Case of the Month #27: Lower back and buttock pain by Dr Kerry Bosworth

Published: 02/05/2023

Management Plan

Differential diagnoses include

  • Lumbar disc herniation
  • Lumbar spinal stenosis
  • Sacroiliitis
  • Hip osteoarthritis
  • Piriformis syndrome
  • Lyme disease
  • Neoplasm impinging on nerve root

Management plan:

After a thorough discussion of investigation and treatment options, the following management plan was agreed:

  • Piriformis injection if any suitable target was identified on ultrasound knowing that she could ask for the procedure to be stopped at any point if she found it too painful
  • Referral to Pain Psychology service for guided self-help with pain management


She returned for her follow-up appointment six months later. She had had an ultrasound of her piriformis which showed potential impingement of her sciatic nerve. A local anaesthetic and steroid injection was performed which much improved her symptoms.

She had purchased a book recommended by the Pain Psychology team [1] but had decided to work through the exercises in it by herself rather than using their Guided Self-help service or attend sessions with a psychologist. She felt this was also making things more manageable.

She had attended a baby session at her local swimming pool with her daughter and granddaughter and been inspired to join their exercise in water classes. She had also joined a weight management group and was pleased with the progress she was making.