Good afternoon all. I have a query re occasional piriformis pain in my right buttock. I have had this on & off since being diagnosed with PMR & GCA in Nov 2018. At the beginning it was very very painful, but when it happens now, which thankfully isn’t too often, it’s more of a dull ache. I am currently on alternate days of 4 & 5 mg Prednisolone as per my rheumatologist’s suggestion, reducing gradually. I generally don’t have any of the other original symptoms of PMR. Does anyone know if this is related to PMR or a separate issue....which I have always assumed it was! The reason I’m asking now is that I’ve just spent the last 4 months, getting residency in Spain, packing up & selling my U.K. house & moving into a little bolt hole here until I can get back to Spain, so it’s been a pretty stressful time, doing it mostly on my own due to Covid restrictions! I’ve had a bit of downtime the last few days & thats when the ache came on, along with fatigue.
Sorry for the rambling post folks!
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Lyndaki
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Hi Lyndaki! I have had similar issues with my right buttock throughout my history of PMR... going on one year anniversary. I have repeatedly questioned my rheumatologist about this, and he stays firm that this is one of my symptoms involved with my PMR. Since it responds to prednisone increases and decreases, I tend to agree with him.
It is a nasty complication and I send my sympathies your way. I have found I have to monitor my activities carefully to prevent deep pain with this. I frequently use an infared heating pad to sit on when it begins to ache. Only recently I have felt I can do more movement without more pain. Hope you find this information helpful knowing someone else experiences this also.
I have a bit of bilateral glute pain, so I try not to sit for prolonged periods of time. I ordered a cushion, but it is not working very well. There are exercises you can do with a roller and a ball, so you may want to look into physio options to try to alleviate the pain. Good luck with the move; what a stressful situation, especially under the current circumstances. Vx
It is a part of myofascial pain syndrome which can exist on its own or it can be part of PMR. I have suffered with it for years but it has been more pronounced along with the PMR. One Australian group are catching up with central Europe where we have realised the part it plays in PMR for years!
It really doesn't like you lifting things, bending too much, even doing activities that require you to lean forwards slightly. Even carrying a heavy bag can start mine off. When I have an acute episode I take 800mg ibuprofen (what is called a flooding dose) and sit upright with a strategically positioned hot water bottle over the spasmed area for the following few days! I rarely (but occassionally) need more ibuprofen - the pain relief lasts a good 24 hours and by then the warmth has done the trick.
I am a regular customer at our local pain clinic - where they practice a form of needling using lignocaine which encourages the spasmed muscles to relax, I am coming to the end of a series of physio appointments where she has been doing manual mobilisation of the trigger points - the places where the muscles attach to the skeleton - and that also results in relaxation of the spasmed muscles. I gather the Leeds UK physios do similar treatments and also find acupuncture useful. I suspect acupuncture is a bit like marmite - it works and you like it or it doesn't.
Thanks. I have had physio & acupuncture in the past but was just wondering if it was related to the PMR. I take 2 Cocodamol if it’s really bad as I didn’t think you were supposed to take ibuprofen when on steroids? It’s not bad at the moment but just nagging now & then. With moving house & lifting lots of boxes, I’m not surprised it’s kicked off from what you say! 😂
Not recommended to take it regularly - but the antiinflammatory effect is also useful. I can't take codeine and paracetamol is useless. That's why I emphasised only needing the one flooding dose.
I've had right sided piriformis pain for years - my fabulous sports therapist (when I can actually see him - not so much lately becuase he isn't a physio) also works on trigger points all around the area and also frees up other areas that co tribute to the tightness.
Acupuncture plus Cupping works for me and I, luckily, get about 6 or 7 months pain free after 6 weekly sessions.
Remember, Joanna sent me there when I re-read your article on 'Myofascial Pain Syndrome and Piriformis Syndrome' published May 2016 and Bowen did zilch.
Extract:-
"Both myofascial pain syndrome (MPS) and piriformis syndrome (PS) are often found alongside PMR – I've written about it a lot on the forums in the past."
Yes, when I had my worst episode 2 years ago I had acupuncture which was amazing! At that point I didn’t associate it with my PMR as I hadn’t long been diagnosed & the pain was completely different to the original trouble....hips, arms & shoulders
Thank you. I was taking 600mg ibuprofen before being diagnosed with PMR which was a godsend! ....& that’s the normal pill size sold over the counter in Spain!!!
Really??? That is amazing! It was designed to be used with this flooding dose and then top-ups of 400mg but when it was released as an OTC drug in the UK they insisted on 200mg doses - which are useless and the company were NOT happy! One dose of 800mg does more and lasts longer than taking 200mg repeatedly. With only one irritation of the stomach... I always take it with food and lots of fluids.
I've had problems with the piriformis muscle in my left buttock where it seemed to have trapped the femoral nerve going round to the top of my thigh at the front.That caused me problems walking for about a year until my physio diagnosed the cause of the problem. Eventually, it has been cured by physio including having a tennis ball under my buttock in the offending area. It was a painful experience to say the least, but fortunately, all is well for now.
That’s exactly what I had originally! And at the time, being new to the whole PMR thing, didn’t associate them! I was in agony for ages. Thankfully after various physio & acupuncture treatments it got sorted, but it’s only reared its head again after the stress of moving.
Hi, your not on your own with this pain it's awful ! I suffered terribly with this on and off for a couple of years ! My Dr is lovely she explained exactly to me how this nerve works , the Pred gradually took over , I only suffer occasionally now .Btw I'm writing this sitting on my heat pad does wonders ! Chin up it will fade.😊
I would say that the Periformis discomfort is def connected to PMR, but can be stretched out with daily physio exercises completed at home. A similar situation existed for me and occasionally still does, but stretching out the Periformis helps massively. Good luck...
Hi LyndakiI have had piriformis syndrome on and off but I think mine is related to wfh and sitting in a bad chair. My neighbour, an excellent physio gave me exercises and I bet you can find some online. I take paracetamol and try to stretch and get out every day. It comes and goes. Good luck.
Hi Lyndaki, I have had the same issue, as well as others. I tested borderline for rheumatoid for many years. I finally tested positive with an RF33 after going off everything for 2 weeks. I guess it evolved! Keep an eye on your RF in case it is something other than PMR.
Also, as part of the rheumatoid, I have had tendinosis in various places. One of those places is the hamstrings where they meet the ischial tuberosities. This can cause sitting pain while driving or sitting in an office chair. I've had PRP injections there with some slight improvement, with hopefully more improvement to come. Some people may not recommend Tramadol for pain because it is a synthetic opioid, but it does help a great deal. I also have tested HLA b-27 positive, which has confounded doctors. My current rheumatologist is at Mayo, so I have to believe he knows what he's doing. Physical therapy may help, reducing stress will absolutely help, eat nutritiously, if you aren't already. I hope you figure it out. It can be a challenge.
It is associated with spondyloarthropathies - though it doesn't have to be - and they can present looking like PMR. The bone changes can be very elusive sometimes.
My sacroiliac pain is due to muscle spasm - doctors tend not to think muscles but I was lucky here with an orthopod and the pain clinic and physios do think that way.
In addition to the rheumy drugs, I'm taking Gabapentin, which helps with spasms. What a mess I've become. I used to be so fit and strong. This all hit around Menopause, and with a lot of job stress.
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