Cluneal Nerve Blocks and Stimulation
Diagnosis and treatment for low back and buttock pain from irritated cluneal nerves near the top of the pelvis.
What is cluneal nerve pain?
The cluneal nerves are small sensory nerves that cross over the top of the pelvic bone (the iliac crest) and supply feeling to the low back and buttocks. Where they pass through tight tissue near the bone, they can become trapped and irritated.1
Cluneal nerve pain often feels like low back or buttock pain that can spread toward the leg. Because it can mimic pain from the spine or sacroiliac joint, it is easy to miss. A tender spot along the top of the pelvis is a common clue.1
- Low back or buttock painOften on one side, near the top of the pelvis
- Tender trigger spotPressing along the iliac crest reproduces the pain
- Worse with movementBending, twisting, standing up, or walking
Step 1: A diagnostic block
A small amount of numbing medicine, sometimes with a steroid, is placed near the cluneal nerves using ultrasound guidance. If your usual pain disappears while the medicine is active, the cluneal nerves are very likely the source.1
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Find the spot
Your clinician locates the tender area along the top of the pelvis.
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Ultrasound guidance
Ultrasound shows the nerves and surrounding tissue in real time.
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Numbing medicine
A thin needle places medicine around the nerves.
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Track your relief
You note how your usual pain changes over the next several hours.
Step 2: Longer-lasting relief with nerve stimulation
When blocks help but relief doesn’t last, SPRINT peripheral nerve stimulation can target the same nerves. A thin wire is placed near the nerves through a needle and connected to a small wearable stimulator for up to 60 days. Then the wire is removed, with nothing left behind.
For many patients, stimulation provides longer-lasting relief than repeated injections, without nerve ablation or a permanent implant.
What to expect
Before your block
Tell us about your medications, especially blood thinners. Come in with your usual pain so the block can be tested accurately.
During your block
You lie on your stomach or side. The skin is numbed, and the injection takes just a few minutes.
After your block
Do the activities that usually hurt, and note how your pain changes. Mild soreness for a day or two is common. You can usually drive yourself home.
Common questions
How is this different from SI joint pain?
The pain can be in a similar area. The cluneal nerves sit on top of the pelvic bone, while the SI joint is deeper. Your exam and the response to targeted blocks help tell them apart.
Why not just ablate the nerves?
Ablation of these nerves is often not covered by insurance. Nerve stimulation is a well-studied, temporary, and drug-free alternative.
Can surgery help?
When other treatments fail, a surgeon can release the trapped nerve. Most people do well with less invasive treatment first.1
Will insurance cover it?
Most plans cover diagnostic nerve blocks. Coverage for nerve stimulation varies, and our staff will check your benefits and request any required prior authorization.
Talk with a specialist about low back and buttock pain
Our physicians will examine you to decide whether cluneal nerve treatment, or another approach, is the right fit for you.
New pain management patients need a referral. Your provider can fax it to 870-706-2428.
Risks
Possible side effects of a nerve block include soreness, bruising, temporary numbness, bleeding, and, rarely, infection. Nerve stimulation can cause skin irritation under the bandage or wire movement. Your clinician will review the risks with you. Individual results vary.
Sources
- Isu T, et al. Superior and middle cluneal nerve entrapment as a cause of low back pain. Neurospine. 2018;15(1):25-32. doi:10.14245/ns.1836024.012
SPRINT image courtesy of SPR Therapeutics.