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?