deep and extreme pulsing pain

[April]

Hi all,

I wanted to see if anyone has insights on two issues. I’ve recently had episodes of pain that are new, internal, and very extreme, and I’m just wondering what this is. So my first question is: what is this? I provide more details about the pain below. My second question is: could this be caused by my physical therapist’s massage of my piriformis muscle? I provide more details on that below as well.

Details on the pain: The first episode happened last week after I got off a plane coming home after work-related travel. After several days of sitting in chairs without full lumbar support, my back began spasming and I had to walk bent over in the airport. (This looks and sounds much worse than it feels—I’m just extremely stiff and not in that much pain). In any event, that seemed to suddenly trigger something absolutely awful in my left pudendal area near the ischial spine. It was so bad that I had to lie down in the airport. But, the pain was manageable as long as I stayed lying down on my right side, and it subsided after an hour or so. I figured the inflammation in my back created inflammation around my pudendal nerve, so I thought it wouldn’t happen again if my back stayed okay. But yesterday I had this same problem, but it was much worse and my back was not spasming. It was easily the worst pain I’ve had with my pn and, perhaps, the worst pain in my life. It was a deep pulsing pain like someone was repeatedly squeezing the nerve and letting go, and it continued even after I was lying down. It was out of control. My husband gave me ice, lidocaine, my prescription strength anti-inflammatories (which I have for my back), and gradually the pulses became further apart and after 15-20 minutes it subsided. I again had shorter episodes of it later in the day. What is this? Is it a muscle spasm? It doesn’t seem anything like the spasms I have in my back, which create stiffness but aren’t that painful. I’ll also mention that for the first time ever yesterday I woke up with razor blade pudendal pain (normally I am virtually pain-free in the morning before I get out of bed). So, yesterday was all around a bad pudendal day for me.

Details on the possible cause: On Thursday afternoon, I had my second pt session with a new and very good pt person. She has never touched the pudendal nerve, but she did rub my piriformis muscle on my buttocks, and I was very sensitive in a few of specific small areas. She explained that these were trigger points and linked to my pn. I’m guessing that this caused yesterday’s outrageous pain since that was the only unusual thing I’ve done recently. Does that sound right?

Many thanks,
April

[nyt]

Sorry to hear that you've had such a bad flare. It is possible that the massage on the piriformis irritated the pudendal nerve. The nerve runs under the piriformis therefore can irritate the nerve. I've had this same problem, ie increase in pudendal pain if my PT or massage therapist just gets a little too aggressive working on my tight piriformis. See what you PT thinks when you mention it to them.

[April]

That's interesting. So it probably was caused by the pt session. But I will definitely ask her next week when I see her again. Luckily, the problem has not returned, and yesterday and today have been pretty good. Many thanks, NYT.

April