I have been suffering with piriformus syndrome for the last year and the pain is excruciating. I have had several (over 8) injections of steroid, lidocaine and one of toradol. All of these injections have been done either under xtay in the hospital or under ultrasound in my Dr.’s office. Thay have not given much relief so i inquired about botox about 8 months ago. So i was referred to another Dr. In the same practice. I met with him 4 weeks ago and he thought i might get some relief with the botox. I was scheduled today and went in this morning. This Dr. Was going to have me lay on the table and give me a botox injection in my piriformus muscle. I asked how he was going to find it. He said by pushing to see where it hurt and then inject into the pirifomus till i told him where i feel the muscle jump. I told him i cannot tell by pushing on it. It doesnt hurt like that. Well he assures me that it takes skill to do these injections and he knows where the pirifomus muscle is. He left the room to mix my botox shot and i got even more nervous thinking to myself this is wrong. How is he going to be sure he’s injecting the right place and with botox of all things! When he came back i was almost in tears. I said im not so sure about doing this without ultrasound. I felt like an idiot and i was wasting his time. I apologized and said i would be more comfortable under ultrasound. He said he doesnt do ultrasound. So i decided to wait for the injection even though im in terrible pain. He said he would put my mixed needle in the fridge for next week so my other Dr. Can do it under ultrasound. My other Dr. Doesnt do botox injections so i dont know what will happen. This Dr. I saw today said that my original dr. Will give me a trigger point injection and i said ok but with the botox right? He said it doesnt matter whats in the needle. I said well ive been waiting for this botox for 8 months and of course it matters whats in the needle! Ive tried all the steroid and lidocaine etc and i want the botox to help ease my pain. He made me feel stupid. I know im not a dr but i believe that i made the right decision to not just let this man stick a needle full of botox in my butt without a 100% guarantee that it is in fact going in my piriformus muscle. I have no ides what he wrote in my file but he said that he agreed i shouldnt get the shot. Now i dont know if i insulted his intelligence by actions and words. So i have 2 questions for you #1 Do you think i made the right decision? And #2 will this mixed botox needle be ok in the fridge for a week till i can have the injection under ultrasound? Please respond to me. I am desperate and in pain and now im afraid that this Dr. Put some thing in my file that im paranoid or anxiety ridden. I was nervous today. I always am. I dont like needles. But i felt very torn today because i want that shot!
Early trials of intra-articular corticosteroids showed equal systemic absorption of methylprednisolone in patients with rheumatic and osteoarthritic hands 42 and knees. 43 This suggests that steroid pharmacokinetics, rather than disease-related factors, should guide steroid selection. A recent review by the National Health Service of the United Kingdom 44 recommends triamcino-lone and methylprednisolone as preferred agents for injection of large joints (., knee). For smaller joints (., finger), either hydrocortisone or methylprednisolone (Hydeltrasol, brand no longer available in the United States) is recommended. Tables 5 and 6 45 compare commonly available steroid preparations.
Systemic corticosteroids can reactivate tuberculosis and should not be used in patients with a history of active tuberculosis, except when chemoprophylaxis is instituted concomitantly. The incidence or course of acute bacterial infection are probably minimally affected by inhaled triamcinolone. Application of topical corticosteroids to areas of infection, including tuberculosis of the skin, should be initiated or continued only if the appropriate antiinfective treatment is instituted. If the infection does not respond to the antimicrobial therapy, the concurrent use of the topical corticosteroid should be discontinued until the infection is controlled.