Chronic, severe right buttock pain when sitting

I'm a 39 year old male. I was very active prior to the chronic pain. I'm at my wits end. My anxiety and depression are at at their worst. I'm now in psychotherapy, but I don't think one hour a week of talking about how my pain is degrading my mental capacity is helping me. I'm not criticizing therapy, it's just not helping me.

My pain is in my right buttock and sometimes in my right hamstring.

I wake up everyday at a 2/3 on the pain scale. Driving and sitting in my office chair cause my pain to rapidly increase from a 2/3 to an 8/9. When I say rapidly I mean 10 to 30 minutes. of driving or sitting upright. My right butt muscles spasm randomly every day from one spasm to multiple spasms lasting anywhere from 1 to 10 seconds. The spasms do not trigger painful sensations.

Imaging
Over the last 3 ½ years I’ve had several MRIs (with and without contrast) of my lower back, right hip and hemi-pelvis, x-rays of lumbar spine, ultrasound of ischial bursa area, and whole body bone scans. The latest MRI shows:

• L4-L5: minimal posterolateral disk bulges are identified bilaterally. There are no focal significant disk herniations or evidence of central canal stenosis. There is mild narrowing of the neural foramina bilaterally.
• L5-S1:  There is a small broad-based posterior central disk protrusion at this level. There is no evidence for compromise of central canal or nerve roots. There is no significant foraminal narrowing.

Treatments
Over the last 3 ½ years I’ve tried the following treatments, and have summarized each treatment’s effectiveness.

• Cold and Heat Therapy: Doesn’t relieve the pain.

• Piriformis stretching: Doesn’t relieve the pain.

• Core muscle strengthening: Doesn’t relieve the pain.

• Psoas muscle release: Doesn’t relieve the pain.

• Piriformis muscle release: Doesn’t relieve the pain.

• About 3 months of weekly Physical Therapy: Doesn’t relieve the pain.

• TENS unit: Delays the onset of the pain.

• Sitting on a 70cm exercise ball versus office chair: Doesn’t relieve the pain.

• Sitting on a FitBall disk on top of office chair: Doesn’t relieve the pain.

• Sitting on pillow on top of office chair: Doesn’t relieve the pain.

• About 1 year of weekly Chiropractic manipulation: Relieved the pain for two weeks after manipulation and taping of my arches. Provided me ortho inserts due to fallen arches proven by Gait scan. Since then the pain is worse.

• Acupuncture (3 visits): Doesn’t relieve the pain.

• CT-guided Epidural steroid injections: First injection relieved the pain for 6 months, second injection relieved the pain for 3 months and third injection relieved the pain for 2 weeks.

• CT-guided Ischial bursa injection: Doesn’t relieve the pain.

• CT-guided Piriformis injections (steroid and Botox): First steroid injection relieved the pain for a couple of months; second steroid injection relieved the pain for 2 weeks. Botox injection doesn’t relieve the pain.

•                RF Ablations of T-11 through L3 twice with 3 month periods (Sept 5 and Dec 2, 2011), Doesn’t relieve the pain

•                3 years and 3 different chiropractors, and no relief from the pain


Pain Management

• Ibuprofen/Aleve/Tylenol: Doesn’t relieve the pain. Took Ibuprofen almost every day for 1 year and ended up with Gastritis. I stopped taking NSAIDs. I cured my Gastritis by drinking Aloe Vera Gel over a 3-week period.

• Darvocet 10MG: Decreased the pain by 1-2 points for 30 to 60 minutes.

• Hydrocodone/APAP 10MG: Decreased the pain by 2-3 points for 30 to 60 minutes.

• Oxycodone/APAP 10MG: Decreases the pain by 4-5 points for 1 to 1.5 hours.

• Lyrica: No change.

• Gabapenton: Couldn't tolerate.

• Topirimate: Only been taking it for one month, no change.

• Lidodoerm Patch: Just started wearing these five days ago. Doesn't relieve the pain.

