If you are living with multiple sclerosis (MS), you may be familiar with nerve pain, including numbness and tingling. Unfortunately, these sensations affect 8 out of 10 people living with the neurodegenerative autoimmune condition. However, it’s possible that not all your nerve pain is caused by MS.

Another medical condition, piriformis syndrome, can cause nerve pain in the legs. Although piriformis syndrome and MS can cause some similar symptoms, they have distinct causes. People with MS are more likely to develop piriformis syndrome, and it’s possible to have both conditions at once.

Some clues can help you determine when numbness, tingling, or pain in the legs may not be related to MS. Continue reading to learn more about piriformis syndrome, a distinct condition with unique symptoms, causes, and treatments.

What Is Piriformis Syndrome?

Piriformis syndrome is the uncomfortable result of problems in the piriformis muscle. This muscle, which is deep in the buttock region, begins at the lower spine and attaches to the top of each thighbone (femur).

The piriformis muscle can cause pain in the buttocks region during spasms (sudden uncontrolled contractions). Another source of pain is when the muscle presses on or irritates the nearby sciatic nerve. The largest nerve in the body, the sciatic nerve runs beneath — or in some people, through — the piriformis muscle. The nerve connects the spinal cord with the skin and muscles in the legs and feet to detect sensations and control movement. Pain, numbness, and tingling from piriformis syndrome are often confused with sciatica because the symptoms are very similar.

Common Symptoms of Piriformis Syndrome

Piriformis syndrome often leads to pain or tingling in the lower back and legs. Common symptoms include a dull aching in the buttocks and pain down the back of the thigh, which may radiate to the calf and foot, as well as less range of hip motion. Walking uphill or up stairs may hurt, and pain may worsen after sitting (due to tightening of the piriformis muscle).

Causes of Piriformis Syndrome

If you have signs or symptoms of piriformis syndrome, you may wonder why you are experiencing the pain and tingling. In most cases, the exact reasons are not known. However, the medical community suggests the following causes of piriformis syndrome:

• Spasms in the piriformis muscle
• Tightening or swelling of the muscle after an injury
• Bleeding in a nearby region

Piriformis Syndrome and MS

Numbness, tingling, and pain can be uncomfortable and stressful symptoms of MS. In fact, more than 29,000 MyMSTeam members have reported numbness as a symptom of MS. These sensations are often caused by the damage to the myelin sheath, which forms a protective layer around the nerves in the central nervous system (CNS) — the brain, spine, and optic nerve. MS can cause various painful sensations, including:

• Facial pain
• Muscle spasms
• Feelings of burning, tingling, or aching in the lower legs
• Shocklike sensations traveling from your back to your lower limbs

Neuropathic pain and other abnormal sensations can occur due to MS-related damage to the CNS. However, the causes of piriformis pain syndrome are related to the piriformis muscle spasming or pressing on the sciatic nerve. Certain lifestyle habits, such as sitting for long periods, are also more likely to cause piriformis syndrome pain.

What’s the Connection?

Although MS nerve pain and piriformis syndrome have different causes, the two conditions have a connection. MyMSTeam members often report pain from piriformis syndrome along with their MS symptoms.

It is known that MS can lead to changes in a person’s activity level. For example, decreased mobility and muscle spasticity may lead to more time spent sitting, which is known to tighten the piriformis muscle and trigger piriformis syndrome.

Additionally, a study published in 2017 found that MS nerve damage can affect the sciatic nerve in some people who have MS. This research revealed that people living with MS have slightly more lesions on the sciatic nerve compared with people without MS. However, this publication is one of very few studies showing lesions on the peripheral nervous system — generally, MS lesions are confined to the CNS.

Treating Piriformis Syndrome and Multiple Sclerosis

The combination of piriformis syndrome and MS can worsen quality of life. Interventions such as pain management medications and physical therapy can help relieve some of the discomfort caused by piriformis syndrome.

Piriformis Syndrome Treatments

Successful treatment of piriformis syndrome usually requires a combination of the measures to address the symptoms:

• Pain management interventions such as nonsteroidal anti-inflammatory drugs can help reduce swelling and inflammation. Narcotics may be prescribed for severe pain.
• Muscle relaxants provide temporary relief by stopping muscle spasms.
• Corticosteroid (steroid) injections reduce inflammation at the muscle and nerve sites.
• Physical therapy gently stretches the piriformis muscle and surrounding muscles and corrects posture that may be straining the muscle or sciatic nerve.
• Lifestyle changes such as getting more exercise and improving sitting posture can help reduce piriformis muscle flare-ups.
• Losing weight and wearing loose-fitting clothes can ease pressure on the sciatic nerve.
• Alternative therapies such as acupuncture and chiropractic adjustments can help align the body to relieve pain.
• Surgery, although rarely used for piriformis syndrome, might be performed in severe sciatica cases that result in loss of bowel or bladder control.

It may be difficult to differentiate the types of nerve-related pain, so be sure to talk with your health care provider if you have new or worsening pain. Since certain medications may interfere with your MS treatments or cause side effects, your doctor or health care team can help you determine which treatments are right for you.

Talk With Others Who Understand

On MyMSTeam, the social network for people with multiple sclerosis and their loved ones, more than 186,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.

Do you have symptoms that could be caused by either multiple sclerosis or piriformis syndrome? Have you been diagnosed with both conditions? Share your experience in the comments below, or start a conversation by posting on your Activities page.