Dr. Filler suggested piriformis injections after MRN as my piriformis muscles are bipartite (split) and very tight. I had them injected with steroid (approved without a problem by same insurance), but that only put me into a flare and gave me sciatica. I really want to try botox because if I can rule out the piriformis as the culprit by relaxing it with no result, I will know for sure i need tarlov cyst surgery; whereas if relaxing the piriformis relieves my symptoms I will be able to avoid the surgery. Tarlov cyst treatment is major neurosurgery so I think it only makes sense to try this 1st.
Here is the wording of the denial; my Doc is trying to do a peer-to-peer but if that doesn't work I wil need to fight it myself and would appreciate suggestions:
""Botox injections for this condition which includes myofascial pain syndrome, low back pain, and anismus (pelvic floor dyssynergia) is considered investigational. Studies in the medical peer review journals for the piriformis myofascial pain syndrome do not support conclusions about the effects of the botulinum toxin. The medical information made available shows that you have piriformis muscle and pelvic pain. The reason for the decision is based upon out Medical Policy (DRUG.00006.Botulinum Toxin)"
I can argue a good case for myself if necessary but it would be particularly helpful if anyone has peer review literature to counter their claim that botox use for pelvic pain is not supported.
Thanks
