Chronic Buttock Pain: Causes, Treatments, and Expert Insights

Q: Chronic Buttock Pain: Causes, Treatments, and Expert Insights

Hello： 1. <br>If you have already undergone multiple ineffective treatments from other physicians and it is considered a complex case, it is not possible to diagnose and arrange treatment based solely on a few written words. <br>It is recommended to make an appointment and have t

Persistent pain in the buttocks that prevents sitting, standing, or lying down?

The patient has been experiencing severe pain in the buttocks (especially the right side) while sitting, standing, and lying down for a year.
This pain began shortly after undergoing arthroscopic surgery on the right knee in August of last year (the knee has since become more painful).
There are tender points localized near the ischial area of the buttocks and at the junction of the upper posterior thigh and the gluteal line, without radiating down to the lower thigh or calf (although there is numbness in the front of the left foot).
The patient often feels significant soreness in the lower back.
Currently, both pelvic and lumbar spine MRIs have been performed twice, and ultrasounds have failed to identify the cause.
The patient has received steroid injections five times, prolotherapy seven times, and lumbar nerve blocks four times, all without relief.
The patient has consulted orthopedic, rehabilitation, neurosurgery, and internal medicine specialists, but opinions vary.
The only medication that provides slight relief is Lyrica for neuropathic pain; NSAIDs and even tramadol have been ineffective.
The pain is so severe that the patient feels like jumping off a ledge.
Q1: What are the possible causes of buttock pain? Which specialties can treat it? Could the knee pain be causing compensatory issues? Is there a possibility of muscle spasm or calcification? Is it neuropathic pain? Are there minimally invasive surgical options for the gluteal muscles? Who would perform such procedures?
Q2: The patient has severe osteoporosis; could this be a contributing factor?

Peng Ren, 60~69 year old female. Ask Date: 2020/12/21

Dr. Lai Zhaokang reply Neurosurgery

Hello: 1.
If you have already undergone multiple ineffective treatments from other physicians and it is considered a complex case, it is not possible to diagnose and arrange treatment based solely on a few written words.
It is recommended to make an appointment and have the patient come in for a consultation, bringing relevant examination results from other facilities (such as MRI) for proper evaluation.
2.
General osteoporosis is an invisible killer.
Osteoporosis itself does not cause pain; it is the injuries, such as fractures, that result in pain.
Wishing you all the best.
// Dr.
Lai Chao-Kang, Neurosurgery.

Reply Date: 2020/12/21

More Info

Chronic buttock pain, particularly when localized to the right side, can be a complex issue with various potential causes. Given your history of knee surgery and the subsequent onset of pain, it is essential to consider several factors that may contribute to your symptoms.

Possible Causes of Chronic Buttock Pain
1. Post-Surgical Complications: After knee surgery, it is not uncommon for patients to experience referred pain or compensatory pain in other areas, including the hips and buttocks. This can occur due to altered gait mechanics or muscle imbalances that develop as a result of the surgery.

2. Muscle Strain or Injury: The gluteal muscles, which are located in the buttocks, can become strained or injured due to overuse, improper lifting, or prolonged sitting. This could lead to localized pain and tenderness in the area.

3. Sciatica: Compression or irritation of the sciatic nerve can cause pain that radiates from the lower back through the buttocks and down the leg. This condition can be exacerbated by herniated discs or spinal stenosis.

4. Piriformis Syndrome: This occurs when the piriformis muscle, located in the buttock region, spasms and compresses the sciatic nerve, leading to pain in the buttocks and potentially down the leg.

5. Bursitis: Inflammation of the bursae (small fluid-filled sacs that cushion bones) in the hip can lead to pain in the buttock area, especially when sitting or lying down.

6. Nerve Entrapment: Conditions such as tarsal tunnel syndrome or other forms of nerve entrapment can lead to pain and numbness in the buttocks and legs.

7. Bone Density Issues: Severe osteoporosis can lead to fractures or stress fractures in the pelvis or spine, which can manifest as chronic pain in the buttock area.

Recommended Specialists
Given the complexity of your symptoms and the treatments you have already undergone, it may be beneficial to consult with the following specialists:
- Orthopedic Surgeon: They can evaluate any structural issues related to your knee surgery and assess the alignment and function of your hips and pelvis.

- Physical Medicine and Rehabilitation (PM&R) Specialist: Also known as physiatrists, these doctors specialize in non-surgical treatments for musculoskeletal pain and can develop a comprehensive rehabilitation program.

- Neurologist: If nerve involvement is suspected, a neurologist can perform further evaluations to determine if there is any nerve damage or entrapment contributing to your pain.

- Pain Management Specialist: They can offer advanced pain management techniques, including nerve blocks or other interventional procedures.

Treatment Options
1. Physical Therapy: A tailored physical therapy program can help strengthen the muscles around the hip and buttock, improve flexibility, and correct any gait abnormalities.

2. Medications: While you have mentioned that NSAIDs and tramadol have been ineffective, other medications such as gabapentin or pregabalin (Lyrica) may provide relief for nerve-related pain.

3. Injections: Corticosteroid injections or nerve blocks can help reduce inflammation and pain in specific areas.

4. Surgery: If conservative treatments fail and a specific structural issue is identified, surgical options may be considered, such as decompression of the sciatic nerve or repair of any damaged structures.

5. Lifestyle Modifications: Weight management, ergonomic adjustments at work, and regular low-impact exercise can help alleviate symptoms.

Conclusion
Chronic buttock pain can stem from various causes, especially following knee surgery. It is crucial to work closely with healthcare professionals to identify the underlying issue and develop an effective treatment plan. Given your history of severe osteoporosis, it is also essential to manage this condition to prevent further complications. Regular follow-ups and a multidisciplinary approach will be key in addressing your pain and improving your quality of life.

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