Ross Hauser, MD; Danielle Matias, PA-C; Demi Foster, APRN
We have many articles on our website that discuss corticosteroids and cortisone injections. In our article Alternatives to Epidural Steroid Injections, we noted that it is common for doctors to use epidural or other steroid injections to treat pinched nerves in the spine. We do occasionally, more so very rarely, use cortisone, epidural injections, facet blocks, and a host of other injection techniques to help patients who may be suffering from severe pain in the lumbar and SI joint region. However, without treating the ultimate cause of the inflammation in the area, the beneficial effects will only be temporary and the person will be left with the same symptoms once the steroid shot wears off. That is exactly what the scientific literature shows and has been demonstrated in the research. . . no evidence exists supporting injections of steroids into and around the nerve for long-term benefit.
Here we will present a brief review of this research both for and against the use of corticosteroid or epidural injection.
Recently doctors said that image-guided injections of the epidural space and of the sacroiliac joints are effective techniques for the treatment of pain; their effectiveness is sometimes not lasting, but considering the low associated risk when performed by trained personnel, they can be easily repeated. That was published in the European Journal of Radiology in 2015. (1). Multiple applications of steroids is usually not something that doctors are eager to do nor do patients seemingly want. However, we have seen many patients over the years who have had multiple steroid injections into the spine. Now let’s follow the research path on multiple steroid injections into 2026.
Why some people need multiple injections and still may not respond at all
Built on this research and moving to a November 2022 study from the University of California San Diego (2) doctors examined why some people respond to cortisone injections and why some people need multiple injections or do not respond at all.
This is what they found: “Intra-articular or peri-articular corticosteroid injections are often used for the treatment of sacroiliac joint (SIJ) pain. However, response to these injections is variable and many patients require multiple injections for sustained benefit.” The purpose then of this study was to see if the doctors could come up with a screening process that would help other doctors understand who the cortisone injections would help and those the injection would not help. In looking at 100 patients, the patients who did not respond or had limited response suffered from a history of depression and anxiety. They also found older patients did not respond as well.
The researchers also pointed out an enigmatic finding. They found that “the associated Numerical Pain Rating Scale (NPRS (A scoring system of 0 – 10 with 10 being intolerable pain)) score change for SIJ injection responders was less than the minimally clinically significant value of a 2-point differential, suggesting that reported changes in pain scores may not accurately represent a patient’s perception of success after SIJ injection.”
In other words, the patients did not believe that the cortisone worked as well as they thought it would
What does this mean? A minimally clinically significant value of a 2-point differential, if you had 9 out of 10 pain you should have seen it reduced to 7 – or – if you had a 6 out of 10 level pain, that should have reduced to 4 level pain. Was in fact not being achieved. In other words, the patients did not believe that the cortisone worked as well as they thought it would. However, a February 2022 paper in the journal Advanced Biomedical Research (3) evaluated the effects of corticosteroid intra-articular injections on 27 patients with sacroiliac pain and noted pain and disabilities of patients reduced significantly after injections and these results continued for up to within 6 months after interventions.
A June 2023 paper in the Journal of Ultrasound (4) also noted that the combination of non-steroidal anti-inflammatory drugs (NSAIDs) and biological disease-modifying drugs does not achieve the desired pain relief for the patient. In this study of 26 patients (average age 55 years old with 25 patients being females and 1 male, the researchers found ultrasound-guided sacroiliac joint injections were effective and a safe technique for patients who have active sacroiliitis yet are ineligible or do not respond to non-steroidal anti-inflammatory drugs (NSAIDs) and biological disease-modifying drugs.
A February 2026 study in the Interventional pain medicine (5) looked at how effective intra-articular steroid injections for sacroiliac joint pain in patients with predisposing risk factors. There are several known risk factors that can predispose patients to sacroiliac joint (SIJ) pain. These include lumbosacral fusion, total hip arthroplasty, pelvic fracture, inflammatory bowel disease, and seronegative spondyloarthropathy. While it is established that these conditions increase the likelihood of experiencing SIJ pain, it remains uncertain whether they can predict how patients will respond to intra-articular steroid injections for the sacroiliac joint.
