Terlemez Rana, Erçalık Tülay
Department of Physical Medicine and Rehabilitation, Health Sciences University, Şişli Hamidiye Etfal Hospital, Health Research and Application Center, İstanbul, Turkey.
Department of Algology, Health Sciences University, Şişli Hamidiye Etfal Hospital, Health Research and Application Center, İstanbul, Turkey.
Agri. 2019 Nov;31(4):178-182. doi: 10.14744/agri.2019.34735.
The aim of this study was to investigate the effect of a piriformis injection on neuropathic pain in patients with piriformis syndrome.
Thirty patients with unilateral hip and/or leg pain, a positive FAIR test (increased H-reflex latency with Flexion, Adduction and Internal Rotation), and a trigger point at the piriformis muscle were enrolled in this prospective study. All of the patients exhibited neuropathic pain scored according to the Douleur Neuropathique 4 (DN4) of ≥4 for at least 6 months. All of the patients received 4 mL of lidocaine 2%+1 mL of betamethazone to the piriformis muscle under the guidance of ultrasound. The Numeric Rating Scale (NRS), DN4, and the painDETECT (PD) questionnaire were used for outcome assessment.
A statistically significant improvement was seen in all scores (p<0.001) when both first week and first month results were compared with the baseline values. Comparison of the first week results with those of the first month revealed a statistically significant improvement in only the NRS and PD scores (p<0.001). The greatest improvement in all scores was seen in the first week after the injection. A mild increase was seen in all scores at the first month compared to the first week.
A piriformis injection was found to be effective for both somatic and neuropathic pain in piriformis syndrome patients. Long-term follow-up is needed in order to consider this option alongside other treatment alternatives, like botulinum toxin and myofascial release.
本研究旨在探讨梨状肌注射对梨状肌综合征患者神经性疼痛的影响。
30例单侧髋部和/或腿部疼痛、FAIR试验阳性（屈曲、内收和内旋时H反射潜伏期延长）且梨状肌有触发点的患者纳入本前瞻性研究。所有患者均表现为神经性疼痛，根据神经病理性疼痛4级量表（DN4）评分≥4，且持续至少6个月。所有患者在超声引导下接受向梨状肌注射4 mL 2%利多卡因+1 mL倍他米松。采用数字评定量表（NRS）、DN4和疼痛检测（PD）问卷进行疗效评估。
将第1周和第1个月的结果与基线值比较时，所有评分均有统计学显著改善（p<0.001）。第1周结果与第1个月结果比较显示，仅NRS和PD评分有统计学显著改善（p<0.001）。所有评分在注射后第1周改善最大。与第1周相比，第1个月时所有评分均有轻度升高。
发现梨状肌注射对梨状肌综合征患者的躯体性和神经性疼痛均有效。为了将该治疗方案与肉毒毒素和肌筋膜松解等其他治疗选择一起考虑，需要进行长期随访。
