Multiple professional multispecialty groups have endorsed or affirmed the benefit of guidelines for addressing sacroiliac joint complex pain, according to an article published Nov. 20 in Pain Medicine.
Development for the multispecialty guidelines were approved by the Boards of Directors for the American Academy of Pain Medicine (AAPM) and American Society of Regional Anesthesia & Pain Medicine in 2023. Twenty-five organizations, along with the Department of Defense and Veterans Affairs agreed to participate in development. Twenty-one questions spanning diagnostic criteria, interventional and nonintervertional treatments, parameters to optimize results and guidelines on what constitutes positive outcomes were developed.
Highlights of the guidelines include:
1. Physical exam tests have “reasonable sensitivity, but lower specificity, for identifying intra-articular but not extra-articular pathology.” Negative tests have greater predictive value than positive ones.
2. There’s unclear or negative evidence to support imaging in diagnostics.
3. Non-interventional therapies have an indirect evidence base.
4. The guidelines say there’s weak evidence to support dextrose-based prolotherapy and platelet-rich plasma to provide at least 3 months of pain relief.
5. There’s strong evidence to support sacral lateral branch RFA.
6. For patients who failed conservative therapies, the guidelines found “weak or very weak” evidence that minimally invasive SI joint fusion can benefit for at least a year.
A total of 21 organizations formally endorsed the guidelines, and The American Society of Anesthesiologists; and American Academy of Physical Medicine & Rehabilitation, and the North American Spine Society affirmed the benefit of them without endorsing them. Representatives for the DoD approved the guidelines but didn’t formally review for endorsement, per policies.
