Piriformis muscle pain syndrome: the myths and reality

Abstract

Issues of diagnosis, effective treatment and prevention of chronic pain syndromes represent an urgent problem of modern medicine. About 80% of the population has experienced low back pain (LBP) at least once in their life; in 20% of patients acute LBP becomes chronic. Pain in the gluteal region with radiation to the leg can be caused by damage to various structures (joints, ligaments, deep muscles of the gluteal region, spinal roots), which are closely located and have similar innervation. The article presents a clinical case that illustrates the difficulties of diagnosing deep pain syndrome in the gluteal region in a young athlete. The condition, which was initially considered as myofascial pain syndrome of the piriformis muscle, upon detailed examination and observation turned out to be a rheumatological pathology (Bechterew’s disease). The article discusses the etiology, diagnostic criteria, differential diagnosis and treatment of piriformis muscle syndrome. There are currently no reliable diagnostic tests or validated diagnostic criteria to confirm the diagnosis, and therefore piriformis syndrome should be considered a diagnosis of exclusion. In clinical practice, there is both overdiagnosis of piriformis muscle syndrome with the widespread use of various invasive procedures, and ignorance of this syndrome. In most cases, secondary piriformis syndrome is observed and identification of the causative factor is decisive for the successful treatment of patients. Treatment of piriformis muscle syndrome should include the elimination of provoking factors, kinesiotherapy, NSAIDs, muscle relaxants, and, if indicated, therapeutic blockades, and for chronic pain syndrome, cognitive behavioral therapy and antidepressants. Nimesulide is a NSAID with proven effectiveness and a good safety profile, and therefore can be recommended for the treatment of both musculoskeletal pathologies and symptomatic treatment of rheumatological diseases.