Abstract Details

Title Diagnostic pudendal nerve blocks followed by Pulsed Radiofrequency treatments in refractory chronic pelvic pain: A case series

Topic Pain

Presentation(s) P11 - Poster Session 11 (8:00 AM-9:00 AM)

Poster/Presentation
Number 6-011

Objective NA

Background Pudendal Neuralgia often leads to refractory chronic pelvic pain. Neuromodulation of the pudendal nerve with Pulsed Radiofrequency (PRF) treatment has been described as a successful treatment in published literature, however these reports haven’t consistently established the diagnosis of pudendal neuralgia prior to PRF.

Design/Methods A 42-year-old male (A) and an 81-year-old female (B) presented with refractory chronic pain in the buttock and perineal area which worsened with sitting and which was refractory to conservative management. Other pathologies were rule out by imaging studies and an evaluation by a urologist. The diagnosis of pudendal neuralgia was confirmed with pudendal neve blocks using 1 ml of 1% Lidocaine, 1 ml of 0.25% Bupivacaine, and 1 ml of Triamcinolone 40mg/ml injected near the ischial spine under fluoroscopy guidance. Both patients experienced >50% pain improvement lasting for at least 8 hours. Then 2 cycles of PRF treatments were performed for 120 seconds each at 42°C after satisfactory sensory testing.

Results Patient-A experienced incremental pain relief with each treatment: 100% relief in pain for 3 months after 1st treatment, 100% relief for 3.5 months after 2nd treatment, 100% relief for 4.5 months after 3rd treatment, and 100% relief for 6 months after 4th treatment. While Patient-B continues to experience >50% ongoing pain relief for >6 months since 1st treatment.

Conclusions Prior pudendal nerve blocks aren’t just diagnostic for pudendal neuralgia, but also seem to indicate longer term pain relief following PRF. Patient-A is the first report of incremental pain relief with subsequent pudendal nerve PRF treatments.

Authors/Disclosures
Saugat Dey, MD (DARTMOUTH HITCHCOCK MEDICAL CENTER) PRESENTER	No disclosure on file

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