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Chronic pain despite multiple interventions, advice please!

Hi everyone,

I have posted in this sciatica forum a few times during my long and painful journey with chronic pain.  Long story summarized:  I have had chronic pain in my butt, hip, and sometimes leg/foot/lower back for one and a half years.  It seemed to start after I began training for a half marathon.  The pain onset was gradual and not sudden, and mostly began in my low back.  When I went to go see an orthopedic doctor just to make sure everything was fine, he prescribed PT.  The pain immediately became worse, and my doctor ordered an MRI of my low back.  The MRI came out completely normal, and around that time the pain re-located to my butt.  My orthopedic doctor then diagnosed me with piriformis syndrome based on my symptoms and instructed my PT to work on the piriformis muscle.  I felt no relief after months of PT.  My doctor ordered an MRI of the piriformis muscle and hip, and of course it was normal.  Despite the normal MRI, I had two injections into the piriformis muscle 2 months apart, both of which provided no relief at all, and if anything made the pain worse.  I was referred to a different doctor, who ordered a hip arthrogram and MRI due to increasing pain in my hip, in addition to the butt and low back pain.  The arthrogram and MRI were totally normal.  Shocking.  The doctor then did an injection into my SI joint to determine whether it could be causing the pain.  I felt no relief.  After that, this doctor essentially stopped working with me because I'm pretty sure he was out of ideas on what to do next.  I returned to my original orthopedic doctor who recommended a nerve conduction study/EMG.  Results of the EMG revealed "slight" S1 nerve root irritation.  I was so excited because it was the first thing that identified anything wrong.  I followed that EMG with 3 subsequent S1 nerve root injections, all 3 of which did not help the pain.  I was unbelievably frustrated.  The neurologist who did my nerve conduction study referred me for another low back MRI, which of course was normal.  During this time, I was doing my second round of PT which was not helping at all, and my PT essentially told me after several months that he felt he was wasting my time because nothing was working.  All of this time, I had been on tramadol 6 times a day, plus advil and tylenol.  Months later, I decided to see a hip surgeon as a last ditch effort.  He gave me a hip joint injection which didn't do anything significant.  The hip surgeon also did a standing x-ray, which revealed irritation/calcification in my hip joint and an extra bump on my femur that he believed was causing a tear in my hip cartilage.  He was also convinced that my butt pain sounded like piriformis syndrome.  I was scheduled for arthroscopic surgery to correct my hip impingement and to examine my sciatic nerve in my upper leg/butt area and remove any impingements there may have been.  I did not take this surgery lightly, but at this point I had been in 24/7 pain for over a year.  The surgery was performed on December 21, 2015 and he shaved down the bump on my femur, fixed the tear in my hip cartilage, and looked at my sciatic nerve.  He said my nerve actually looked good, but he removed a fibrous band he saw just in case it was impinging the nerve.  It has been over 2 months since the surgery and I am worse than ever.  My sciatica is much more aggravated than it ever has been and hasn't calmed down at all, and my hip is still really hurting.  Obviously I know that there is a period of inflammation following any surgery, but I just don't feel that I'm moving in the right direction at all.  I am on tramadol 6 times per day, plus taking the maximum amount of tylenol and advil every 6 hours.  I'm so scared that all of this medication is going to ruin my body and stomach lining, as I've been taking it for over a year.  I'm only 31, am in good shape, and was active before all of this began.  I've tried chiro and acupuncture while healing, all of which makes the sciatic pain much worse.  Now I'm just sticking to my PT twice a week and trying not to aggravate it, but no matter what I do, the butt/hip pain is constant, and its starting to go into my leg and foot more than ever before, even when I've taken it completely easy with no exercise.  I've had 2 post-op appointments with my surgeon and he keeps telling me all this pain is normal and to just "take advil."  Umm hello, I'm on multiple pills a day, including tramadol, and it barely touches the pain.  

At this point, I feel that no one has nailed down the proper diagnosis.  With all of the intervention I have had, including 7 injections, 4 MRI's, 3 rounds of PT, chiro, 2 rounds of acupuncture, and now surgery, I'm still getting worse and not getting better.  I have been reading up on MR Neurography, which apparently is like an MRI that can examine nerves and find irritation.  I'm wondering whether this would be a good next move for me because perhaps it would identify once and for all where this pain is truly coming from.  It's so hard to know if its piriformis syndrome, hip issues, or spinal issues, when imaging won't confirm any of those (other than the hip cartilage tear).  Has anyone had anything similar to this kind of pain?  The pain is definitely the worst in my butt and is made significantly worse by sitting or standing for too long.  I sit on ice all day at work and home just to keep the pain manageable.  Also, has anyone had any experience with MR Neurography?  I'm curious about whether it would be helpful.  

Thank you all for reading my very long post!  I appreciate any input or recommendations.

*Denise* Over 2 years of chronic pain in right hip, buttock, lower back, and sometimes leg/foot. No definitive diagnoses for my sciatica despite numerous MRI's. Underwent arthroscopic labral repair surgery in 12/2015 which did not alleviate any pain. Trying to live a normal life!


  • SavageSavage United StatesPosts: 7,385
    Hello Denise.......
    I do not have similar experiences or knowledge of MR Neurography....
    I can hear your frustration and I'm sorry that you've not yet been helped.

    You are asking interesting questions.
    I will be looking forward to reading responses to your post and also how you are doing as you move forward.

    I wish you the best! And also with your decision making process!

    It seems you've been a member for awhile, so maybe just a reminder that the search on site, upper right on page may be helpful to you.
    Honorary Spine-Health Moderator
    Please read my medical history at: Medical History

  • MarWinMarWin OhioPosts: 688
    I had sciatica for over two years. Tried all kinds of therapies, except for surgery. Nothing worked. I'm not a doctor, nor am I giving medical advice or a diagnosis. I'm just a sciatica sufferer giving my experience:). My take is that regardless of so-called "piriformis syndrome" or herniated disc, whatever the reason for sicatica, it all hurts and there has to be a root cause. 

    Since the piriformis is a muscle, and if that is what's putting pressure on the nerve then you might deduce that the muscle is inflammed, yes? Further, if it's a herniated disc putting pressure on the nerve then you might deduce the vertebrae are pinching the disc making it bulge and hence putting pressure on the nerve, yes? My Chiropractor explained to me that the only reason a disc would bulge/herniate is due to the vertebrae being out of alignment or pinching it. 

    In the later scenario (herniation) you'd have to ask "why are the vertebrae pinching the discs? So I figured, and asked myself, "what's holding the vertebrae in line and helping the disc to keep them correctly spaced?". "What makes the body able to support its own weight? Gives it the ability to move?" 

    In both scenario's I think, and found, that the answer was obvious and the same. When I applied the principles and techniques of a therapy called Postural Alignment Therapy is when I realized the best answer for me. 

    I'm not declaring that anyone not use meds or not undergo surgery. Only stating what I found that works for me and hope it gives someone else hope for their situation. It's a tough decision for anyone and I wish you all the best. In the end you'll do what's right for you. Keep looking. There's an answer for ya! :)  
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