931 - Comparative efficacy of rehabilitation and injection techniques in patients with piriformis syndrome: a systematic review and network meta-analysis

Objectives: to investigate the best evidence regarding the efficacy of physical therapy, extracorporeal shockwave therapy (ESWT), dry needling, Botox, lidocaine, corticosteroid, platelet-rich plasma, and other injections in patients with piriformis syndrome.

Design: A systematic review and network meta-analysis study design.

We searched PUBMED, EMBASE, Web of Science, COCHRANE, and SCOPUS for randomized controlled trials that examined the best evidence treatment in patients with Piriformis Syndrome by Aug 14, 2023. Three reviewers independently performed data extraction and assessed the risk of bias. The primary outcome was pain score at post-treatment 1 week, 4 weeks, and 12 weeks. We performed a random-effects network meta-analysis to assess direct and indirect comparisons. Treatment rankings were calculated using the surface under the cumulative ranking curve (SUCRA).





Results: We included 15 studies (n=871 participants). The network meta-analysis demonstrated the efficacy of Botox injection as the best-ranked treatment at 1 week (SUCRA=93.9), 4 weeks (SUCRA=66.4), and 12 weeks (SUCRA=74.5). At post-treatment 1 week, the platelet-rich plasma and lidocaine injections were second-ranked (SUCRA=70.2) and third-ranked treatments (SUCRA=68.9) respectively. At post-treatment, 4 weeks, lidocaine injection and ESWT were second-ranked (SUCRA=61.1) and third-ranked treatments (SUCRA=53.1), respectively. At 12 weeks of follow-up, lidocaine, and steroid injections were second-ranked (SUCRA=50.8) and third-ranked treatments (SUCRA=48.3) respectively. The Botox injection showed effect sizes of WMD -32 to -44.57 to reduce pain levels at 1 after treatment.

Conclusions: This study shows that the Botox injection is the best treatment in patients with piriformis syndrome both short-term and long-term efficacy. However, future studies with larger sample sizes and robust methodology are needed, especially on the platelet-rich plasma and ESWT interventions.