Abstract
Piriformis syndrome is characterized by chronic buttock pain exacerbated by long periods of sitting. It is believed to be due to the irritation of nearby sciatic nerve (or one of its major divisions) by a tense and overactive piriformis muscle. Current treatments consist of stretching exercises, oral medications, and anesthetic or steroid injections; these approaches are only partially effective. Two double-blind, placebo-controlled studies have strongly supported the efficacy of onabotulinumtoxinA in management of piriformis syndrome. Two comparator studies favored onabotulinumtoxinA and abobotulinumtoxinA treatment over steroid injections in respect to both pain relief and duration of relief in piriformis syndrome. Limited open studies suggest that type B toxin (rimaB) is also effective. Botulinum neurotoxins provide a safe and effective treatment for relief of pain in piriformis syndrome.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Beatty RA. The piriformis muscle syndrome: a simple diagnostic maneuver. Neurosurgery. 1994;34:512–4.
Campbell WW, Landau ME. Controversial entrapment neuropathies. Neurosurg Clin N Am. 2008;19:597–608.
Childers MK, Wilson DJ, Gnatz SM, Conway RR, Sherman AK, Childers MK, Wilson DJ, Gnatz SM, Conway RR, Sherman AK. Botulinum toxin type A use in piriformis muscle syndrome: a pilot study. Am J Phys Med Rehabil. 2002;81:751–9.
Durrani Z, Winnie AP. Piriformis muscle syndrome: an underdiagnosed cause of sciatica. J Pain Symptom Manag. 1991;6:374–9.
Fanucci E, Masala S, Sodani G, Varruciu V, Romagnoli A, Squillaci E, et al. CT-guided injection of botulinic toxin for percutaneous therapy of piriformis muscle syndrome with preliminary MRI results about denervative process. Eur Radiol. 2001;11:2543–8.
Fishman LM, Anderson C, Rosner B. BOTOX and physical therapy in the treatment of piriformis syndrome. Am J Phys Med Rehabil. 2002a;81:936–42.
Fishman LM, Dombi GW, Michaelsen C, et al. Piriformis syndrome: diagnosis, treatment, and outcome – a 10-year study. Arch Phys Med Rehabil. 2002b;83:295–301.
Fishman LM, Konnoth C, Rozner B. Botulinum neurotoxin type B and physical therapy in the treatment of piriformis syndrome: a dose-finding study. J Phys Med Rehabil. 2004;83:42–50.
Gulledge BM, Marcellin-Little DJ, Levine D, Tillman L, Harrysson OL, Osborne JA, Baxter B. Comparison of two stretching methods and optimization of stretching protocol for the piriformis muscle. Med Eng Phys. 2014;36:212–8.
Hallin RP. Sciatic pain and the piriformis muscle. Postgrad Med. 1983;74:69–72.
Hopayian K, Song F, Riera R, Sambandan S. The clinical features of the piriformis syndrome: a systematic review. Eur Spine J. 2010;19:2095–109.
Jankovic D, Peng P, van Zundert A. Brief review: piriformis syndrome: etiology, diagnosis, and management. Can J Anaesth. 2013;60:1003–12.
Kirschner JS, Foye PM, Cole JL. Piriformis syndrome, diagnosis and treatment. Muscle Nerve. 2009;40:10–8.
Lang AM. Botulinum toxin type B in piriformis syndrome. Am J Phys Med Rehabil. 2004;83:198–202.
Marino MJ, Terashima T, Steinauer JJ, Eddinger KA, Yaksh TL, Xu Q. Botulinum toxin B in the sensory afferent: transmitter release, spinal activation, and pain behavior. Pain. 2014;155:674–84.
Michel F, Decavel P, Toussirot E, Tatu L, Aleton E, Monnier G, Garbuio P, Parratte B. Piriformis muscle syndrome: diagnostic criteria and treatment of a monocentric series of 250 patients. Ann Phys Rehabil Med. 2013;56:371–83.
Mika J, Rojewska E, Makuch W, Korostynski M, Luvisetto S, Marinelli S, Pavone F, Przewlocka B. The effect of botulinum neurotoxin A on sciatic nerve injury-induced neuroimmunological changes in rat dorsal root ganglia and spinal cord. Neuroscience. 2011;175:358–66.
Miller TA, White KP, Ross DC, Miller TA(1), White KP, Ross DC. The diagnosis and management of Piriformis Syndrome: myths and facts. Can J Neurol Sci. 2012;39:577–83.
Natsis K, Totlis T, Konstantinidis GA, Paraskevas G, Piagkou M, Koebke J. Anatomical variations between the sciatic nerve and the piriformis muscle: a contribution to surgical anatomy in piriformis syndrome. Surg Radiol Anat. 2014;36:273–80.
Pace JB, Nagle D. Piriformis syndrome. West J Med. 1976;124:435–9.
Papadopoulos EC, Khan SN. Piriformis syndrome and low back pain: a new classification and review of the literature. Orthop Clin N Am. 2004;35:65–71.
Porta M. A comparative trial of botulinum toxin type A and methylprednisolone for the treatment of myofascial pain syndrome and pain from chronic muscle spasm. Pain. 2000;85:101–5.
Robinson DR. Piriformis syndrome in relation to sciatic pain. Am J Surg. 1947;73:355–8.
Rodrigue T, Hardy RW. Diagnosis and treatment of piriformis syndrome. Neurosurg Clin N Am. 2001;12:311–9.
Stewart JD. The piriformis syndrome is overdiagnosed. Muscle Nerve. 2003;28:644–6.
Tiel RL. Piriformis and related entrapment syndromes: myth & fallacy. Neurosurg Clin N Am. 2008;19:623–7.
Welch MJ, Purkiss JR, Foster KA. Sensitivity of embryonic rat dorsal root ganglia neurons to Clostridium botulinum neurotoxins. Toxicon. 2000;38:245–58.
Yoon SJ, Ho J, Kang HY, Lee SH, Kim KI, Shin WG, Oh JM. Low-dose botulinum toxin type A for the treatment of refractory piriformis syndrome. Pharmacotherapy. 2007;27:657–65.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer Science+Business Media New York
About this chapter
Cite this chapter
Jabbari, B. (2015). Botulinum Toxin Treatment of Piriformis Syndrome. In: Botulinum Toxin Treatment of Pain Disorders. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2501-8_7
Download citation
DOI: https://doi.org/10.1007/978-1-4939-2501-8_7
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4939-2500-1
Online ISBN: 978-1-4939-2501-8
eBook Packages: MedicineMedicine (R0)