• Baclofen: Stops the buttock muscle spasms but doesn not relieve the buttock and leg pain.

In summary, the only way for me to not have pain is to never stand up or sit up, or not in other words to not have a life.

Please help.

[sueduva]

Hi My name is Sue,
I am so sorry you are going through this chronic pain.

I don't think I can help you solve the problem, but I do understand what it is like to live in chronic pain. And I understand not getting relief from surgery or chiropractors.  

I do get pain relief from drugs, but they always give me so many side effects that I can't tolerate being on them! It is like a catch 22 you trade off pain to ruin your stomach. That also happened to me from taking Nsaids.

My chronic lower back pain and spasms started in my late 20's, with each pregnancy my L4 and L5 were moving out of place.  I really had no idea what was going on and was told it is normal to have back pain when you are pregnant! I have had a few back surgeries, and have had my s1,L5 and L4 fused.

I also ended up very depressed. Living in pain is miserable and depressing, but pain actually changes your brain chemistry! So I don't know if you are taking an antidepressant, but most people who live with chronic pain do need to take something.  I have found Effexor helpful, but everyones brain chemistry is different so you may have to try a few before you find one that works for you.

Please hang in there, I know it is horrible and most people really don't understand how chronic pain can take over your life.  So It is very difficult to get support from otherwise caring family and friends.

I was going to ask you if you have tried botox injections into the muscles that spasm.  But it sounds like you've gone down that path already.  I get injections once every 3 months.  It doesn't relieve the pain, but helps with the huge knots I was getting in my muscles. These knots were really annoying, but the regular botox injections have really helped.

Regular massages have helped relax my muscles too.  I've tried going to a chiropractor, and it didn't help at all. But a deep tissue massage seems to help keep my muscles relaxed, but I am still in chronic pain and need meds to dull the pain.

This chronic pain journey has been 20 years for me, I am still sane (most days)  I survived the depression (which I think is the worst part of chronic pain) and I have raised 3 children with my husband.

Yes I feel very left out when I can't dance, play tennis or go skiing with everyone else.  But I am thankful I am still here to enjoy life. I have had to change my priorities and expectations of life.  Don't get me wrong, I still feel ripped off by my body and sorry for myself :(

I too have tried many pain relief techniques, tens, acupuncture...
I have tried so many pain meds, and have become dependent on most of the opioid meds.  It sounds like you are trying so hard to find an answer,
and hopefully you will find one that works for you.

This is what I am doing right now to manage my chronic pain.
Tylenol 3's as needed, a muscle relaxant when needed, and medical marijuana when the pain becomes intolerable and to help me sleep at night.

It hurts me to stand and to walk for distances, so I use a wheelchair when I go out for the day.  I can pop into a grocery store for 15 minutes and walk.  But if the kids want to go shopping at the mall or we are doing a day out, I will use my wheelchair.  

The botox and deep tissue massages also help.  Swimming is the best exercise for me, I don't feel any pain :) and I feel free in the water.  I also use a heating pad everyday. And the heated seats in the car, make driving so much more comfortable.

You may not be able to fix your problem?  Then you need to look at managing your pain and discomfort.

I hope you can find some pain relief. I go for counselling on and off depending on how I am coping. It is always good to talk about your problems. So please don't give up.

Take care,
Sue

[groundhogday]

Thank you for your kind words Sue. I did try Botox. 100 units into the Piriformis but it did nothing for the pain. In the last 1,500 days the best I've ever felt was last Saturday and Sunday. I wore my Lidoderm patches and took my medications and didnt drive or sit in my office chair. I HAD NO PAIN AT ALL. I felt so good that I went to work Monday morning without my TENS unit. By noon on Monday I was practically in tears. I might as well not even have had the Lidoderm patch on.

For me, the catalyst seems to be sitting at an angle particular to sitting/driving. But what does this mean?  

[groundhogday]

I also forgot to metion that I had an SI joint injection as well but that didnt provide relief either.