Pain management

Managing at home

These are things you can do on your own. Because everyone is different, it may take some experimentation to find what works best for you.

Activity modifications

Avoid heavy lifting, straining, or pulling. Generally the more you do, the more pain you may have the next day or week afterwards. Sitting or standing for long periods may increase your symptoms. Some people living with Tarlov cysts find that zero-gravity pillows, cushions, and chairs help reduce pressure and make sitting more comfortable.

Ice or heat

Some find that ice packs bring some relief, while others prefer heat packs. Be careful not to turn electric heating pads up too high or lay on them for too long or else you may burn yourself, especially if you are heavily medicated or have numbness or lack of feeling where you applying the heat pack.

Lidoderm or lidocaine patches

Applying these may provide some temporary relief.

Over-the-counter medications

You may find relief from non-prescription anti-inflammatories such as Aleve, Advil or Motrin. In states where it is legal, some people living with Tarlov cysts have found CBD (cannabidiol) or THC (tetrahydrocannabinol) products helpful to take the edge off.

Avoiding constipation

If you have Tarlov cysts in the sacral area, it is important to prevent straining and causing more pressure on the cysts. To prevent constipation, drink more fluids and add more fiber to your diet. Some people need a stool softener and or a laxative while others rely on enemas to help them empty their bowels daily. Speak to your primary care provider if you have trouble having regular bowel movements.

Managing with help from healthcare professionals

These are some options you could explore in conversation with your care team.

Prescriptions

Your healthcare professional may prescribe pain relievers known as analgesics. Depending on the specific medicine, these could help by blocking inflammation, lowering pain-signaling activity in your nervous system, or lowering electrical activity. Your healthcare professional may also prescribe other medicines like tricyclic antidepressants and antiseizure drugs, which change the way your body handles pain signals.

Psychological measures

Meditation, relaxation, cognitive behavioral therapy, and mindfulness-based therapy could help by changing how your mind manages pain and thus how your body responds to pain. Similarly, biofeedback could also help you control muscle tension that is contributing to your pain.

Physical therapy

Formal pelvic floor therapy, physical therapy, or aqua therapy could help with pain by lessening muscle tension and increasing blood flow to reduce pressure on the compressed nerves. It is common for physical therapy to increase pain and symptoms. If you find you have more pain after sessions or cannot tolerate physical therapy you may have to discontinue therapy.

Transcutaneous electrical nerve stimulation (TENS)

TENS devices deliver electrical impulses through the skin and nerves to control pain. Unlike medications and topical ointments, TENS does not have any known side effects, other than skin irritation from the electrodes seen in some patients.

Epidural steroid injection (ESI)

This is a powerful anti-inflammatory medication injected directly around the spinal nerves. Treatment usually consists of three injections spaced a week apart. Each procedure takes about 15 minutes while the doctor uses an X-ray to guide the needle. Side effects from ESIs are rare, but you should still talk to your doctor ahead of time about potential infection, bleeding, dural tears, and increased blood sugar. Types of doctors who may be trained in this technique include anesthesiologists, orthopedic surgeons, neurologists, and interventional radiologists.

Massage

Light or gentle massage with an experienced therapist who is willing to learn about Tarlov cysts could help relax cramped and painful muscles; however, vigorous massage or pressure over the area of the cysts could prove to be more painful.

Acupuncture

A licensed professional with experience in spinal diseases could provide relief by inserting needles into target points on the body. The needles may relax the muscles, reduce inflammation, and increase blood flow.