Botulinum Toxin Treatment of Pain Disorders2022

Piriformis syndrome (PS) is characterized by pain in the buttocks, exacerbated by long periods of sitting. It is believed that in most cases, the cause of pain is the pressure from piriformis muscle upon nearby sciatic nerve (or one of its major divisions). The sciatic entrapment is usually at the level of ischial tuberosity. Current treatments of PS consist of stretching exercises, deep tissue massage, physical therapy, oral analgesic medications, as well as anesthetic or steroid injections; these approaches are only partially effective. Three published double-blind, placebo-controlled studies strongly support the efficacy of botulinumtoxinA injections 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 botulinumtoxin (RimaB) is also effective. Botulinum neurotoxins provide a safe and effective treatment for relief of pain in piriformis syndrome.