Category: Treatments

The piriformis muscle, a small muscle located deep in the buttock, plays a crucial role in hip rotation and stabilization. However, when this muscle becomes tight or inflamed, it can lead to a condition known as piriformis syndrome. Privium offers Piriformis Injections to help alleviate this recurring pain.

Piriformis Syndrome: Understanding the Pain

As the provided content explains, piriformis syndrome often manifests as:

• Back or buttock pain: This pain is typically exacerbated by prolonged sitting, as this position can put increased pressure on the piriformis muscle.
• Sciatic nerve irritation: The sciatic nerve, the longest nerve in the human body, runs directly beneath or, in some cases, even through the piriformis muscle. When the piriformis muscle tightens or spasms, it can compress or irritate the sciatic nerve. This compression can lead to radiating pain, numbness, or tingling sensations down the back of the leg and into the foot, a condition often referred to as “sciatica.”
• Mimicry of herniated disc pain: The symptoms of piriformis syndrome, particularly the radiating leg pain, can closely resemble those caused by a herniated disc in the lumbar (lower) spine. This similarity can sometimes make diagnosis challenging, highlighting the importance of a thorough medical evaluation.

Piriformis Injections: A Therapeutic Approach

When conservative treatments such as rest, physical therapy, stretching, and anti-inflammatory medications fail to provide adequate relief, piriformis injections can be a highly effective therapeutic option. The process typically involves:

Fluoroscopic guidance:

This is a key component of the injection procedure. Fluoroscopy is a type of medical imaging that uses real-time X-rays to visualize the internal structures of the body. By using fluoroscopic guidance, the physician can precisely visualize the piriformis muscle and surrounding structures, ensuring accurate needle placement. This precision is crucial to deliver the medication directly to the affected area and minimize the risk of complications.

Medication injected: Two components

• Local anesthetic: This medication, similar to what a dentist might use, provides immediate pain relief by temporarily numbing the area. This can offer rapid symptomatic relief and help confirm that the piriformis muscle is indeed the source of the pain.
• Corticosteroid (steroid): This powerful anti-inflammatory medication works to reduce inflammation and swelling within the piriformis muscle. By decreasing inflammation, the steroid can help to relax the muscle, alleviate pressure on the sciatic nerve, and provide longer-lasting pain relief.

How the Injection Works

The combined action of the local anesthetic and corticosteroid aims to:

• Decrease inflammation: The steroid directly targets the inflammatory process within the piriformis muscle, reducing swelling and irritation.
• Relax the muscle: By reducing inflammation and pain, the injection can help to break the cycle of muscle spasm and tightness, allowing the piriformis muscle to relax.
• Relieve pain: Ultimately, the primary goal of the injection is to alleviate the pain associated with piriformis syndrome, including both localized buttock pain and radiating sciatic nerve pain.

Benefits and Considerations

Piriformis injections can offer significant relief for individuals suffering from piriformis syndrome, particularly when other treatments have been unsuccessful. The relief can be temporary or long-lasting, depending on the individual and the underlying cause of the piriformis tightness. It’s important to note that piriformis injections are generally considered a part of a comprehensive treatment plan, often combined with physical therapy to address muscle imbalances, strengthen supporting muscles, and improve flexibility to prevent recurrence. As with any medical procedure, there are potential risks and benefits, which should be thoroughly discussed with a healthcare professional before proceeding with the injection.

The facet joints are small joints on the back of your spine, and are found in all levels from your low-back to your neck. Facet joint pain is usually due to arthritis or degeneration of the joints and is usually described as an ache that stays along the spine and is worse with prolonged sitting, standing or driving. If your pain condition is consistent with facet joint pain, your physician will likely recommend one of the following procedures.

Facet Joint Procedures

Epidural steroid injections (ESI) are performed to place anti-inflammatory medication (steroid) and local anesthetic in the epidural space to target irritated nerves and relieve pain. They are most commonly performed for patients with spine pain and radiating pain into either the arms or legs.

Injections are performed under X-ray guidance. If an initial series of three injections fails to provide lasting relief, your physician will discuss options for altering the treatment plan.

There are three different ways to do an epidural steroid injection and your physician will choose the route that offers the best chance of relieving your pain based on several factors.

Three Types of Epidural Steroid Injections

The sympathetic nervous system helps control many functions in your body (blood pressure, sweating, peripheral blood flow) and is usually not involved in pain sensation. However, in some pain conditions, such as Complex Regional Pain Syndrome (CRPS) or Reflex Sympathetic Dystrophy (RSD), the sympathetic nerves become activated in an abnormal way and begin to transmit pain.

Blocking these sympathetic nerves can improve pain and a positive response is also useful in helping to provide a diagnosis for your pain.

Sympathetic blocks are done with either x-ray or ultrasound guidance, and all involve the injection of local anesthetic around bundles of nerves. The blocks may be done initially in a series of three over 6 weeks, but in some patients, are repeated several times per year.

