More on Piriformis Syndrome

I have now had two steroid injections into the piriformis. The first one was great and I felt normal for a short time. The second time, the radiologist managed to hit the sciatic nerve and that was a bit disastrous. I completely lost any feeling in my right leg. I couldn’t believe that the hospital let me go. They just told me  to be careful. But the leg wouldn’t take any weight and it felt like my knee was going to bend backwards…my husband had to get me out of the car and to the bottom of the stairs and he hurt his shoulder. I had to climb up the stairs on my bum and for the rest of the day, I had to ask for help to move. It was unbelievable.

The next morning there was still parts of my foot that were “frozen”. And the sciatic nerve was really irritated. Totally different. It took about a week for the irritation to go away but the piriformis is still hinkey although it is better. On Sunday Oct 11 the muscle went into spasm and would not stop. Horrible. The next day, the leg was so fatigued I couldn’t walk around the block. It’s coming and going which I’m grateful for. Before it was spasming all the time.

I saw Dr. Devonshire on Friday and she agreed that it was time to do the Botox. At least there will be a more lasting effect. I asked her what would happen if the nerve got hit again and she said that it would stop the pain fibers which is all right by me.

I have had tremendous relief from the lift in my shoe. I also had the left shoe built up all along the bottom. It is unbelievable what a difference this has made. Physio said that my leg length discrepancy was only seen on standing. Anyway, the lift puts me back in a more neutral alignment. That translates into less pain. All of a sudden I am standing straight. It’s so strange. I have exercises to do to strengthen the surrounding muscles (first stretched the piriformis but now it’s good). And we’re trying to move the ribs separate from the hips. I have been locked for a long, long time so even being able to do the side bend and move the ribs separately is a huge big deal. I”m just watching the end ranges of movement. Also strengthening proximal hamstrings. Amazing how those little things are so hard to do. One day I expect to get back on that reformer. I’m also doing the elliptical everyday or walking.

Using a TENS unit for Pain Management

I had someone ask me if I tried a TENS unit for pain management. It’s worth a try so I told her I would post the info. Back in 1994 I bought a TENS (transcutaneous electrical nerve stimulation) unit. You get one or two leads that glue or stick onto the area of pain. The opposite end goes into the unit control mechanism. I paid $600 for my unit and now they are around $150. I had two leads which gives you 4 pads. I would put them on the upper and lower limits of where I felt pain. And then you can set the amplitude, strength, pulsing or not and depending on your unit – other controls. I think that they basically work by scrambling the pain signal to the brain. It might sound hokey but I was able to get off my anti inflammatories and continuing running using just the TENS unit.

The problem lies in allergic reactions to the glue that is used to stick the pads on. It’s a very common problem and the company, Medtronics, has gone into surgical implants. It didn’t take long for the allergy to get going and I got around it by using pads without glue and then taping them in place with paper tape. That worked very well but unfortunately, the unit wasn’t so effective this time.

And I have to tell you it only works while you are wearing it. And the leads can get caught in things plus you always have the control unit and what to do with it. No dresses. You have to have something to attach the unit to.

Anyway, it does work for some people and it’s drug free. Most physio therapists will have a unit so you can try it out with their guidance and see if you are one of the lucky ones.

Neuropathic Pain

I find it very interesting to see the pain managed so successfully with non-narcotic drugs. I’ve been in pain for years supposedly from my arthritis although my case is quite complicated. But isn’t everyone’s case different and complicated in other ways?

NSAIDs (non-steroidal anti-inflammatories) helped the pain but this was far from complete. And these types of drugs are not meant to be taken forever. The ideal case is that you get an acute inflammation from something eg spraining your ankle and you go on the NSAIDs for 10 days to aid with the healing.  Arthritis, however, is not an acute situation but rather is chronic. People go on the NSAIDs because of the pain and the drugs help to different degrees.Unless the patient is persistent about their level of pain, it often stops here. And the patients’ don’t know what is “normal” pain from arthritis. The one thing that they do know is they can’t manage many “normal” daily tasks and this can impact their quality of life (QOL) to varying degrees.

Update August 21, 2009

Well, I can hardly believe the difference between now and the last post. Let me start off by saying that the pain is well under control. In fact, most of the time during the past week I have not had any pain. That’s a show stopper.

Two weeks ago, I had to stop taking my Arthrotec (an antiinflammatory) because I was having the steroid injection into the piriformis muscle. I began taking Cymbalta several weeks prior to that. I’ve had to stop the NSAIDS before and couldn’t wait until the time I could start them again because of the increase in pain. Believe it or not, I didn’t even notice the difference. I was stunned. After a couple of days I thought the inflammation would come back and the pain would get worse. Nada. And now it’s been two weeks and I haven’t taken a single antiinflammatory.

Feeling a Lot Better Then Not

Yesterday, I felt terrific. It gave me new hope. The cymbalta is definitely working. Each day it has been a little better and then yesterday, I almost felt normal. Well you know how that works.

