Interventional Pain Management for Chronic Pain
People suffering from chronic pain seek help from a wide variety of sources. After trying over-the-counter medications, altering their physical activity, and relying on the support of friends and family, many turn to healthcare providers for any relief that may be available. Physicians, nurses, physical therapists, chiropractors, and several other classes of professionals offer therapies aimed at reducing pain and improving functionality and quality of life.
At some point along the course of their pain progression, many patients are evaluated and treated by an Interventional Pain physician. This specialist may offer treatment with targeted procedures that focus on pain generators and allow the patient some respite from his or her daily struggle.
Interventional Pain physicians are specially trained to diagnose chronic pain conditions and to perform procedures aimed at treating underlying causes of pain. Most of these physicians underwent a residency training program in anesthesiology, neurology, or physical medicine and rehabilitation after medical school. After residency, these doctors go through another year of additional training in an accredited fellowship program, which allows them to obtain board certification in Pain Medicine after passing a battery of tests. These physicians often manage many classes of medications, but they are also prepared to offer more definitive treatment.
Historically, the most common procedures performed by “pain doctors” were epidural steroid injections. These injections place medication in the space around the lining of the spinal fluid. In the appropriate setting, they can reduce inflammation from disc material, bony contact of nerve roots, or other inflammatory processes and can reduce pain while the body recovers from the underlying process.
Because these procedures were the best alternative to surgery, they became heavily utilized. The problem, though, is that epidural steroid injections don’t treat every cause of pain.
Interventional Pain physicians now have many more options for procedural pain relief, but many pain patients and healthcare providers are hesitant to seek the aid of an Interventional Pain physician if they don’t think epidural steroid injections will help.
Since Interventional Pain Management has become a formalized subspecialty, the techniques available for treating chronic pain have progressed rapidly. Epidural steroid injections remain a valuable tool, but many patients now benefit from nerve blocks, ablations of nerves that transmit pain, and more advanced therapies, such neuromodulation, a blanket term for using implanting minimally-invasive devices to manage pain. Two great examples of the latter two options are knee pain after a knee replacement and chronic low back and leg pain after spine surgeries.
While total knee replacement usually offers great relief to patients with knee pain, up to 10% of patients suffer from residual pain after surgery. Over the last few years, Interventional Pain physicians have developed techniques to ablate sensory nerves to the knee to offer prolonged pain relief with no loss of function.
For patients who suffer from continued pain after one or multiple spine surgeries, Interventional Pain physicians can now use minimally invasive devices to change the way the spinal cord transmits pain signals to provide substantial pain relief for years. While this technology has existed for decades in crude form, the last several years have seen rapid progress in the field of neuromodulation, which portends an exciting future for Interventional Pain Management and for patients seeking relief.
Chronic pain is too complex to rely on medications alone. Fortunately, our field continues to improve in assimilating different types of therapies to achieve the best overall outcome for each patient. In order to continue to improve pain care, physicians and other practitioners must continue to incorporate treatment from multiple disciplines. Along with physical therapy, medications, and psychological support and techniques, interventional pain procedures are integral to pain management and will continue to offer relief and functional improvement to a rapidly-growing group of people suffering with pain.
Interventional procedures Infomation
(All interventional procedure will be performed in FV Hospital by Dr Hoa)
Instruction for procedure
PRE – INJECTION
Dr. Hoa has recommended you undergo an interventional procedure as part of the treatment of your pain problem. Our medical secretary will help you to prepare all administrations for this.
We would like to advice our patients on what to do when undergoing interventional procedures with the information below.
A- BEFORE THE PROCEDURE
1- Please tell us:
– If you are taking:
** Blood thinners’(Anticoagulant) such as Warfarin (Coumadin, Sintrom) Aspirine, Ticlopidine (Ticlid), Clopidogrel (Plavix), Levenox (Enoxaparine)….,
** Diabetic medication
** Medication for high blood pressure
** AINS (Anti-inflammatory non steroïd).
– If you have a history of allergic reactions to contrast dyes, iodine, seafood, steroids or local anesthetic (such as Lidocaine, Marcaine etc…)
– If you have a history of dizziness or faiting spells during or after injection or other procedures.
– If you are able to have pregnancy
2– The following change to your medications must be made before your procedure can be performed:
– Regular Aspirin should be stopped 7 days prior to the procedure.
