Rana Terlemez1, Tülay Erçalık2. 1. Department of Physical Medicine and Rehabilitation, Health Sciences University, Şişli Hamidiye Etfal Hospital, Health Research and Application Center, İstanbul, Turkey. 2. Department of Algology, Health Sciences University, Şişli Hamidiye Etfal Hospital, Health Research and Application Center, İstanbul, Turkey.
Abstract
OBJECTIVES: The aim of this study was to investigate the effect of a piriformis injection on neuropathic pain in patients with piriformis syndrome. METHODS: Thirty patients with unilateral hip and/or leg pain, a positive FAIR test (increased H-reflex latency with Flexion, Adduction and Internal Rotation), and a trigger point at the piriformis muscle were enrolled in this prospective study. All of the patients exhibited neuropathic pain scored according to the Douleur Neuropathique 4 (DN4) of ≥4 for at least 6 months. All of the patients received 4 mL of lidocaine 2%+1 mL of betamethazone to the piriformis muscle under the guidance of ultrasound. The Numeric Rating Scale (NRS), DN4, and the painDETECT (PD) questionnaire were used for outcome assessment. RESULTS: A statistically significant improvement was seen in all scores (p<0.001) when both first week and first month results were compared with the baseline values. Comparison of the first week results with those of the first month revealed a statistically significant improvement in only the NRS and PD scores (p<0.001). The greatest improvement in all scores was seen in the first week after the injection. A mild increase was seen in all scores at the first month compared to the first week. CONCLUSION: A piriformis injection was found to be effective for both somatic and neuropathic pain in piriformis syndrome patients. Long-term follow-up is needed in order to consider this option alongside other treatment alternatives, like botulinum toxin and myofascial release.
OBJECTIVES: The aim of this study was to investigate the effect of a piriformis injection on neuropathic pain in patients with piriformis syndrome. METHODS: Thirty patients with unilateral hip and/or leg pain, a positive FAIR test (increased H-reflex latency with Flexion, Adduction and Internal Rotation), and a trigger point at the piriformis muscle were enrolled in this prospective study. All of the patients exhibited neuropathic pain scored according to the Douleur Neuropathique 4 (DN4) of ≥4 for at least 6 months. All of the patients received 4 mL of lidocaine 2%+1 mL of betamethazone to the piriformis muscle under the guidance of ultrasound. The Numeric Rating Scale (NRS), DN4, and the painDETECT (PD) questionnaire were used for outcome assessment. RESULTS: A statistically significant improvement was seen in all scores (p<0.001) when both first week and first month results were compared with the baseline values. Comparison of the first week results with those of the first month revealed a statistically significant improvement in only the NRS and PD scores (p<0.001). The greatest improvement in all scores was seen in the first week after the injection. A mild increase was seen in all scores at the first month compared to the first week. CONCLUSION: A piriformis injection was found to be effective for both somatic and neuropathic pain in piriformis syndromepatients. Long-term follow-up is needed in order to consider this option alongside other treatment alternatives, like botulinum toxin and myofascial release.
Authors: Neeraj Vij; Hayley Kiernan; Roy Bisht; Ian Singleton; Elyse M Cornett; Alan David Kaye; Farnad Imani; Giustino Varrassi; Maryam Pourbahri; Omar Viswanath; Ivan Urits Journal: Anesth Pain Med Date: 2021-02-02