Association Between Corticosteroid Dose and Pain Reduction After Sacroiliac Joint Injections.

Objective: Sacroiliac joint-mediated back pain has proven therapeutic benefit from fluoroscopically guided sacroiliac joint corticosteroid injections. We examined corticosteroid dose and pain relief after fluoroscopically guided sacroiliac joint injections to better understand their relationship.

Design: This is a retrospective observational cohort analysis of electronic health record data on 661 patients who received unilateral fluoroscopically guided sacroiliac joint intraarticular corticosteroid injection with 40 mg versus 80 mg of methylprednisolone from 2012 and 2019. Patients were injected by fellowship trained proceduralists after diagnosis by board-certified physiatrists in an academic physiatry practice. Absolute change in pain scores (postprocedure and first follow-up) was modeled using linear regression of methylprednisolone dosage (40 mg vs. 80 mg) controlling for age, sex, body mass index, baseline pain scores, and follow-up time.

Results: Linear regression indicated that dosage of methylprednisolone, age, and body mass index were not statistically significantly associated with change in pain scores. Sex approached significance ( P = 0.0501) indicating that females may have a lower degree of pain resolution than males.

Conclusions: Practitioners should consider corticosteroid dose when performing these beneficial procedures. This could reduce cost and potential side effects associated with larger doses, while still providing therapeutic benefit. This pilot study can guide future research and dosing guidelines for fluoroscopic spine injections.