Thank you for replying and your kind words. I did have a minor injury during exercise to my right inner groin while doing Pilates. I have sapams every day in one of my butt muscles but they dont come with pain. The baclofen keep the spasms at bay. However, the pain is chronic.

You can injure tendons in the groin, and when that happens, it can last a LONG TIME.
It might not be piriformis at all.

I had a fall and strained some ligaments there, and had IFc electrical stim and ultrasound and the pain went away. I was unable to return to the same flexibility however after 3 months of PT. I think you may have a groin injury and not piriformis at all.

The lidoderms need to be applied to the lower sacral area on your back for best results. That is where I used mine. This intercepts the nerves before they enter the spine.

I will say a groin strain takes forever to heal up. When mine occurred I couldn't even roll over in bed !
Of all pain relievers, aspirin worked best 3 times a day. I used Alka Seltzer original formula because the aspirin in it is soluble and doesn't affect the stomach so much. This simple thing gave me a bit a relief until I could get home (we were on vacation in the boonies) to PT.

For spasms I'd look into magnesium to relax those muscles.
Topical works very well in lotion form. CVS has an Epsom lotion, which they are foolishly discontinuing, but some stores still have it on the shelves. Another topical is called Epsom-It. It is made for feet but it will work anywhere you need it like the CVS one.

Oral magnesium will work too, but avoid mixtures or any that say OXIDE on the label (oxide is not absorbed from the GI tract). Don't do HEAT... but try some ice once or twice a day. Heat stimulates nerves and injuries. Try the ice in the groin area, or on your lower back. When I had the IFc (inferential current --which is different from TENS) the therapist put an ice pack over the electrodes to ramp up the current and suppress pain . It worked really well for the acute stages of pain that were incapacitating. Since all your interventions for piriformis are FAILING, I'd look at the groin area instead. That may be where the pain generator really is.
Just my opinion.

Just throwing some things out there that I was told/advised when doc suspected my issue was piriformis - Please let docs know if you did do anything odd or accidently prior to pain (sure you probably already got that covered!), was told not to use heat as that INCREASES inflammation - use ice instead, and Voltaren Gel was prescribed (it's a script only NSAID - I can't take oral anti-inflammatories). Oh, and was told to cut my exercise in half - I walk, or did, walk 4 miles in one hour. Never considered that as athletic, just walking like I had somewhere to go and I was late, but have since learned that does qualify as athletic.

Wish I could be of more help.....

Absolutely. Thank you seahorse02. I will quit using the heated seats in my car immediately and start bringing an ice pack to work. Still in search of diagnosis and cure...

I've just been diagnosed with this as well. I have some spinal degeneration but nothing that would indicate the numbness and loss of reflex I'm having in my heel. My physiatrist thinks it must be piriformis.

She mentioned myofascial release therapy/massage. Anybody tried that?

I've already been through lots of PT and it seems to either not help or make it worse -- stretching in particular.

Can the sensation and reflex in my heel come back, or are they permanently gone?

The only kind of exercise I can do anymore is pool walking or aerobics. Even walking down the block is too painful. I used to walk every day, and this is very very frustrating.

Yes, and under the right circumstances, it can work great. It's important to get a good certified myofascial triggerpoint therapist - not just a PT who thinks they know what they're doing. The right training and experience make all the difference. Of course I can't make any promises; I'm not a doctor, and I don't know your particulars, but if your symptoms are caused by the piriformis muscle being in spasm, myofascial release may release that spasm and ease the pressure on the nerves. It may work for a long time, or temporarily (a few days) but the therapist should be able to show you how to help yourself if/when it happens again. It will hurt like cuss when they're doing it, and be sore afterward, and it will involve some stretching, but if it works (and IMO it's definitely worth a try) it'll be worth it.

http://www.myofascialtherapy.org/

Doc

Darn it. There is not a single one in my state listed on that website. x-(

Please see my information. I went through exactly what you have for forty years. I no longer have problems due to a tiny little implanted computer. Pre-program electrodes send messages to my brain whenever pain begins. As you may know, the brain is REALLY what lets you know you are hurting. Must go to a reputable Pain Managment Specialist. They will insist you have a psychological exam to make sure you understand this procedure. It has saved my life, my career, and I can do most anything - including riding a camel across the Egyptian desert. I can stand for long periods, bend over without pain, participate in sports, and sitting and sleeping without problems. My pain is 95% gone - I actually was put on disability before I had this procedure done. I had similar symptoms as yours, and additionally discovered the piriformis muscle also interfered. Hope this is helpful.
BLM