Chronic Buttock Pain: Causes, Treatments, and Medication Concerns

Persistent pain in the buttocks that makes it difficult to sit, stand, or lie down?

Q1: What are the possible causes of buttock pain? Which specialties can treat it? Who should I consult?
Q2: Is it CRPS (Complex Regional Pain Syndrome)? Can stellate ganglion block be used? (There are none available in Hsinchu.) I also have severe osteoporosis.
Over the past year, I have primarily taken pregabalin (Lyrica), clonazepam (Rivotril), acetaminophen (Tylenol), and even tramadol.
I have also used chlorzoxazone for muscle relaxation and imipramine HCL.
Additionally, I have taken alprazolam (Xanax) and NSAIDs like celecoxib (Celebrex).
Q3: Which of the above medications could cause or worsen osteoporosis? I am quite concerned.
Thank you.

Peng Ren, 60~69 year old female. Ask Date: 2020/11/26

Dr. Huang Baiqing reply Anesthesiology

1.
For your symptoms and discomfort, if you are seeking a potential cure, it is recommended to consult with specialists in neurosurgery or orthopedics.
If surgical intervention is not possible or if you are dealing with stubborn chronic pain or neuropathic conditions that cannot be cured, you may consider seeking relief through pain management, rehabilitation, or neurology specialists.
2.
Osteoporosis is not within the expertise of anesthesiology; please consult an orthopedic physician regarding this issue.
Thank you for your understanding if there are any omissions.

Reply Date: 2020/11/26

More Info

Chronic buttock pain can be a debilitating condition that significantly impacts daily life. Understanding the potential causes, treatment options, and medication concerns is crucial for effective management.

Q1: Possible Causes of Buttock Pain and Relevant Specialists
Buttock pain can arise from various underlying conditions. Some common causes include:
1. Sciatica: Compression of the sciatic nerve can lead to pain radiating from the lower back through the buttocks and down the legs.

2. Piriformis Syndrome: The piriformis muscle, located in the buttock region, can irritate the sciatic nerve, causing pain.

3. Herniated Disc: A herniated disc in the lumbar spine can lead to nerve compression, resulting in buttock pain.

4. Bursitis: Inflammation of the bursae (small fluid-filled sacs) in the hip area can cause localized pain.

5. Muscle Strain: Overuse or injury to the muscles in the buttock can lead to pain and discomfort.

6. Arthritis: Conditions like osteoarthritis can affect the hip joint, leading to referred pain in the buttock area.

7. Referred Pain: Conditions affecting the lower back, pelvis, or even the abdomen can manifest as buttock pain.

Given the complexity of your symptoms and the lack of definitive findings from imaging studies, it is advisable to consult with specialists such as:
- Orthopedic Surgeons: They can evaluate structural issues in the spine and pelvis.

- Pain Management Specialists: They focus on chronic pain conditions and can offer various interventional treatments.

- Neurologists: If nerve involvement is suspected, a neurologist can help assess and manage nerve-related issues.

- Physical Medicine and Rehabilitation (PM&R) Specialists: They can provide rehabilitation strategies and non-surgical management options.

Q2: Is it CRPS? Can Stellate Ganglion Block be Used?
Complex Regional Pain Syndrome (CRPS) is a chronic pain condition often following an injury. It is characterized by prolonged pain and changes in skin color, temperature, and swelling. Given your description, it may not fit the typical presentation of CRPS, especially since you have not reported the hallmark symptoms associated with it.

Stellate ganglion blocks are primarily used to manage pain in the upper extremities and are less commonly indicated for buttock pain. However, if there is a sympathetic component to your pain, a pain management specialist may consider this option.

Q3: Medication Concerns and Osteoporosis
You mentioned using several medications, including pregabalin (Lyrica), clonazepam, acetaminophen, tramadol, chlorzoxazone, imipramine, alprazolam, and NSAIDs like celecoxib. Here’s how these medications relate to osteoporosis:
- Pregabalin and Clonazepam: These medications are not directly linked to bone density loss, but long-term use of benzodiazepines (like clonazepam) can increase the risk of falls, which is a concern for individuals with osteoporosis.

- Tramadol: While it is primarily a pain reliever, there is no strong evidence linking tramadol to osteoporosis.

- NSAIDs: Chronic use of NSAIDs can potentially affect bone healing and may have indirect effects on bone density, but they are not typically associated with significant bone loss.

- Imipramine: Some studies suggest that certain antidepressants may have a negative impact on bone density, but the evidence is not conclusive.

- Chlorzoxazone: Muscle relaxants generally do not have a direct effect on bone density.

Given your concern about osteoporosis, it is essential to discuss your medication regimen with your healthcare provider. They may recommend bone density testing and consider alternatives that have a more favorable profile regarding bone health.

Conclusion
Chronic buttock pain can stem from various causes, and a multidisciplinary approach involving different specialists may be necessary for effective management. Understanding the potential risks associated with your medications, especially concerning osteoporosis, is crucial. Regular follow-ups and open communication with your healthcare team will help tailor a treatment plan that addresses both your pain and overall health concerns.

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