Tuesday, July 22, 2008

Who's the pain in the butt here?

My patient has a pain in the butt. Not 'is a' mind you, but 'has a'. I've never seen anything like it. Her sit bones (ischial tuberosities) are painful to sit upon. She's o.k. with standing or lying, but her sitting hours are intolerably painful so, therefore, seriously curtailed.

I didn't know what to do with her (my father's advice from my childhood regarding things medical that were problematic --"Don't look at it for three days and it will go away"-- didn't work). Ibuprofen and such made no difference. I had to send her to a specialist, and believe me, it was hard to know just what specialist to use.

The orthopedist ordered an MRI of her butt. It showed minimal inflammation of the spot where the hamstrings insert onto the butt bones, but treatment for tendonitis, including cortisone injections, was useless. The neurologist was clueless, the physical therapist energetic but likewise without results.

We finally sent her to a pain management specialist. If you can't beat it, treat it. She was frantic to travel (out of the question) or simply to read a book in the seated position (if you're like her, reading while lying down is a recipe for sleep).

He listened to her story. Don't know if he examined her butt. He suggested Tylenol (heavens, Doc, been there/tried that already!). When she asked him what else could she do to once again achieve comfort in her life, he answered "Just stand up!"

I kid you not, that's what our pain specialist recommended.


Ruth said...

Chronic pain is a tough problem and getting down to the pain trigger is like solving a mystery. I review my patient's use of chairs, mattresses, pillows, positions they are in for work, posture etc before applying any local treatment. I think the "three day" advice is excellent but sometimes it takes 3-6-9 months and the pain just resolves. I wonder what the specialist billed for his advice!?

kenju said...

I'm not surprised. Could her pain be related to sciatica, or is that ruled out because it is bi-lateral?

JeanMac said...

Feel for her. Wonder if she responded to her "pain specialist" or bit her tongue?
I have aches and pains but have never heard of this scenario.

Cilicious said...

I've had a couple unexplained aches and pains that did go away by themselves after months, but they were not in such an awkward location.
I really feel sorry for that lady.
Great post title, too.

Mauigirl said...

Reminds me of the old joke,,,"Doc, it hurts when I do this!" "So don't do it!"

The poor woman. I hope she goes for another opinion from a better pain specialist!