Spine Levels for Sympathetic Nerve Blocks

Sympathetic blocks can be done at five different levels of the spine, depending on the area and type of pain involved:

1. Stellate Ganglion Block
   The Stellate Ganglion is a bundle of sympathetic nerves that lies roughly at the C7 level, or at the base of the neck. This block may be suggested if you have nerve pain in one or both arms that is difficult to treat with other methods.
2. Celiac Plexus Block
   The Celiac Plexus nerve bundle is at the T12-L1 level and receives pain transmission from many organs in the abdomen. If you have abdominal pain from cancer, chronic pancreatitis or other conditions, this block may be recommended by your physician.
3. Lumbar Sympathetic Block
   The lumbar sympathetic plexus is located at roughly the L3 level. Painful conditions in one or both legs, to include CRPS and some peripheral vascular disease, may respond to blockade of this plexus with local anesthetic.
4. Superior Hypogastric Plexus Block
   Located at the L5 level, the hypogastric plexus receives pain signals from most pelvic organs. This block may be recommended if you have pelvic or low-abdominal pain.
5. Ganglion Impar Block
   The lowest collection of sympathetic nerves is found in the Ganglion Impar, which lies near the junction of your sacrum and coccyx. Blocks at this level may be helpful if you have coccydynia, or tail-bone pain.

Sacroiliac joint is formed from the connection of sacrum with the pelvis on either side. Sources of pain or inflammation can result from degenerative joint changes, decreased or increased range of motion, injury, dysfunction of surrounding soft tissue structures. This can cause pain on either side of buttocks just below the lumbar spine.

Sacroiliac Joint injection

Under Fluoroscopic guidance, Injection of steroid and local anesthetic into the joint space to aide in decreasing the inflammation, relieve pain, and improve functioning.

Lateral Branch Blocks

The lateral branch nerves are small nerves that branch off the sacral spinal nerves and provide sensation to the sacroiliac joint. These nerves can be blocked by the injection of local anesthetic with or without steroid under X-Ray guidance. If beneficial, radiofrequency ablation of the nerves can be performed to provide longer lasting relief.

Lateral Branch Radiofrequency Ablation (RFA)

In cases where either the sacroiliac joint injection or the lateral branch blocks provided good relief but did not last long enough, radiofrequency ablation may be performed to provide longer lasting relief. RFA targets the nerves by using heat energy to stun the nerves. RFA can provide relief for up to 6-12 months.

Knee pain can be chronic, debilitating, and can lead to loss of function. Genicular nerve blocks are indicated for those who have osteoarthritis (DJD), those who want to avoid knee replacement, those who have had knee replacement or any type of knee surgery, and those with chronic knee pain.

Genicular Nerve Blocks
The genicular nerves transmit pain impulses to the knee and surrounding structures. These nerves can be blocked by the injection of local anesthetic and with or without steroid under x-ray guidance.

Genicular Radio Frequency Ablation (RFA)
In cases where the genicular blocks provide good relief that did not last enough, radio frequency ablation may be performed to provide longer pain relief by stunning the nerves.

This procedure, which does not require x-ray or ultrasound guidance, is for the treatment of painful areas of muscle tension or spasm. Muscle spasms in the neck, low or middle back can be quite painful and may persist for weeks to months.

Trigger point injections involve the placement of a thin needle directly into the worst areas of pain for injection of local anesthetic and sometimes steroid. They can provide pain relief for weeks to months, and can also be useful for treating pain associated with Fibromyalgia or tension-type headaches.

Platelet-Rich Plasma (PRP) therapy is an innovative approach to promote and stimulate healing from a tissue and bone injury using body’s own cells (autologous). Platelet-rich plasma therapy uses blood plasma that has a high concentration of platelet cells. Platelets are “first responders” of the body to the site of injury and contain growth factors and other cell types called cytokines that start the healing process.

Several clinical trials have shown this therapy to be effective and safe to treat various forms of muscle, tissue and joint disorders. It is also used to target pain generating from arthritis of the shoulder, knee, elbow and spine. It is also now commonly utilized to target soft tissue and fascia related pain in neck, feet and lower back.

It is an FDA approved non-surgical treatment that is safely performed in an office setting without the need for sedation or anesthesia. Platelet-rich plasma therapy has gained international attention from the medical communities and media by demonstrating its benefits in treatment of injuries sustained by several high profile professional athletes throughout the world.

Benefits Platelet-Rich Plasma Therapy

Benefits of treating chronic pain with Platelet-rich plasma therapy therapy may include:

• Natural, Safe, Effective, FDA approved treatment
• Pain relief from healing of underlying injury
• Use of body’s own cells (autologous)
• Avoidance of a major surgery
• Improved quality of life and increased ability to perform activities of daily living
• Reduced need for oral medications for pain and avoidance of side effects such as nausea, vomiting, sedation, and constipation