Pudendal nerve block scheduled for the first time

Nerve blocks using many techniques, and medications - options discussed in detail
Camelote28
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Re: Pudendal nerve block scheduled for the first time

Post by Camelote28 »

Hello April, thank you for your reply.
I have been struggling with pain for more than 7 years, and it started after a very intense workout. I saw 30+ doctors to diagnose my issue.
When I visited the urologist in 2023, she said we should try the pudendal block with a trigger point injection.
My biggest problem was that my bladder was very painful and always in spasm, burning and very sensitive V area mostly after intercourse. I went to the bathroom at night more than 10 times. Physical therapy helped a little, but if I did something a little extra, like working out or taking a long walk, my bladder was on fire.
I didn’t even question my doctor much because I was so exhausted from my condition.
After the injection, I was a little sore; the pain was at a level of 1-2, but on the third day, the nightmare started again!
The pain was 10 out of 10, and all my pelvic muscles were inflamed; I couldn’t even contract them. It’s been about a year now, and my buttocks, legs, and pelvic area all still hurt a lot.
I was so upset with the decision regarding this nerve block. I was much better before.
My problem now is that my pelvic muscles cannot function properly.
Physical therapy does not work for me anymore because I don’t have any approval from their recommendation. I still do very light stretching movements at home, but if I do something a little more intensive, my flare-ups last for many days and go down to a level of 5-6.
I cannot forgive myself for being so blind and not doing any research before the injection.

I have a question! If the block is not therapeutic, and my doctor already knows that it’s my pudendal nerve (plus sciatica involved after the first injection), why do you think they want to do it again?
What if I deny the offer and just ask to manage my pain and simply wait? Can it go away by itself?
I would like to combine all of your experiences to make the right decision about what to do next!

Hanna
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Violet M
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Re: Pudendal nerve block scheduled for the first time

Post by Violet M »

Hi Hanna,

Well, that is a tough decision when your doctor is recommending something that you aren't comfortable with. Transvaginal blocks are not considered to be as accurate as an image guided block through the buttocks. Maybe your doctor has had good results with patients having nerve blocks, or maybe they don't know what else to try, but in 20 years of moderating this forum, I know of very few people who had any permanent relief from nerve blocks, and I know a number of people who have gotten worse long-term, especially from steroid nerve blocks. So, I see them as primarily diagnostic as April said. And new guidelines were recently published by some major medical organizations concluding that there is no evidence for pudendal nerve blocks using steroids. You can read my post that has a link to the guidelines. viewtopic.php?t=11593
You could show your doctor this publication and get their opinion.

My problems started with exercise, and like you, PT flared up the pain and so did exercise. Not necessarily immediately, but several hours later. I concluded that it didn't make sense to continue doing things that flared up the pain. Movement and sitting increased the pain which led me to suspect that there was something mechanical going on. In the end, it turned out to be a nerve entrapment. I had urinary symptoms, getting up 6 times a night to the bathroom, pelvic pain with burning and feeling like I had been hit with a baseball bat in the crotch. Has your doctor mentioned the possibility of a nerve entrapment? Maybe you want to consider seeing a pudendal neuralgia specialist.

Whether or not it will go away on its own depends on the root cause. If it is simply a nerve injury or irritation without an entrapment, then peripheral nerves can heal over time. But if there is a nerve impingement or entrapment and the nerve is continually being irritated by ligaments or is encased in fascia and cannot glide, then I think it is unlikely that it will go away on its own. If your ligaments are hardened and sclerosed, or if they are lax or strained from exercise and are impinging on the nerve, it's tough to get ligaments to heal, so I think that is a less rosy scenario. In the meantime, are there any medications that help?

Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
Camelote28
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Joined: Sun Sep 29, 2024 1:16 am

Re: Pudendal nerve block scheduled for the first time

Post by Camelote28 »

Thank you for your reply, Violet.
I have done all the tests possible for my pain after the block, including an MRI of the pelvis and lumbar spine with contrast on my pelvic area, and an EMG on the left side because I feel they hit my sciatic nerve too. . All of those images came back negative.
Nothing showed any indication of what might be the problem. This suggests that the block with steroids irritated my nerves and muscles a lot!
We excluded everything possible from what could be, and the diagnosis of inflammation of the pudendal nerve was made as an exception to everything. Additionally, it was based on palpation of the pelvic floor and my complaints before I did the nerve block.
If you know of any tests that I need to do, please let me know.
Right now, I am on Lyrica 75 mg twice a day, plus supplements. I have valium suppositories that I use as I need it
The pain is at a level of 5-6 every day, and I can't sit for more than 15-20 minutes.
I started doing soft wave therapy. I have done it four times out of six, and it flares me up a lot. This treatment is very painful, but I have hope for its effectiveness.
Nothing helps with my pain. I would like to discuss with my doctor the possibility of adding amitriptyline to Lyrica and see if that combination will work.
Unfortunately, my doctor won’t prescribe any painkillers, and I don’t know what would be beneficial for me.
My muscles are very painful. I am trying to stretch them, but sometimes I feel it's better to leave them alone. Ice and hot compresses and biofreeze are my friends now.
Also, my doctor prescribed me methylprednisolone, but I see no results from it—just more inflammation, in my opinion.
April
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Re: Pudendal nerve block scheduled for the first time

