Clinical Experience
Treatment at first was simply physical therapy, informed and enriched by the
generous
giving forth of experience from the international medical community. In essence,
the
therapy lengthened the piriformis muscle, reducing spasm and pressure on the
descending
sciatic nerve, and giving the nerve enough slack to remove itself from harm's
way. See
the rest of the website for the specific program. The therapy was helpful, but
progress
was slow. On the suggestion of Dr. Janet Travell, we began injecting
Triamcinolone
Acetonide 20mg with 1.5cc of 2% lidocaine into the motor point of the piriformis
muscle,
just medial to its musculotendinous junction in the lateral buttock.

This had only rare minor and transient side-effects on non-diabetics, and
shortened
the recovery time considerably.

On average 10.2 month followup time of 1014 cases of piriformis syndrome, more
than
hat these patients had suffered from piriformis syndrome for an average of 6.2
years,


Probably due to piriformis syndrome being considered a diagnosis of exclusion,
other,
less important diagnostic entities had received undue attention in these
patients.
Among these1014 cases there had been over 400 spinal, trochanteric and
gynecological
surgeries, none of which was definitive, more than 1500 imaging studies, of
which less
than 1/5 were relevant, and more than 10,000 appointments with clinicians for
diagnostics,
epidurals, physical therapy, and alternative methods of pain relief.

More recently we have conducted several IRB-approved studies of more specific
nerve
blocks, using the toxin of the botulinum bacterium. In the latest and most
successful
of these, we have found that 12,500 units of botulinum B toxin has well above
85%
efficacy, and fewer side effects than Triamcinolone and Lidocaine, giving more
relief
faster, and appearing in early studies to last longer. Containing no steroid,
this
preparation is also suitable for diabetics. Showing a much more rapid decline in
pain
levels, and normalization of the FAIR-test, it obviates physical therapy
sessions that
surpass the cost of the injection.

In summary, there are four reasons that botulinum toxin helps in the treatment
of
piriformis syndrome.

A reliable correlation between diagnosis and effective treatment exists.
More than 5,000,000 currently improperly treated patients will continue to
suffer, and
continue to consume health care resources in vain unless and until adequate
treatment
is afforded them. In clinical experience, injection of botulinum toxin has
proven the
most effective treatment.

Cost-benefit analysis of current data strongly supports injection of botulinum
toxin
in the treatment of piriformis syndrome.
Two other considerations are relevant:

Wider applicability. While the anti-insulinemic effect of steroids strongly
contraindicates
their use in diabetic patients, there are virtually no documented allergic
reactions to
botulinum toxins.

Longer efficacy. Steroid injection without physical therapy is generally
effective for
1-3 weeks. Botulinum toxin injections without physical therapy are effective for
at
least three months. In the past, approximately 15% of patients treated without
botulinum
toxin injections have had recurrence of piriformis syndrome within three years.
As of
today, (14 months after our first injection) we have seen 3 relapses following
botulinum
toxin injections in 61 patients.

A Patients Success Story: Link
Cindy W., IT manager from NC.

Successful ADR, but I was still completely disabled.

The first time I met Mark was on September 19, 2002. We were in the waiting
room at
the Alpha Klinik and we both had surgery scheduled for the next day. After we
chatted
for a while, I realized that I was speaking to someone who had written a great
deal on
the internet about his research into ADR. I said, "Oh my gosh, you are
RumorSlayer!
I used to look for you online. I'd call my husband over. Ed, Ed, he's here
again!!!
Come read this!"

I was in Munich for surgery because I had disabling back pain, hip pain and foot
pain.
I was very relieved after my discogram because it so clearly reproduced all my
pain.
That made me an excellent candidate and gave me every reason to be hopeful.

My first week post-op was incredible. I felt sorry for Mark because he was
having such
a tough post-op experience, while I was walking many miles a day and sightseeing
around
Munich just 5 or 6 days after my surgery. I knew just a few days after my
surgery that
my back pain and my foot pain were GONE!

Fast forward about a year and Mark's in great shape, but I was still
functionally disabled.
Although my disc replacement solved my back and foot pain, my disabling hip pain
still had
me unable to function. I was still on large doses of OxyContin. I'd been to
doctor after
doctor, but none of them had any good ideas. I had been referred to pain
management.
I was ready to give up.

One day Mark called me up and told me about someone he met on the Internet forum
he'd
started for people who want to discuss non-fusion technologies. He told me that
I there
was a man he'd spoken with, who described disabling hip pain EXACTLY like I
described mine.
I took Mark's advice and called Brian. Brian had a similar story, but had found
his way to
a Dr. in Cincinnatti who specialized in Piriformis syndrome. I called the Dr.
but he warned
me that Piriformis syndrome is very rare and that I shouldn't get my hopes up.

Fast forward another 6 or 7 months! It turned out that I had profound PS. Out
of 80 cases
this doctor had seen, he said that my case was certainly one of the worst. I
had the
piriformis release surgery in October of 2003 and by mid-2004, I was riding my
mountain
bike with my husband, camping, hiking, working full time, back to a rewarding
workout
regimen (I was an athlete before my disability). I can't believe it, I'm living
a NORMAL
LIFE! I was ready to give up. I don't know where I'd be now if it wasn't for
Mark and
his Patient Network. I suppose that I'd still be in pain management, on large
doses of
opiates and completely disabled. Instead, I have a new lease on life and can
live every
day to the fullest. With the perspective that you gain from being reborn after
such a
painful disability, life is even better than it was before I could truly
appreciate what
it means to enjoy a day without pain!

Thanks
I copied it for you from this web page:
http://www.spyhunter007.com/spy_medical_records3.htm

I like reading stories from people who are back to normal and not just getting
by...

And it seems botox is the second best thing before a surgery up to now.



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