BACKGROUND: Sacroiliac joint (SIJ) pain is a frequent cause of chronic low back pain, but the comparative effectiveness of available interventional treatments remains unclear.
OBJECTIVE: We explored the therapeutic effects of interventional treatments on SIJ using a network meta-analysis.
EVIDENCE REVIEW: A comprehensive systematic search of multiple databases was conducted to identify randomized controlled trials comparing conventional, cooled, and pulsed radiofrequency (RF) ablation; intra-articular steroid injections under different imaging guidance techniques; prolotherapy; platelet-rich plasma; sham procedures; and conservative management.
METHODS: Primary outcomes were pain intensity and Oswestry Disability Index at 1, 3, and 6 months. Random-effects network meta-analysis estimated mean differences with 95% CIs, and P scores were used to rank treatments.
RESULTS: 18 trials involving 1075 patients were included. RF-based interventions consistently outperformed steroid injections, sham, and conservative care. For pain relief, cooled RF ranked highest at 1 month, conventional RF at 3 months, and pulsed RF at 6 months, demonstrating significant superiority over most comparator treatments. For disability outcomes, pulsed RF provided the greatest improvement at 1 and 3 months, whereas CT-guided intra-articular steroid injection ranked highest at 6 months. However, the certainty of evidence was generally low to very low due to imprecision and study limitations.
CONCLUSIONS: These findings support the overall effectiveness of RF techniques for SIJ pain while highlighting important evidence gaps that warrant further high-quality trials with longer follow-up.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
Meta-analyses of interventional pain management techniques often primarily reflect the commercial interests of companies seeking to promote their devices. Clinical reality is often far removed from what these studies show, many of which are funded by the industry itself. This is a clear example.
, McMaster University