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Does a failed nerve block injection mean the diagnosis is wrong?

Hello everybody,

My pain saga continues...

I have had 10 months of consistent pain in my butt and hip on the right side, and the pain also extends now into my lower leg and sometimes my foot. When I initially went to the orthopedist, he thought it was a herniated disc and prescribed PT. When the pain got worse, he did an MRI in October 2014 which showed my lumbar spine to be normal. At that point, the pain in my butt had increased exponentially and he diagnosed me with piriformis syndrome. He had me do a special MRI that apparently focused on my right hip and piriformis muscle, but of course that came back normal. At that point it was the start of 2015, and my hip pain was getting much worse in addition to my butt pain. My doctor then thought maybe a labral tear. Had a hip arthrogram (ouch) and MRI done, and no labral tear, hip looks fine. During this time, I had two piriformis injections and an SI joint injection, and none of these three injections provided any relief. The SI joint injection did make my low back feel better for about a day, but my low back really isn't my most painful area so it didn't feel like significant relief to me. About two months ago I started on my second round of PT with a new physical therapist who came highly recommended. After evaluating me, he right away said that he didn't think it was piriformis syndrome but rather something wrong with my back/spine based on my pain patterns. He has continued to work with me twice a week with treating the spine and strengthening the muscles of my core, back, hip, and butt. I had some weakness on my right side (the affected side) so I definitely feel a little stronger after these two months, but the pain has not subsided. I was recently referred to a neurologist for a nerve conduction study, and once the testing was done he told me that I had a mild irritation in the S1 nerve root. I was jumping for joy because someone had finally identified an area that was causing the pain after all this time. He had me do another lumbar MRI, which of course came back clean, but said that maybe we just won't know what exactly is causing the root to be inflamed. He referred me back to pain management and I was scheduled for a nerve block of the S1 root right away. I was so hopeful for this injection and thought it would relieve a lot of the pain I had been experiencing and was finally the answer I had been looking for. Well....I had the injection 5 days ago and have experienced ZERO relief. If anything, my pain got worse for a few days. When the numbing agent was injected during the procedure, my right leg did go numb so I didn't feel any of the sciatic pain going down my leg, but honestly, that pain has always been the least of my worries because its not severe. But the pain in my butt has been honestly debilitating, and the numbing agent didn't even touch that. To make matters worse, I had a PT appointment yesterday and my PT sat me down and essentially said he didn't think there was anything he could do for me anymore and that I obviously was not getting better. He said without a clear picture of what is going on, he doesn't want to just keep guessing at what to treat. He was really disappointed that the nerve root injection didn't work, which also makes him wonder whether that nerve root really isn't the problem.

So my question is, has anyone had any experience like this? And if this injection failed, is it possible that the S1 nerve really isn't the problem, even though it was identified as being irritated through the nerve conduction study? I am seriously losing hope and am at my wits end. I've become very depressed recently and find it hard to get out of bed, because I know that I'm just going to spend the day in pain. I'm just not sure what else could be causing this extreme butt pain with some pain in the hip, lower back, and leg/foot other than a spinal issue, SI Joint issue, or piriformis syndrome.

I was also tested for rheumotological disorders and diabetes, which came back fine. Even had a pelvic ultrasound to make sure there weren't any "woman problems" causing this pain, especially since the hip pain often radiates into the groin area. I'm living on pain killers and can't work out, and I'm only 30 and have always been active and in good shape. Was running when this pain started last summer.

Any advice, similar experiences, or words of wisdom are very appreciated!

1 1/2 years chronic pain in butt, hip, and sometimes low back. 7 steroid injections (piriformis, s1, si joint, hip joint). Hip labral repair arthroscopic surgery 12/2015. Sciatic neurolysis 12/2015.


  • It just means the nerve block injection didn't work. This time. I have a friend have the first one not work. Then a second on administered two months later did the trick.

    I've had four in the last 18 months. Only the last one did and it worked like a dream. But everyone is made and wired differently. What works for some, doesn't for others. Some work first time, some work on the sixth attempt. Just don't give up. Ask for a second opinion or an independent review.

    Using my friend Charlie as an example... He had congenital heart defects. He was on the transplant waiting list for five years and couldn't walk for more than 50 yards. Then his consultant moved away and his new one reviewed his file. New consultant decided that stents would fix him and put three in. Six months later he was going on 20 mile walks! Fresh eyes see more than tired eyes.

    Hope that helps,


    L5-S1 herniation. Both knee meniscus tear. L4-5 herniation - 2 x nerve block injections. L4-5 discectomy. L1-2 nerve block injection. L4-5 reherniation - TLIF fusion. 2016: L1-2 and L5-S1 retrolistheses and multiple facet joint degeneration.
  • SavageSavage United StatesPosts: 5,459
    edited 05/22/2015 - 12:26 PM
    I agree with Steve, above.
    I have had some epidurals that are successful, but most were not. When I told PM doctor about my groin pain, he said that related to one of my spinal issue...similar to yours.

    You said you're living on pain killers and can't work out. Your body may be forcing you to rest more now to maybe function better later. Always tell doc your symptoms so he can adjust your activity levels and or restrictions....and work toward improved for future.

    Feeling depressed can happen with chronic pain, but not to be accepted as normal. Pain takes its toll on all aspects of our being......physically, mentally and emotionally.
    Please tell doctor how you are feeling. There are some meds that may work with depression and pain control. Doctor could advise you.

    You need your strength and energy to endure the pain, treatments, etc......to work through to best future outcome.
    You're not alone! Hang in there!
    Spine-Health Moderator
    Please read my medical history at: Medical History

  • buttpainbbuttpain Posts: 1
    edited 09/03/2015 - 10:56 AM

    Did you ever get relief from your pain? I have the exact same issue on right side of my body + the pain goes all the way into my neck on right side along with butt and my heel. I used to run and was in good shape until this happened a year ago. The s1 and piriformis injection made the condition worse. PT and chiropractors could not help. Orthopedic and sports medicine doctors did not find issues with spine or hip after multiple mris and hip arthoscopy. If u had relief I would any advice u may have.
  • SavageSavage United StatesPosts: 5,459
    Welcome to Spine-Health
    Please click on link for helpful information!
    Spine-Health Moderator
    Please read my medical history at: Medical History

  • I have had several epidural steroid injections. Most recently have had two nerve block injections into my neck. Doesn't seem like it gave me much relief. So not sure if the Doctor will follow through with the more permanent medial branch procedure. I understand how you feel living with constant pain, depression and not being able to live your life like you are used to. Working out and running used to be a big part of my life. For the last 6 months I haven't been able to participate in any of it.

    Definitely talk with your Doctor about your depression and see if they can help you with some anti depressants at least.
  • Different types of injections, done for two different purposes.
    A nerve block is temporary and mostly diagnostic in nature. It is done to see if a particular nerve is the source of pain, and lasts a few hours.
    An Epidural steroid injection injects steriods into an area of suspected inflammation and irritation, and can take up to a week before you see results.
    Is the pain located on the outside of the hip? It could be bursitis, which can mimic hip pain and if it is severe enough, can cause pain in the low back because of gait changes.
    I have had bursitis several times now, and injections into the bursa relieved it.

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