– Baby Aspirin /day: should be stopped for 3-5 days
– AINS (anti-inflammatory medications): Alaxan, Mobic, Votarene, Celebrex should be stopped for 48hours .
– If you are taking anti-coagulants (Blood thinners) or anti-platelet drugs such as: Coumadin, Sintrom, Plavix, Lovenox, we will ask your physician who has prescribed the medication if it is safe for you to stop for 5 to 7 days before the injection. Ticlid has to be stopped for 14 days.
– Iodine containing x-ray contrast material will be injected during the procedure. Inform us if you have had allergic reactions to iodine in the past.
– Diabetic medications such as Metformin (Glucophage) should not be taken on the day of the procedure.
B- DAY OF PROCEDURE
* Patient can eat a normal breakfast, can drink one cup of milk (200ml-250ml) before 10AM. No lunch nor drink after 10.
– If patient will undergo the procedure after 3PM, patient can have lunch around 11AM and nothing more.
* It is not advisable for you to drive on the day of your procedure. You will need a responsible adult to accompany you home after that.
* Please follow all instructions of administration office.
* Bring your MRI, CT Scan, X-ray films.
+ You need to arrive at Day ward 1-2h before the scheduled appointment.
+ You will be transfered into an operating theater
+ A small canulla will be attached to your hand to administer medication and keep you safe and comfortable during the procedure.
+ You will be mildly sedated with local anesthetic and monitored closely during the procedure.
+ An X-ray machine will be used to identify the internal structures, making the procedure precise and safe.
+ Depending where the procedure site is, you may be required to lie on your lateral or abdomen for 30 minutes to 2 hours.
+ Occasionally, you may experience transient spontaneous movement of your limbs during nerve conduction. This experience is normal.
+ Plan to stay all afternoon for the procedure or at least 4 hours
POST PROCEDURE
- Transient urinary incontinence or urinary retention may be experienced in some patients . Full urinary control will usually resume the following day after the anaesthesia has worn off.
- The initial effects of any local anesthetic will wear off after 2 –6 hours . However, you may experience numbness and weakness of the affected limbs, which will go away the following day and you should regain your normal function by then.
- Be careful stepping over curbs, rugs, bathtubs or other uneven surfaces until normal muscle strength, balance and equilibrium have returned.
- Showers are advised only after complete return of normal sensation and strength.
- You may experience soreness at the injection site for a few days. Anti- inflammatory medications or painkiller may be taken to reduce the soreness.
- You may resume all your previous medication unless otherwise indicated by your pain specialist .
- Medications such as anti – platelet and anti- coagulant should only be resumed 3 days after the procedure.
- If you are prescribed an antibiotic after the procedure, please complete the entire course.
- There will not be any dressing or band aid required over the procedure site.
- Contact Dr Hoa PPC if you experience any symptoms of infection including fever, night sweats or chills and local swelling.
Also notice the injection may cause some temporary discomfort. If you have any question related to the injection.
You may call at: Dr HOA PPC 0932098039
PROCEDURE
Epidural Steroid Injections
Reasons to perform the procedure:
Steroids are medications that reduce inflammation and pain. They may be injected into the epidural space in your spine to help relieve your back, leg, neck, or arm pain.
Description of the procedure:
Your consent will be obtained.
A small cannula will be inserted into the back of your hand for security
You will lie on your lateral for the procedure. The skin on your back or neck will be cleaned with antiseptic and numbed with medication
An epidural needle is then passed through the skin, and directed to the epidural space with the help of the x-ray images. Once it is thought to be in the correct place, some dye is injected, and the position is confirmed by taking an x-ray picture (epidurogram).
The epidural mixture is then injected slowly over 2 – 3 minutes.
You may feel a build up of pressure in your back whilst the solution is injected, but this feeling is mild and soon passes.
You may notice that during the injection you experience some sciatic feelings in either or both of your arms or your legs.This is normal for patients with sciatica and is due to temporary pressure build up in the spinal canal.These feelings soon pass.
After the procedure:
You will be transferred to your bed
You will be positioned with your bad side downwards, and kept in this position for 30’. This is to encourage the epidural solution to reach the affected levels in the back.
You may notice that your legs feel slightly warm and numb for a few hours afterwards.
Pain relief may occur in the following ways:
-Immediate relief which lasts for several weeks.
-Worse for a while, and then relief which lasts for several weeks.
