Consensus practice guidelines on sacroiliac joint complex pain from a multispecialty, international working group

A battery of physical exam tests has reasonable sensitivity but lower specificity for intra-articular, not extra-articular, pain; negative tests have greater predictive value than positive ones.

Intra-articular injections have diagnostic validity for sacroiliac joint (SIJ) intra-articular, but not extra-articular, pain.

Unclear or negative evidence for imaging.

Intra- and extra-articular steroid injections provide at least 4 weeks of relief in well-selected patients; evidence slightly stronger for extra-articular corticosteroid injections for short-term relief.

Evidence base for non-interventional therapies is indirect, extrapolated mostly from low back pain studies.

Dextrose-based prolotherapy and platelet-rich plasma provide at least 3 months of pain relief.

Sacral lateral branch radiofrequency ablation (RFA) provides relief for at least 6 months in extra-articular pathology; sacral lateral branch blocks supported as a prognostic tool.

Larger lesions or more aggressive lesioning strategies over less stringent techniques.

NSAIDs to prevent neuritis after RFA; in most cases anticoagulation does not require periprocedural cessation.

With aggressive lesioning, sensory stimulation provides minimal therapeutic benefit; weak, extrapolated evidence that motor stimulation can provide safety benefit.

Diagnostic or prognostic blocks positive at 50% cut-off; for therapeutic outcomes a positive response is ≥30% pain relief or meaningful benefit on non-pain outcomes (eg, opioid cessation).

Minimally invasive SIJ fusion can provide benefit for at least one year in carefully selected patients with intra-articular SIJ complex pain based on controlled blocks who failed conservative therapies.