves to destroy nerve tissue) has been used when other more traditional treatments have failed. Early results were favorable and now studies done over the last 10 years are being analyzed and reported on.

Whenever a new form of treatment arrives on the scene, physicians want to know: 1) How well does it work? and 2) Who would benefit most from this treatment? Let’s start with the answer to the second question. Patient selection is always a key factor in the success of any treatment like this.

What we know so far is that people with sacroiliac joint pain who get some relief from a steroid injection into the joint seem to respond best to radiofrequency ablation. Younger patients have the best results.

How well does it work? That’s harder to say for a number of reasons. First, the SI joint can vary considerably from patient to patient. Likewise, the number, size, shape, and location of the nerves are equally variable.

Finding the nerve affected most can be a challenge. Then getting to the involved nerve is the next dilemma. Some of the nerves are right on the bone, while others are embedded in the soft tissues around the joint. Often, there’s more than one nerve that is involved requiring more than one procedure.

And evaluating the results of studies already published isn’t as clear and easy as physicians would like. For example, different surgeons use different techniques, select their patients using different criteria, and have different standards by which to judge “success” or “failure”. Those kinds of differences make it difficult to compare one study to another and/or report overall trends for this treatment technique.

Radiofrequency does have some potential in the successful treatment of chronic sacroiliac joint pain. The most effective nerves to target for most patients are between the L5 and S3 levels. Cooled-probe radiofrequency seems to have the best outcomes but more studies are needed to compare the different techniques.