– No change for several days, and then slowly improves for several weeks.
You will be discharged shortly after the procedure.
What are the side effects of the treatment ?
-Temporary numbness in the legs – usually wears off in 2 – 4 hours.
-Salt and water retention – Steroid may cause temporary salt and water retention.
– Blood sugar control – Steroid may cause a temporary mild rise in blood sugar in diabetics for a few weeks afterwards. Non insulin diabetics do not normally need to take further action. Insulin dependant diabetics may need a slight increase in their insulin doses. Please ask your family doctor for further advice
Potential Complications: (rare)
- Bleeding and haemorrhage into the epidural space
- Anaphylaxis
- Temporary numbness or weakness
- Infection
- Spinal headache
- Nerve damage
Follow-up:
You will receive further instructions from your doctor.
If you have any question related to the injection.
You may call at: Dr HOA PPC 0932098039
https://www.spine-health.com/video/cervical-epidural-steroid-injection-video
https://www.spine-health.com/video/epidural-steroid-injections-back-pain-and-leg-pain-video
Reasons to perform the procedure:
Your doctor thinks that you have back or neck pain caused by inflammation of the spinal facet joints. These joints can cause spinal pain and also referred pain to the arms or legs.
There is usually muscle spasm in the area of the joint close to the centre of the spine on examination. The combination of muscle spasm and joint pain can make movements in the neck and back stiff and painful.
What is a facet joint injection and how does it work ?
-The aim of a facet joint injection is to get a small amount of local anaesthetic and steroid inside the joint using a fine needle.
-This produces an anti-inflammatory effect inside the joint, reducing pain.
-There may be also a reduction in the painful muscle spasm around the joint through dorsal horn mechanisms in the spine.
Description of the procedure:
Your consent will be obtained.
A small cannula will be inserted into the back of your hand for security
Lumbar facet joint injections are performed lying face down, whilst cervical facet joint injections are done either lying on one side, or lying on your back.
The area to be injected is cleaned with anti-septic solution, and the skin in the area numbed with some local anaesthetic – this stings a little at first.
Using x-ray guidance, a fine needle is inserted into the cente of each facet joint to be injected. A small amount of local anaesthetic and steroid is then injected.
If the facet joint is difficult to inject, then an alternative is to block the nerve to the joint instead (medial branch block).
After the procedure:
What happens after the injection ?
- You will normally be able to get up off the x-ray table by yourself and walk unaided.
- Pain relief may occur in the following ways:
– Immediate relief which lasts for several weeks.
– Worse for a while, and then relief which lasts for several weeks.
– No change for several days, and then slowly improves for several weeks.
How long will the pain relief last for ?
– It is not possible to answer this question on an individual basis.
– Pain relief can be as follows:
-The injection eliminates the pain never to return again
– The injection reduces the pain for several weeks, the pain returns but not as bad.
-The injection reduces the pain for several weeks, but it returns as bad as ever afterwards.
Facet joint injections can be used in two ways:
- As a diagnostic tool to confirm whether the facet joints are the cause of the pain, and in particular which joint is the main culprit. If the diagnosis is confirmed many people choose to go on to RF Facet Joint Denervation as the next step.
- As a treatment for back pain repeated intermittently.
What happens after the injection ?
You will normally be able to get up off the x-ray table by yourself and walk unaided.
You will be discharged shortly after the procedure.
What are the side effects of the treatment ?
- Temporary numbness in the legs – only occurs if the local anaesthetic is injected too close to the spinal nerve roots.
- Salt and water retention – Steroid may cause temporary salt and water retention.
- Blood sugar control – Steroid may cause a temporary mild rise in blood sugar in diabetics for a few weeks afterwards. Non insulin diabetics do not normally need to take further action. Insulin dependant diabetics may need a slight increase in their insulin doses. Please ask your family doctor for further advice
Potential Complications: (rare)
- Bleeding
- Anaphylaxis
- Temporary numbness or weakness
- Infection
– Local soreness / bruising at the injection site – usually settles in a few days.
– Worse Pain – like any other treatment, the pain can be worse afterwards rather than better. The commonest reason for this is increased muscle spasm in the area of the injection. The needle has to pass through some of the spinal muscles to get to the joints. These occasionally react by going in to spasm, but in most cases this resolves spontaneously.
Follow-up:
You will receive further instructions from your doctor.
