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Have piriformis syndrome, EMG test and bone scan clear. Had dissectomy. Want relief from pain

Hi I ve been diagnosed with piriformis syndrome after a myriad of tests to rule out other causes of my constant sciatic pain. Three sets of MRI s have not shown any anomalies, an EMG test and bone scan also came up clear. I ve been in pain for 2 years, but it seems to ease off slightly in winter, with a flare-up every summer. During a flare-up, that can last for months, I m unable to sleep and for a few weeks stuggle to walk. I ve had cortisone injections, NSAIDs, physiotherapy, seen osteopaths, acupunturists and tried many other alternative therapies with very little success. I try to stay active, although I can only swim and walk. I do daily physio prescribed stretching , but it s very painful during flare-ups. I ve had a EMG guided botox injection (100 units) 12 days ago and the pain seemed to have increased instead of subsided. I was not involved in any accidents or trauma to have caused the pain, I literally just woke up with the pain one morning. Apart from seasonal changes, nothing else is triggering the flare-ups either. I ve had a discectomy L4-5 in August of 2004, but have gone through rehab and are very cautious when moving or exercising, I have no pain or discomfort in my back. L5-S1 is also damaged, but to date have not herniated or caused any problems. I was really hoping the botox will sort the problem, but sadly I was disappointed. I m desperate for pain relief - this is interfering with my daily life and I m starting to get really depressed. What else can be done to relief this excruciating pain? Do I go for more botox, is surgery necessary?
Asked On : Sat, 7 Jul 2012
Answers:  1 Views:  213
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Orthopaedic Surgeon 's  Response
Thanks for writing to us.
The persistent pain after discectomy can be due to piriformis spasm. Oral muscle relaxants and TENS therapy can help-[ in relieving pain.
I hope this information has been both informative and helpful for you.
Dr. Praveen Tayal ,
Answered: Thu, 1 May 2014
I find this answer helpful
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