A 27 year old lady was seen in the Pain Clinic with sacroiliac joint tenderness. She was working as a nurse and over the last 2 years had had increasing pain from the lower part of her back. This was particularly aggravated by lifting and handling of patients and other similar activities.
On examination she had extreme tenderness of her left sacroiliac joint and left L5/ S1 facet joint. These were so tender that examination proved difficult and caused her distress. She had sensory changes around the area with some discrete areas of hypersensitivity to light touch, which she felt as pain. She had previously tried a number of different treatments including a TENS machine, medication such as Paracetamol, Ibuprofen and Codeine, Physiotherapy and a Chiropractor.However, the pain was getting worse and she was unable to complete her tasks at work properly. This was causing her a lot of anxiety and she was looking to control the pain and find different ways of working. Initially she started off with a course of acupuncture; she had 4 sessions at weekly intervals including trigger point and local point needling. Unfortunately, this led to an aggravation of her symptoms and was discontinued. She then underwent a left sacroiliac joint and left L5/S1 facet joint injection under X ray guidance using local anaesthetic and steroid. Unfortunately, she found this procedure extremely unpleasant and uncomfortable and she required sedation to complete it. It also only gave her relief for approximately 2 hours and then the pain worsened once again. In the meantime, we had tried a number of different medications including opiates but she was unable to tolerate the side effects of these. Searching for other treatments, we gave a series of injections of Botulinum Toxin A to the paravertebral area and around the painful sacroiliac joint. She tolerated this poorly for the actual procedure and the area was extremely painful for the next 5-6 days. However, following that the pain started to subside and by one month the pain had resolved following the Botulinum Toxin injection. This lady stopped taking all other medication and was discharged from the Pain Clinic.