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TREATMENT:
 It is multimodality requiring a team approach. The goal is to take care of pain, to treat some of
the associated problems like muscle spasm, emotional problems including insomnia and
depression.
Pain management – non steroidal anti-inflammatory (NSAID) are of limited value with temporary control of pain. Also, physical therapy with use of ultrasound, TENS unit and
local heat to control pain offers only temporary relief. We have achieved good success with
strategically placed series of three (3) steroids mixed with local anesthetic injections given
two (2) weeks apart. We give these shots in the Pain Clinic with IV sedation.
Emotional and stress management – It is an important part of the treatment of chronic
pain. It addresses the vicious cycle and patients learn to cope with pain.Idealy it is better
to refer these patients to a psychologist or psychiatrist; however, due to the stigma
associated in seeing a psychiatrist majority of our patients refuse to see one. We have
taken a different approach and start questioning about their sleeping habits and
emphasize how important is sleep to the human body. Surprisingly, the majority of these
patients do take anti-anxiety and anti-depressant even though we mention the word
anti-depressant. These patients are extremely happy when they come back for the return
visit that they elected to take these medications.
Recently during the past year we have started using a newer drug called Lyrica
(pregabalin). This medication is believed to reduce the number of electrical signals in
damaged nerves. They can help you feel less pain. This drug has recently been released
by the FDA for the use of fibromyalgia which is somewhat similar to POPSS syndrome.
Steroid injections, anti-anxiety/anti-depressants and pregabalin are started simultaneously
and seem to compliment each other’s action and have additive effects.
To prevent future flares up we recommend physical therapy and we have found it to be
very useful. Very few physical therapists are specialized in pelvic muscle and core muscle
therapy and have knowledge of paradoxical relaxation and trigger point release treatment.
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