If you have any question related to the injection.
You may call at: Dr HOA PPC 0932098039
https://www.spine-health.com/video/medial-branch-block-video
https://www.spine-health.com/video/facet-joint-injections-procedure-video
Radiofrequency (RF) Facet joint Denervation
Reasons to perform the procedure:
- Your doctor thinks that you have back or neck pain caused by inflammation of the Spinal facet joints.
- These joints can cause spinal pain and also referred pain to the arms or legs.
- This treatment can produce longer lasting pain relief than other techniques.
- It is usual to have a positive response to either diagnostic facet joint injections or medial branch nerve blocks prior to going ahead with this treatment.
- In some cases, where an MRI scan has suggested the facet joints are the cause of the pain, denervation may proceed without a diagnostic injection first, especially if technical difficulties are anticipated e.g. excessive obesity, osteoporosis, anatomical abnormalities.
What is Radiofrequency (RF) Facet Joint Denervation and how does it work ?
- Each of the spinal joints has its own nerve supply, the medial branch nerve, which normally carries information about the state of the joint to your brain e.g. pain caused by inflammation, joint position etc.
- The aim of this treatment is to interrupt the nerve supply to the affected facet joint(s) on a permanent or semi-permanent basis, thereby preventing the passage of pain signals to the rest of the nervous system.
- The medial branch nerve is located by using a combination of real time x-ray pictures, and a specially designed needle, connected to a radiofrequency generator machine. This machine performs a series of electrical tests, allowing the doctor to get the tip of the needle as close to the nerve as possible.
- Once the needle is in the correct position, a final electrical test is done to make sure that the needle tip is well away from the main spinal nerve to your leg / arm, thereby improving the safety of the procedure.
- When the doctor is happy with the needle position, a high frequency (radiofrequency) electrical signal is passed down the needle for 90 seconds, causing the tip to heat up to about 80 degrees C. The tissues within 2 mm of the needle tip, including the medial branch nerve, are coagulated, just like when the white of an egg turns white when you cook it.
Description of the procedure:
Your consent will be obtained.
- A small cannula will be inserted into the back of your hand, and increments of a short acting sedative given into a vein until you feel relaxed and comfortable IF NEEDED.
- You may need to have oxygen administered during the procedure.
- Lumbar RF facet joint denervation is performed lying face down, whilst cervical RF facet joint denervation is done lying on your back.
- The spinal area to be injected is cleaned with anti-septic solution, and the skin in the area numbed with some local anaesthetic – this stings a little at first.
- Using x-ray guidance, a fine needle is inserted to where the medial branch nerve normally lies. The final position of the needle is determined by a series of electrical tests. During these tests you may notice some of your spinal muscles twitching, and your normal spinal pain may be reproduced as well for a short time.
- When the doctor is happy with the needle position a radiofrequency lesion is made – you may notice some discomfort in the area for about 90 seconds. It’s important not to move during this time so that the needle position is not disturbed.
- The other levels in the spine are then treated in a similar fashion.
- To treat the facet joints on one side of the spine, 3 medial branch nerves are coagulated. To treat the facet joints on both sides of the spine, 6 medial branch nerves are coagulated.
- After each coagulation lesion, the area is injected with a mixture of local anaesthetic and steroid, to help reduce discomfort afterwards
After the procedure:
What happens after the treatment ?
-You will be transferred to your bed
– Pain relief may be very good initially due to the effects of the injected local anaesthetic during the procedure. This will wear off after 6 hours or so.
– There may then a period of worse pain which lasts a variable time – anything from 2 – 6 weeks.
– Paracetamol and codeine plus ibuprofen is a reasonable mixture of pain killers that you can buy over the counter. If you require anything stronger, Please call or go back to the clinic.
– A follow up appointment will be automatically arranged so that the effects of the treatment can be assessed by your consultant.
How long will the pain relief last for ?
- It is not possible to answer this question on an individual basis.
- Pain relief can be as follows:
- The denervation eliminates the pain never to return again
- The denervation reduces the pain for several weeks, the pain returns but not as bad.
- The denervation reduces the pain for several weeks, but it returns as bad as ever afterwards.
At the end of the procedure the sedative is reversed with another drug, and then you will be allowed to recover in bed until you are fit to return home (usually the same day). Most people can go home after a few hours, accompanied by a responsible adult, once they have recovered from the intravenous sedation.
Your blood pressure, pulse and oxygen levels will be checked afterwards.
If the procedure is performed without sedation, you will be discharged shortly after the procedure.
What are the side effects of the treatment ?
- Temporary numbness in the legs – only occurs if the local anaesthetic is injected too close to the spinal nerve roots.
- Salt and water retention – Steroid may cause temporary salt and water retention.
- Blood sugar control – Steroid may cause a temporary mild rise in blood sugar in diabetics for a few weeks afterwards. Non insulin diabetics do not normally need to take further action. Insulin dependent diabetics may need a slight increase in their insulin doses. Please ask your family doctor for further advice
Potential Complications: (rare)
- Bleeding
- Anaphylaxis
- Temporary numbness or weakness
- Infection
- Local soreness / bruising at the injection site – usually settles in a few days.
- Worse Pain – like any other treatment, the pain can be worse afterwards rather than better. The commonest reason for this is increased muscle spasm in the area of the injection. The needle has to pass through some of the spinal muscles to get to the joints. These occasionally react by going in to spasm, but in most cases this resolves spontaneously.
- Injury to the main spinal nerve – this is a rare complication and can be minimised by using x-ray guidance, electrical stimulation tests, and keeping very still during the treatment. Despite these precautions, nerve damage can occur and may cause tingling, numbness, weakness and nerve-type pain in the leg when the lumbar spine is treated, and in the arm when the neck is treated. Most cases recover spontaneously, but some are permanent. Nerve pain blocking drugs like gabapentin or pregabalin may help the nerve pain.
Follow-up:
You will receive further instructions from your doctor.
If you have any question related to the injection.
You may call at: Dr HOA PPC 0932098039
https://www.spine-health.com/video/lumbar-radiofrequency-neurotomy-video
https://www.spine-health.com/video/cervical-facet-radiofrequency-neurotomy-video
Selective Nerve root injections (FORAMINAL INJECTION)
Reasons to perform the procedure
- Your doctor thinks that you have sciatica in the leg or brachialgia in the arm caused by a trapped nerve in the back or neck.
- The cause of the trapped nerve can be due to a narrowed exit hole (foraminal stenosis), slipped disc (far lateral disc), or by a slipped back bone (spondylolisthesis).
- Injecting around the nerve root just as it leaves the spine can help relieve the pain in the affected limb.
- The problem can show up on an MRI scan.
What is the aim of the treatment ?
- The aim of a spinal nerve root block is to deposit some local anaesthetic and long-acting depot steroid close to the nerve root as it leaves the spine.
- This produces an anti-inflammatory effect and can relieve the arm or leg pain.
Description of the procedure:
Your consent will be obtained.
- A small cannula will be inserted into the back of your hand for security
- A blood sample will be taken to assess your clotting ability prior to the procedure.
- You will be asked to lie face down in the x-ray machine, whilst the area to be injected is cleaned with antiseptic solution, and the skin numbed with some local anaesthetic – this stings a little at first.
- Using x-ray guidance, a fine needle is inserted into the exit hole of the nerve root suspected to be the cause of the pain. A small amount of dye is injected to check the position of the needle (radiculogram), and then a small amount of local anaesthetic and depot steroid is injected around the nerve root.
After the procedure:
What happens after the injection ?
- You will be transferred to your bed
- You may notice that your legs/arms feel slightly warm and numb for a few hours afterwards.
- Pain relief may occur in the following ways:
– Immediate relief which lasts for several weeks.
– Worse for a while, and then relief which lasts for several weeks.
– No change for several days, and then slowly improves for several weeks.
How long will the pain relief last for ?
- It is not possible to answer this question on an individual basis.
- Pain relief can be as follows:
- The injection eliminates the pain never to return again
- The injection reduces the pain for several weeks, the pain returns but not as bad.
- The injection reduces the pain for several weeks, but it returns as bad as ever afterwards.
Spinal nerve root blocks can be used in two ways:
- As a diagnostic tool to confirm whether the trapped nerve root is the cause of the limb pain. If the diagnosis is confirmed many people choose to go on to pulsed RF treatment as the next step
- As a treatment for the pain repeated intermittently.
You will be discharged shortly after the procedure.
What are the side effects of the treatment ?
- Temporary numbness in the arm / leg – usually wears off in a few hours.
- Salt and water retention – Steroid may cause temporary salt and water retention.
