So I got a 35 y/o woman with two VERY large S2/S3 tarlov cysts. She's got a lot of hypersensitivity and central sensitization. Can't touch her or perform any PE maneuvers whatsoever. Her pain is across her LS junction/sacral area with referral into her bilateral posterior hips and proximal thighs. I always thought that tarlov cysts were typically asymptomatic and if they did cause pain it was more of a sacral radicular type. My initial impression of her was a lot of pscyhological overlay. Then I got online and started reading more about tarlov cysts. They describe very low back/sacral pain as a common complaint. They also say that asymptomatic ones often become symptomatic after a traumatic event. Well her pain all started after she fell down a flight of stairs 10 yrs ago. So..... what can I do for this lady? Caudals and meds? Just send out to a neurosurgeon who specializes in this?