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What Causes Chronic Pain When On Piriformis Syndrome Treatment?

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Posted on Sat, 3 May 2014
Question: Yes, since August 2007 diagnosed with piriformis syndrome. Right diagnosis, wrong treatments. 3 lumbar fusions, MRI's show minor herniation that most have, so found new dod that did piriformis resection & thought we had it. Took one year but got one year of relief. All pain came back in left leg with new thoracic spine pain that shows more arthritis on MRI. Had Cervical fusion but herniation was directly into spinal column & had awful neuro symptoms & was great after that surgery but having symptoms again. Have great neurologist that started me on nortriptyline & clonazepam that in a few days helped greatly & also causing the brain to I guess handle the pain signals differently with the left leg etc. But the left pain seems to be now winning. The last MRI of lumbar spine now shows Arachnoiditis which as I read it and it was explained is going to be completely dibilitatiing with worsening and more pain. So now the problem is pain management and my concern with drug interactions. Feel that I am much more disoriented etc. now. Current meds are the two mentioned, XXXXXXX at night, hydrocodone for the bad pain and I had tramadol that I just ran out of that I thought would be safer than the Hydrocodone. The tramadol states to not stop suddenly which happened and been to doc and he will NOT refill. I am 57 & was very athletic is early years, but arthritis with both parents and father dies of a rare bone cancer, so have some things against me. I have researched so much & found a Dr. Filler in Ca that has imaging that can see nerves & maybe stop the leg pain. He had treated so many & so many of his cases mirror mine. But now the docs that sent me for a total of 17 surgeries are now backing away since they state they is nothing more they can do surgically which to me I am not a money maker any more. Also been through surgical malpractice..uggg. So I have had it. Was referred to another physiatrist that does an implant into the spine area I guess but I am not wanting any more patches on this mess. Just want it fixes or at least the pain to be controlled. So my last visit for update with pain mgmt. doc was just grim. He said no Vicodin, no Tramadol and he was done. I am well aware of addiction but do I just sit in a ball of pain causes by these lumbar fusions that caused this new condition? And the 8 steroid injections that also worsen the disease? And now the docs that recommended all this are done with me. So I don't understand the drug interactions that are harmful and I just want to know if I should move on to the doc in CA since I think he is my last resort. My neck pain is also worse and the CT shows Osteophyte at C5-6 which is the level above the fusion and he showed it to me on the imaging but played it down. I am just lost and tired of all the pain and want my life back & want to have my life again with my husband who has been by my side. He is a paramedic/firefighter here in Littleton, CO, and if not for him, don't think I would have made it through all this. Plus a great ER doc at Littleton Hospital that saved me a few times. Thanks so much and sorry this is so long. But I am detailed and this is just the tip of it all. Best Regards, XXXXXXX K. I do have a lengthy medical issue in regards to the spine etc & the continued sciatica or piriformis syndrome which it might not be. I also appreciate the doctors wanting to take more time to research any answer or direction I should take. I forgot to mention on the medical history that I have had two bone density tests, one in 2010 & the last 2/2014. Both show severe Osteopenia & one step away from Osteosporosis. Was worried about a metabolic bone issue especially with the spine fusions and the lumbar fusion being a failed fusion. So wanted to check the bones to see how screws etc. would even hold if they were not strong enough. So have been on supplements, calcium and VD3 to help plus they want me to go to an infusion facility for Calcium infusions. Oh XXXXXXX The left leg and the sciatic pain that is back is the worst issue right now and is hitting an 8 again of the 1 to 10 pain scale if you can forward this to what I have already given the doctors. I viewed a DVD that I was given on the Spinal Cord Stimulator which to me was another bad infomercial on something else for you to spend money on that just masks the problem. I am so looking for a fix to the pain and just not medicate it or trick the brain into how it processes pain. Pain obviously is the way the body says "Hey" something is wrong here. So I am determined to find the miracle doctor that can find the area of sciatic nerve that is being impinged and causing the pain. So that is why I would love to be able to afford to see Dr. Filler in CA who has the imaging that can see nerves & we can stop the guessing game.
doctor
Answered by Dr. Dr. Praveen Tayal (28 hours later)