- Blood sugar control – Steroid may cause a temporary mild rise in blood sugar in diabetics for a few weeks afterwards. Non insulin diabetics do not normally need to take further action. Insulin dependent diabetics may need a slight increase in their insulin doses. Please ask your family doctor for further advice
Potential Complications: (rare)
- Bleeding and haemorrhage into the epidural space
- Anaphylaxis
- Temporary numbness or weakness
- Infection
- Spinal headache
- Nerve damage
- Local soreness / bruising at the injection site – usually settles in a few days.
- No pain relief – the commonest complication would be that the treatment did not help the nerve.
- Worse pain in the arm / leg – like any other treatment, the pain can be worse afterwards rather than better. This is unusual and the cause is not known. No further nerve root blocks should be administered if this occurs.
Follow-up:
You will receive further instructions from your doctor.
If you have any question related to the injection.
You may call at: Dr HOA PPC 0932098039
https://www.spine-health.com/video/cervical-selective-nerve-root-block-video
Reasons to perform the procedure
– Your doctor thinks that you have back or leg pain caused by inflammation of the sacroiliac joints. These joints can cause low back pain and referred pain to the legs.
– Sacroiliac joint inflammation can show up on x-rays, MRI scans and bone scans. It is usually associated with blood test abnormalities.
What is a sacroiliac joint injection and how does it work ?
- The sacroiliac joint is a large joint joining the iliac bone to the sacrum. You have two joints, one on each side.
- The aim of a sacroiliac joint injection is to get a small amount of local anaesthetic and steroid inside the joint using a fine needle.
- This produces an anti-inflammatory effect inside the joint, reducing pain.
- There may be also a reduction in the painful muscle spasm around the joint through dorsal horn mechanisms in the spine.
Description of the procedure
Your consent will be obtained.
A small cannula will be inserted into the back of your hand for security
A blood sample will be taken to assess your clotting ability prior to the procedure
– The injection is performed with you lying face down. The area to be injected is cleaned with anti-septic solution, and the skin in the area numbed with some local anaesthetic – this stings a little at first
– Using x-ray guidance, a fine needle is inserted into the affected sacroiliac joint. A small amount of local anesthetic and depot steroid is then injected.
After the procedure:
What happens after the injection ?
– You will normally be able to get up off the x-ray table by yourself and walk unaided.
– Pain relief may occur in the following ways:
- Immediate relief which lasts for several weeks.
- Worse for a while, and then relief which lasts for several weeks.
- No change for several days, and then slowly improves for several weeks.
How long will the pain relief last for ?
– It is not possible to answer this question on an individual basis.
– Pain relief can be as follows:
- The injection eliminates the pain never to return again
- The injection reduces the pain for several weeks, the pain returns but not as bad.
- The injection reduces the pain for several weeks, but it returns as bad as ever afterwards.
Sacroiliac joint injections can be used in two ways:
- As a diagnostic tool to confirm whether the joints are the cause of the pain. If the diagnosis is confirmed many people choose to go on to RF treatment for next step
- As a treatment for back pain repeated intermittently
You will be discharged shortly after the procedure.
What are the side effects of the treatment ?
- Temporary numbness in the leg(s) – only occurs if the local anaesthetic spills from the front of the sacroiliac joint to the sciatic nerve – usually wears off in a few hours.
- Salt and water retention – Steroid may cause temporary salt and water retention.
- Blood sugar control – Steroid may cause a temporary mild rise in blood sugar in diabetics for a few weeks afterwards. Non insulin diabetics do not normally need to take further action. Insulin dependent diabetics may need a slight increase in their insulin doses. Please ask your family doctor for further advice
Potential Complications: (rare)
- Bleeding
- Anaphylaxis
- Temporary numbness or weakness
- Infection
– Local soreness / bruising at the injection site – usually settles in a few days.
– Worse Pain – like any other treatment, the pain can be worse afterwards rather than better. The commonest reason for this is increased muscle spasm in the area of the injection. The needle has to pass through some of the spinal muscles to get to the joints. These occasionally react by going in to spasm, but in most cases this resolves spontaneously.
Follow-up:
You will receive further instructions from your doctor.
If you have any question related to the injection.
You may call at: Dr HOA PPC 0932098039
https://www.spine-health.com/video/sacroiliac-joint-steroid-injection-video
