Background:
Piriformis syndrome (PS) is a painful musculoskeletal condition characterized by a deep gluteal
pain that may radiate to the posterior thigh and leg. This study was designed to compare the effectiveness of
ozone and BTX to
lidocaine injection in treating
piriformis syndrome that was resistant to medication and/or
physical therapy. Study design: Between November 2018 and August 2019, we involved eighty-four subjects diagnosed with
piriformis syndrome in a double-blinded, prospective, randomized comparative study to receive an ultrasound-guided injection of
lidocaine (control group),
botulinum toxin A, or local
ozone (28 patients each group) in the belly of the piriformis muscle.
Pain condition evaluated by the visual analog score (VAS) was used as a primary outcome, and the Oswestry Disability Index (ODI) as a secondary outcome, before, at one month, two months, three months, and six months following the injection. Results: The majority (58.3%) of patients were male, while (41.7%) were female. At one month, a highly significant decrease occurred in VAS and ODI in the
lidocaine and
ozone groups compared to the
botulinum toxin group (p < 0.001). At six months, there was a highly significant decrease in VAS and ODI in the
botulinum toxin group compared to the
lidocaine and
ozone groups (p < 0.001). Conclusion:
Botulinum toxin may assist in the medium- and long-term management of
piriformis syndrome, while
lidocaine injection and
ozone therapy may help short-term treatment in patients not responding to
conservative treatment and physiotherapy.