I did a nice walk – managed to go a little faster without trying. I was out there for about 30 minutes. Nice. Sunshine. Walking straighter. I really did feel better. By the time I got home, Bill was waiting to go to the beach where the Harmony Art Festival is taking place. I had thought we were going on Sunday or I wouldn’t have done my walk. Whoops. I didn’t say anything and without taking a little rest, we went to the beach. We were there about two hours. It was fun to walk around and see the different craft booths and the gallery. Outside they were doing art demos and Alan Wylie was there. Bill loves his stuff so he sat on a log and watched. I tried to sit next to him but after five minutes I knew it wasn’t a good idea. OK. I went to lawn and sat in one of the chairs.

Bill could tell I was reaching my limit but he wanted to see the gallery. He found a book there by an artist he would like to take a course in. Then we walked around the lawn area, found the schedule for the art demos and just wandered. I think I did something then. I was a bit of a tough go on the lawn, not even ground and there was a dip that I didn´t see. Darn. I could feel something in my back but it wasn’t sore immediately after.

Around and Around We Go

Well, there is no shortage of changes, no shortage of frustrations and sometimes no shortage of hope. The most recent news is difficult to get through. The physicians are getting risky with their suggested treatments and I’m really having to decide just how much I am willing to gamble. I feel, after the hyperthermia trial in Holland, that I am done with the experiments.

Now I am at steroid injections and am stopping that unless they are done radiographically. I was a neurologist’s office last week and she gave me 6 injections trying to hit the piriformis muscle. I feel terrible now and over the last week it’s been hell. I was supposed to go today for a shot into my neck and begged off. She’s made an appointment to do a repeat one radiographically but this being Canada I have to wait a couple of months…She wants to do botox injections into the muscles. I am totally uncomfortable with that and want a second opinion.

Cesamet

So here I am feeling depressed. I mean depressed like you’re going to cry at any given moment…Really weird for me. I am usually pretty upbeat. 

Back in January one of specialists decided that I should try Cesamet to help with the pain. I agreed. It seemed to help…

Here it the end of March and I was having troubles…went to Mexico for a month and felt pretty good there. Actually felt great there and who wouldn’t? Came back home and it has taken awhile but I found myself back “there”.

I admit it, I’m slow but I finally figured out that this couldn’t be me…I just don’t feel this way and don’t behave like that. So I went to see the family doctor and sure enough – Cesamet lists depression as a main possible side effect. Wow…

Quinine?? Nocturnal Muscle Cramps and More

Hi Everyone

I saw a neurologist while I was in Mexico (in Queretaro). He’s fabulous. One of the many things that came out of the meeting was his suggestion to try quinine for my cramping.

I have Small Fibre Polyneuropathy which means that the small muscles fibres are always firing. That can be pretty bad and tiring. I also have Periodic Limb Movement Disorder which was diagnosed here at the UBC Sleep Disorders Clinic. All involve hyperexcitable muscles.

Anyway, I tried the quinine (325 mg) available by prescription in Canada and the US. I tried it in Mexico where it is available over the counter. Anyway, the spasms stopped. Maybe not all of the them but the ones that were in my legs and feet, arms and hands stopped. Just like that. It’s been about a month now and I can’t believe it.

Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain

The complete article is free. It’s well worth visiting the link because there is also a 12 minute video explaining what the Alexander Technique is. I’ve posted the abstract below.

 http://www.bmj.com/cgi/content/full/337/aug19_2/a884

Published 19 August 2008, doi:10.1136/bmj.a884
Cite this as: BMJ 2008;337:a884

Yoga Journal – Yoga Asana Columns – Back Talk

Yoga Journal – Yoga Asana Columns – Back Talk

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For the full article, please go to the website

From the article about Dr. Mary Pullig Schatz, M.D., offers the following information about sciatica in her book, Back Care Basics: A Doctor’s Gentle Yoga Program for Back and Neck Pain Relief (Rodmell Press, 1992):

<<snip>>If the sciatica is from a bulging disc, focus on improving posture and body mechanics in daily activities. Yoga practice should be modified so that the pain is neither created nor intensified. Good poses to work with are Tadasana (Mountain Pose), Adho Mukha Svanasana (Downward-Facing Dog) and its modification, Push the Wall Pose, as well as Virabhadrasana II (Warrior II Pose). Do several sets, holding each pose for a moment.

If a tight piriformis muscle is the problem, then it must be gently stretched. Schatz suggests Piriformis Stretch, a seated pose that resembles the leg position of Matsyendrasana (Lord of the Fishes Pose), but without the torso twist. Parivrtta Trikonasana (Revolved Triangle Pose) with the support of a table or countertop can also help. Do not overstretch or more spasm can result. These poses can help relieve both piriformis spasm and piriformis-related sciatica. Remember to always speak with a physician before beginning any type of physical exercise.<<snip>>