A retrospective cohort study was conducted at the University of Rochester, utilizing electronic medical records from September 1, 2013, to February 1, 2023. The study focused on patients aged 18 to 95 years who had sacroiliac joint pain and underwent fluoroscopic or ultrasound-guided SIJ injections.
Based on patient surveys, the researchers observed that individuals with the preconditions investigated in this study tended to experience marginally better physical function after sacroiliac joint injection compared to those without these preconditions. The findings suggest that preconditions such as lumbosacral fusion, total hip arthroplasty, pelvic fracture, inflammatory bowel disease, and seronegative spondyloarthropathy may influence the effectiveness of SIJ injection treatment.
A March 2026 study in the journal Cureus (7) compared intra-articular corticosteroid injections, platelet-rich plasma (PRP), and hyaluronic acid viscosupplementation in 60 adults with sacroiliitis. Each group consisted of 20 patients treated between January 2022 and December 2024. Pain and function were assessed using Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) at baseline and follow-ups up to six months. All treatments reduced pain and disability. Corticosteroids provided rapid short-term relief, PRP showed greatest improvement by six months, and viscosupplements offered sustained benefits and safety.
Steroid injections or neurotomy
Doctors at the Boston University School of Medicine and Massachusetts General Hospital evaluated the effectiveness of intraarticular steroid injections with lateral branch radiofrequency neurotomy (the nerves from the sacroiliac joint are burned out). This March 2022 (6) study in the journal Pain Physician found both sacroiliac joint intraarticular steroid injections and sacroiliac joint lateral branch radiofrequency neurotomy demonstrated significant pain relief with sacroiliac joint lateral branch radiofrequency neurotomy providing a longer duration of pain relief (82 days) versus sacroiliac joint intraarticular steroid injection (38 days).
More reading
In the articles belwo we discus options to steroid injections including prolotherapy, platelet rich plasma and stem cell therapy.
Prolotherapy Injections for sacroiliac instability and SI Joint pain
Spinal and pelvic ligament weakness as a cause of Sacroiliac joint dysfunction
References
1 D’Orazio F, Gregori LM, Gallucci M. Spine epidural and sacroiliac joints injections–when and how to perform. European journal of radiology. 2015 May 31;84(5):777-82. [Google Scholar]
2 Chandrupatla RS, Shahidi B, Bruno K, Chen JL. A Retrospective Study on Patient-Specific Predictors for Non-Response to Sacroiliac Joint Injections. International Journal of Environmental Research and Public Health. 2022 Jan;19(23):15519. [Google Scholar]
3 Andalib A, Etemadifar M, Bardei MA. Evaluation of Intra-articular Corticosteroid Injections in Patients with Sacroiliac Pain. Advanced biomedical research. 2022 Feb 28;11:13. [Google Scholar]
4 Al Khayyat SG, Fogliame G, Barbagli S, Conticini E, Fabbroni M, D’Alessandro R, Vitale A, Gentileschi S, Bardelli M, Baldi C, Stella SM. Ultrasound guided corticosteroids sacroiliac joint injections (SIJIs) in the management of active sacroiliitis: a real-life prospective experience. Journal of Ultrasound. 2022 Oct 13:1-8. [Google Scholar]
5 Young AC, Deng H, Opalacz A, Roth S, Filatava EJ, Fisher CA, de Sousa K, Mogren G, Chen L. A Retrospective Analysis of Sacroiliac Joint Pain Interventions: Intraarticular Steroid Injection and Lateral Branch Radiofrequency Neurotomy. Pain Physician. 2022 Mar 1;25(2):E341-7. [Google Scholar]
6 Bender NR, El-Hassan R. Intra-articular sacroiliac joint steroid injection in patients with risk factors may have greater effect. Interventional Pain Medicine. 2026 Mar 1;5(1):100726. [Google Scholar]
7 Ruiz FK, Bohl DD, Webb ML, Russo GS, Grauer JN. Oswestry Disability Index is a better indicator of lumbar motion than the Visual Analogue Scale. The Spine Journal. 2014 Sep 1;14(9):1860-5. [Google Scholar]