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TREATMENT:
 Treatment is multimodal, requiring a team approach. The goal is to take care of pain while also treating mental and emotional difficulties, including insomnia and depression.
Pain management— Non-steroidal anti-inflammatory drugs (NSAIDs) are of limited value, offering only temporary pain control. Also, physical therapy with the use of ultrasound, transcutaneous electric nerve stimulator (TENS), and local heat application offers only temporary relief. We have achieved good success with a strategically placed series of three (3) injections of steroids mixed with a local anesthetic given two (2) weeks apart. We give these shots in the pain clinic with IV sedation.
Emotional and stress management—This is an important part of the treatment of chronic pain. It addresses the stress-pain-stress cycle and helps patients learn to cope with their condition. Ideally, it is best to refer these patients to a psychologist or psychiatrist; however, because of the stigma associated with seeing a mental health professional, the majority of our patients refuse this type of help. We have taken a different approach, beginning with questioning patients about their sleeping habits and emphasizing how important sleep is to the human body. Surprisingly, the majority of these patients will take anti-anxiety and anti-depressant medications, even though we do use the words “anti-anxiety or “anti-depressant” when prescribing. On follow-up visits, these patients are extremely glad that they elected to take these medications.
Recently, we have started using a newer drug called Lyrica (pregabalin). This medication is believed to reduce the number of electrical signals in damaged nerves, thus reducing the sensation of pain. This drug has recently been released by the FDA for use in treating fibromyalgia, which is somewhat similar to POPSS syndrome.
Steroid injections, anti-anxiety/anti-depressant drugs, and pregabalin are started simultaneously and seem to complement each other’s actions and have additive effects.
To prevent future flare-ups, we recommend physical therapy and have found it to be very useful. However, very few physical therapists specialize in pelvic muscle and core muscle therapy and have knowledge of paradoxical relaxation and trigger point release treatment.
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