Particulate Corticosteroid Versus Non-particulate Corticosteroid for Sacroiliac Joint Injection

Patients eligible for a sacroiliac joint injection will be randomized to receive one of two
different steroids, dexamethasone or triamcinolone. The response immediately after injection
will be assessed to confirm the diagnosis, and then they will be followed for three month to
assess the degree of pain relief experienced

Inclusion Criteria:

- Aged >18, capable of understanding and providing consent in English, capable of
complying with the outcome instruments used, capable of attending all planned follow
up visits

- Unilateral low back/buttocks pain of at least 2 weeks.

- Patient reported 7 day average of numeric pain rating score (NPRS) low back/buttocks
pain of at least 5/10 at baseline evaluation

- Clinical diagnosis of sacroiliac joint pain as diagnosed by a board certified
Physiatrist including history of low back/buttocks pain and at least 2 positive
physical exam findings (including positive fortin finger sign, pain with palpation of
posterior superior iliac spine, positive FABER's test, positive Gaenslan's test,
positive sacral distraction, positive thigh thrust, positive lateral compression,
positive sacral thrust)

- Patient consents to sacroiliac joint corticosteroid injection in a shared
decision-making process with the treating physician.

- 80% or more relief of index pain within first 5-15 minutes after injection

Exclusion Criteria:

- Clinical suspicion of alternative process is greater than clinical suspicion of
sacroiliac joint pain

- Those receiving remuneration for their pain treatment (e.g., disability, worker's
compensation).

- Those involved in active litigation relevant to their pain.

- Those unable to read English and complete the assessment instruments.

- Those unable to attend follow up appointments

- The patient is incarcerated.

- History of prior sacroiliac joint fusion

- Progressive lower extremity neurologic deficit (from active radiculopathy, unhealed
radiculopathy, or neuromuscular disease)

- Sacroiliac joint steroid injection within the prior 12 months

- 2 Positive lumbar medial branch blocks within the past 12 months

- Radiofrequency ablation of the lumbar spine within the past 12 months

- Lumbar facet steroid injections within the past 12 months

- Prior epidural steroid injection within the prior 3 months in any location within the
spine.

- Possible pregnancy or other reason that precludes the use of fluoroscopy.

- Allergy to steroid, contrast media, or local anesthetics.

- BMI>40.

- Systemic inflammatory arthritis (e.g., rheumatoid arthritis, ankylosing spondylitis,
lupus).

- Active infection or treatment of infection with antibiotics within the past 7 days.

- Medical conditions causing significant functional disability (e.g., stroke,
decompensated COPD, decompensated heart failure)

- Chronic widespread pain or somatoform disorder (e.g. fibromyalgia).

- Addictive behavior, severe clinical depression, or psychotic features.