Post by April »

Hi Hanna,

I avoid anything that I think might be causing pain. I don't know what soft wave therapy is, but if you think it is increasing your pain, I would reconsider. Have you met with a pn surgeon yet? That kind of surgeon could review your medical history and try to determine if the pudendal nerve is entrapped. And if it is, you could consider surgery. Given how long you've been struggling with this and your high level of pain, it seems like that would be an option to consider. Another option is a stimulator. I considered both surgery and a stimulator after 3.5 years of pain. The info I had on my problem suggested it was entrapped (that's what both the surgeons I spoke to thought), so I did go ahead with surgery and it significantly reduced my pain. But, if I had thought that the nerve wasn't entrapped, I think I would have just done the stimulator.

April
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Violet M
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Re: Pudendal nerve block scheduled for the first time

Post by Violet M »

Hi Hanna,

Some people have had significant pain relief with buprenorphine, a narcotic that doesn't cause addiction or tolerance to the drug. But it's hard to find doctors who know how to prescribe it and are willing to. Most likely a pain clinic doctor would know something about it and possibly prescribe it.

I agree with April about soft wave therapy -- if it flares you up so much, it's hard to see how it's beneficial.

Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
Camelote28
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Joined: Sun Sep 29, 2024 1:16 am

Re: Pudendal nerve block scheduled for the first time

Post by Camelote28 »

Hello April and Violet,

Thank you for your support and advice! The software therapy is painful only during the treatment, and the pain goes down from 6-7 to 4-3, but unfortunately, the pain relief is not prolonged. The doctor says that we need to focus on reducing inflammation and wait for the final result. I had 20-30 minutes of no pain yesterday at all, and it was so weird. and I was so happy!

My next steps are:
1. I will speak with my pain clinic about a new medication that was recommended by Violet. I have an appointment today.
2. I want to try dry needling therapy for my piriformis muscles, which are painful and get stiff very easily after the nerve block.
3. I have a scheduled appointment with my urologist about nerve stimulation because I am a good candidate for a trial.
4. All my MRIs don’t show any signs of damage or nerve entrapment, which leads me to think that I am not a candidate for a surgical procedure.
5. May try PT again
This is the link to the software therapy in case someone is interested in reading about it https://softwavetrt.com.

:idea: PS: I just spoke with my pain management doctor. She won’t prescribe me any opioids. She gave me amitriptyline 10 mg on top of my Lyrica 75 x 2.

I asked a few questions about the nerve stimulator, and she said that anyway we need to get a nerve block without steroids to be sure that my pain is nerve pain, not muscle pain.

Also, my bladder is a problem too. It's painful and overreacting. I wake up a few times during the night; it's hard to relax to pee.

The pain clinic doctor said that we need to make sure which stimulator will help.

I think I need to wait for my appointment with my urologist (Dr. Peters) and make a final decision about what I am going to do. If I can’t avoid the nerve block, I need to be aware of the upcoming flare-ups after the injection, and I will need heavy painkillers to get through that crazy pain. Any suggestions

a big hug from me. ;)
Hanna
Last edited by Camelote28 on Mon Oct 14, 2024 9:02 pm, edited 1 time in total.
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Violet M
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Re: Pudendal nerve block scheduled for the first time

Post by Violet M »

Hi Hanna,

I looked at the softwave website. It certainly looks promising based on the mechanism of how it works -- increasing blood flow and reducing inflammation. I'm wondering if it would be effective if someone has a true nerve entrapment where the nerve is compressed between 2 ligaments. Maybe if the inflammation in the nerve decreased enough to glide easily?

Dr. Peters is very knowledgeable so I hope he will be able to help you.

Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
April
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Joined: Fri Jun 19, 2015 9:59 am

Re: Pudendal nerve block scheduled for the first time

Post by April »

Hi Hanna,
Good luck with the upcoming appointment. From what I understand from talking to Hibner and others, MRIs are not a very useful way to diagnose pne because they so often do not show anything when there is entrapment (my MRI was unusual). So I would not conclude from a negative MRI that you don't have entrapment. I think the bigger picture of your symptoms and history (and perhaps a block) is more important in determining that.

Take care,
April
Last edited by April on Mon Nov 18, 2024 5:39 am, edited 1 time in total.
matthewroots77
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Re: Pudendal nerve block scheduled for the first time

Post by matthewroots77 »

Hi All

I just have a question regarding pudendal nerve block,I've had one recently in the UK but did not have any temporary relief,I've recently spoke to another specialist who thinks that the level of drugs used werer not strong enough,so possibly did not completely turn of the nerve.
Does anybody who's had a block have there report and knows what was used and how much??

Thanks Matt
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Violet M
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Re: Pudendal nerve block scheduled for the first time

Post by Violet M »

My blocks had marcaine and kenalog but I don't remember the dose since it was over 20 years ago.
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
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