Brief Answer: Neral pain. Detailed Answer: Hello, Thanks for posting your query. The chronic pain that you are having is due to a neural cause and the osteopenia that you have is adding to your problems. Consulting Dr. Filler is a good idea as he is experienced in treating such nerve related pains. Few other options of treatment which may be useful in reducing pain and maintaining functional lifestyle are 'Transcutaneous Electric Nerve stimulation (TENS) units', relaxation techniques, accupuncture occupational and physical therapy approaches. Some simple back pain exercises will also help.They will help to strengthen the muscles and improve the stability of the spine. If none of the above measures are helpful, pain specialists have used low dose tricyclic antidepressants, gabapentins or other anticonvulsants for modifying the intensity of perceived pain. This is also an option available which can be tried. Discuss with your doctors to prescribe the medications if needed I hope this answers your query. In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out. Wishing you good health. Regards. Dr. Praveen Tayal. For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dr. Praveen Tayal (1 hour later)
Hello again! I sent a reply a few moment ago and when I clicked on submit, it asked me to sign in. I seriously hope my reply was not lost??? Did you received my reply?? Thanks so much, I forgot to ask how the Osteopenia contributes to the pain. This is where I get stumped understanding the medical part of it & what effects what. They want me to have calcium infusions & make sure I take the vitamin D that I do. But a little more detail on the Osteopenia would be wonderful. If you did NOT get my first reply. Was asking WHY if the piriformis muscle was completely removed as the doctor stated & the sciatic nerve was entangle in that muscle plus he freed it up my running his hand down the inside of my leg making sure the nerve had a clear path, that the pain again is radiating from the exact same spot. Runs down the back of my left leg & into the foot. So confuses as to why the pain is exactly the same in all aspects. I am guessing that this sciatic nerve could be impinged upon somewhere else but that area of the buttock now is SO sensitive. Could scar tissue be an issue??? We do have a TENS unit so will start using again. The last visit to the physiatrist who started this mess said I have done enough PT which to me, there is never enough. So will get a script for primary doc. But as mentioned, I love to walk a mile or two & now that just causes more pain. I created a PT book as I went through all the exercises to will use that as well to get going when I am not crying and balled up in pain. Just don't understand how I finally got relief after the piriformis resection & then all the pain comes back, same spot, same leg, same everything & almost worse pain?? I so appreciate you saying that Dr. Filler is a good route to take. It might be expensive if Cigna won't play, but did take the first step & contacted them on their website today. Will see how far we get. They had a MR Neurography machine here in Denver when I contacted them a few years ago, hope they still do. At least if he can see the nerves, then we might be able to see where it is being impinged again. Thank you again for your time & hope all this finds you. Think my first reply was lost due to the system. Best Regards, XXXX
doctor
Answered by Dr. Dr. Praveen Tayal (5 hours later)
Brief Answer: Can be due to scar tissue. Detailed Answer: Hello. Thanks for writing again. The persistent pain in the same spot can be due to the nerve impingement by the soft tissue swelling or the scar tissue. This needs to be evaluated by MR Neurography. Osteopenia causes the thinning of bone cortex and the weight bearing bones like back bone do feel the stress and cause pain. Regular calcium and vitamin D 3 supplements are recommended. Hope my answer is helpful. Do accept my answer in case there are no further queries. Regards.
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dr. Praveen Tayal

Orthopaedic Surgeon

Practicing since :1994

Answered : 12314 Questions

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What Causes Chronic Pain When On Piriformis Syndrome Treatment?

Brief Answer: Neral pain. Detailed Answer: Hello, Thanks for posting your query. The chronic pain that you are having is due to a neural cause and the osteopenia that you have is adding to your problems. Consulting Dr. Filler is a good idea as he is experienced in treating such nerve related pains. Few other options of treatment which may be useful in reducing pain and maintaining functional lifestyle are 'Transcutaneous Electric Nerve stimulation (TENS) units', relaxation techniques, accupuncture occupational and physical therapy approaches. Some simple back pain exercises will also help.They will help to strengthen the muscles and improve the stability of the spine. If none of the above measures are helpful, pain specialists have used low dose tricyclic antidepressants, gabapentins or other anticonvulsants for modifying the intensity of perceived pain. This is also an option available which can be tried. Discuss with your doctors to prescribe the medications if needed I hope this answers your query. In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out. Wishing you good health. Regards. Dr. Praveen Tayal. For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal