Background: The high prevalence of persistent low back pain and growing number of diagnostic
and therapeutic modalities employed to manage chronic low back pain and the subsequent impact
on society and the economy continue to hold sway over health care policy. Among the multiple causes
responsible for chronic low back pain, the contributions of the sacroiliac joint have been a subject of
debate albeit a paucity of research. At present, there are no definitive conservative, interventional or
surgical management options for managing sacroiliac joint pain. It has been shown that the increases
were highest for facet joint interventions and sacroiliac joint blocks with an increase of 310% per
100,000 Medicare beneficiaries from 2000 to 2011. There has not been a systematic assessment of
the utilization and growth patterns of sacroiliac joint injections.
Study Design: Analysis of the growth patterns of sacroiliac joint injections in Medicare beneficiaries
from 2000 to 2011.
Objectives: To evaluate the utilization and growth patterns of sacroiliac joint injections.
Methods: This assessment was performed utilizing Centers for Medicare and Medicaid Services
(CMS) Physician/Supplier Procedure Summary (PSPS) Master data from 2000 to 2011.
Results: The findings of this assessment in Medicare beneficiaries from 2000 to 2011 showed a 331%
increase per 100,000 Medicare beneficiaries with an annual increase of 14.2%, compared to an increase
in the Medicare population of 23% or annual increase of 1.9%. The number of procedures increased
from 49,554 in 2000 to 252,654 in 2011, or a rate of 125 to 539 per 100,000 Medicare beneficiaries.
Among the various specialists performing sacroiliac joint injections, physicians specializing in physical
medicine and rehabilitation have shown the most increase, followed by neurology with 1,568% and
698%, even though many physicians from both specialties have been enrolling in interventional pain
management and pain management. Even though the numbers were small for nonphysician providers
including certified registered nurse anesthetists, nurse practitioners, and physician assistants, these
numbers increased substantially at a rate of 4,526% per 100,000 Medicare beneficiaries with 21
procedures performed in 2000 increasing to 4,953 procedures in 2011. The, majority of sacroiliac joint
injections were performed in an office setting. The utilization of sacroiliac joint injections by state from
2008 to 2010 showed increases of more than 20% in New Hampshire, Alabama, Minnesota, Vermont,
Oregon, Utah, Massachusetts, Kansas, and Maine. Similarly, some states showed significant decreases
of 20% or more, including Oklahoma, Louisiana, Maryland, Arkansas, New York, and Hawaii. Overall,
there was a 1% increase per 100,000 Medicare population from 2008 to 2010. However, 2011 showed
significant increases from 2010.
Limitations: The limitations of this study included a lack of inclusion of Medicare participants in
Medicare Advantage plans, the availability of an identifiable code for only sacroiliac joint injections,
and the possibility that state claims data may include claims from other states. .
Conclusions: This study illustrates the explosive growth of sacroiliac joint injections even more
than facet joint interventions. Furthermore, certain groups of providers showed substantial increases.
Overall, increases from 2008 to 2010 were nominal with 1%, but some states showed over 20%
increases whereas some others showed over 20% decreases.
Key words: Chronic spinal pain, low back pain, sacroiliac joint arthritis, interventional techniques,
interventional pain management, sacroiliac joint injections
Analysis of Growth of Interventional Techniques in
Managing Chronic Pain in the Medicare Population:
A 10-Year Evaluation from 1997 to 2006
