How many people do you know who tell of back pain that has no cure? Or sciatica or leg pain than doctors cannot find the cause for. They tell you that the MRI scan was normal, back injections of steroids do not help and no medication has relieved their pain. There are tens of thousands of people with back pain and sciatica who never get the right diagnosis despite having several MRI scans and seeing numerous physicians. There is a high probability that these individuals suffer from a condition called piriformis syndrome. Unfortunately piriformis syndrome is frequently misdiagnosed as sciatica.

The piriformis muscle is a triangular shaped muscle that is in the middle of the buttocks. The base of the triangle attaches to the side of the sacrum (tailbone) and the tip attaches to the top of the femur (the major bone in the hip and leg.) An excellent piriformis diagram is found on the Institute for Nerve Medicine website. Injury or sprain to the piriformis muscle causes spasm, which in and of itself is painful. This can cause back pain and buttocks pain. Prolonged sitting will make the pain worse. Walking, climbing stairs or bending can be difficult and painful. The sciatic nerve comes out of the spine, exiting just below the piriformis muscle. In approximately 15% of individuals, the sciatic nerve pierces through the lower border of the piriformis muscle. It is these individuals who are predisposed to developing sciatica with injury to the piriformis muscle. Even without this, a strained, inflamed piriformis muscle will cause irritation to the sciatic nerve thereby causing sciatica.

There is no specific test, MRI or EMG findings in piriformis syndrome. It is a diagnosis made on the basis of getting the patient’s history, unique set of symptoms and detailed physical exam. Ordering an MRI of the back and getting an EMG will only help to exclude other causes of back pain and sciatica. Remember, just because you may have a “bulging disc” or “herniated disc” does not mean that this is causing your back pain or sciatica. Thirty percent of the general population have disc herniation on their MRI scans that are causing no symptoms. Therefore disc herniation does not equal back pain or sciatica Once the diagnosis is made, treatment should be started as soon as possible. The first is to educate the patient about the condition and identify activities that they are doing that irritate the piriformis muscle. Avoiding these activities and holding off on sports activities will help to stop straining the hip muscles. A set of stretching exercises for the back and hip muscles should be done twice daily to relieve the spasm, which will reduce the pain. Muscle Ventures has an excellent diagram and explanation of the piriformis stretch, even with a video.  With this stretching, an anti-inflammatory medication, such as ibuprofen or naproxen, can be taken to lessen the pain and treat the inflammation in the muscle, tendon and sciatic nerve. Physical therapy can have a part in treating piriformis syndrome. It takes a therapist familiar with the condition to effectively provide relief. This in combination with deep neuromuscular therapy in the buttocks region will also help. Injections into the piriformis muscle are rarely performed due to its close relationship to the sciatic nerve and risk of injury to the nerve. Surgery has been tried but it is a major procedure and the effectiveness of this remains in question.

In summary, piriformis syndrome is a condition of strain and injury to the muscle. The sciatic nerve runs immediately below or just exits through the lower piriformis muscle. When injury occurs to the piriformis muscle, the sciatic nerve becomes irritated. This causes lower back and buttocks pain with sciatica. Diagnostic tests can only help in excluding other causes of back and leg pain. Therapy for piriformis syndrome consists of daily stretching, antiinflammatory medication and physical therapy. Affected individuals should avoid activities that aggravate their back pain and sciatica. Healing time can be weeks to months.

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Namenda (memantine) is the newest medication used in the treatment of Alzheimer’s disease. New research has shown that Namenda may be effective in treating patients with both migraine and tension headaches. The study done by John Krusz, PhD, MD showed that some patients with chronic migraines that did not do well with other headache treatments, did well with Namenda therapy. Of the migraine sufferers, there was a 56% drop in the number of migraine attacks. In patients with tension headaches there was a 62% drop in the numbers of attacks. This study was well reviewed on the website, Help for Headaches and Migraines.

Migraine and other headaches are chronic medical conditions that require aggressive preventative treatment. Many therapies have been tried but no cure has been found. Botox treatment has been promoted by the press but no clinical studies have showed that it is superior in migraine treatment than placebo. Having said that, there are certainly patients that have had migraine and headache reduction after Botox therapy.

It is important to note that the use of Namenda, Botox and most other migraine treatments are off-label uses of these and other medications. The majority of medications routinely used in the prevention of migraines are off-label. This is the standard of care in most headache clinics. If you suffer from migraines that prevent you from routine activities or interfere with work, you need to seek out help from a qualified neurologist who specializes in migraine headache treatment.

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Neupro patches were approved by the FDA for Parkinson’s disease treatment in September 2007. They proved to be very effective in the control of Parkinson symptoms, as compared to the effects of other dopamine agonists including Mirapex and Requip. Unfortunately, in March, the FDA recalled Neupro due to problem with the patch delivery of the medications. What they found posed no imminent danger to patients. Rather what was happening was that the active drug, rotigotine, was crystallizing in the patch therefore not delivering the full dosage of medication to the patient. What would happen is that affected patients’ Parkinson symptoms would not be as well controlled. It is not clear if Neupro patches will be brought back to market as reported on Emaxhealth.

Dopamine agonists remain one of the main Parkinson treatment medication groups available to control Parkinson symptoms. These can be used as first line medications for early Parkinson’s disease, showing as good as an effect as Sinemet – the gold standard for treatment of Parkinson’s disease. Many feel that it is beneficial and studies have shown that starting early treatment with dopamine agonists can limit the long term side effects of starting Sinemet early. This is particularly true for delaying development of dyskinesia, which are involuntary movements of arms, legs and head. Dopamine agonists can also help to suppress tremor associated with Parkinson disease.

If you are still using Neupro patches, you should contact your treating neurologist or Parkinson specialist to get the weaning patches and titrate off this drug. Many other excellent treatments for Parkinson’s disease are available. For more information visit: Parkinson Doctor.

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