Tethering of the nerve is not the key sign of entrapment. Never has been, never will be,
Let's go back to what I said earlier in this thread:
The problem that needs to be addressed is that the PNE surgeons have not yet acknowledged that adhesions of the pudendal nerve are normal. For instance, here is
Dr Aaron Filler claiming adhesions are pathological:
The term “entrapment” is used to convey any number of problems occurring at a particular point along a nerve, according to Dr. Filler. “The nerve becomes irritated—pinched, squeezed, narrowed, or stuck on something, a condition called an adhesion.” Nerves may slide freely between soft, fatty tissues along most of their course but become pinched or squeezed through tight spots, according to Dr. Filler. Swelling can occur in these areas, increasing compression of the nerve.
Note that Filler is billed as "
the world’s leading expert in treatment of nerve pain"
Now clearly we have a problem when the top expert is characterising the nerve as pathological if it is "stuck on something", when being "stuck on something" is actually the norm (as per the new study)!
Adding to the confusion, here are other "experts" opining on the amorphous nature of this new condition called PNE:
Hibner:
"At the end of the day, no one can say with 100 percent certainty that the nerve is compressed"
Dr. Conway:
"How would you diagnose PNE prior to operating on somebody? The fact is you can’t."
Source:
http://www.pelvicpainrehab.com/pelvic-p ... -answered/
Now when someone has a
surgery or accident that is followed
immediately by symptoms such as unilateral pelvic pain and especially sitting pain, and especially if there is numbness or incontinence, there is a strong case for a PNE diagnosis, and, after injections to make sure, surgery. Otherwise, no, it's rare and should not be diagnosed as frequently as it apparently is. This forum should be
rigorous about sending people without unambiguous histories on their way to forums dealing with much more common causes of pelvic pain. I am appalled to see how many posters here have case histories that do not suggest PNE at all, but still the moderators and site owners do not raise a red flag or suggest that other conditions be investigated. Even if someone comes here and reports unsuccessful treatment for CPPS or IC,
that does not mean they have PN or PNE! I've seen people try treatment after treatment for CPPS without success, then suddenly (after many years in some cases) they try something new and Boom!, huge improvement or cure.
Rounding off this unhappy picture is a paucity of published studies. The only studies we have are mostly written by the surgeons who profit from the surgery, and the results differ so widely (from very low to very high success rates) that nothing can be said to be known about the validity of the PNE diagnosis yet.
PNE is a vague and nebulous diagnosis, rare at best according to the most reliable sources (completely independent studies), and nobody should entertain it before every other condition has been exhaustively investigated.
There is a reason why
insurance companies do not cover PNE surgery, viz. that it is unproven (its effectiveness has not been established).
According to your logic, "saying you are cured" equals "urging someone to get surgery". A huge leap in logic.
Not when the few cured* people here list surgery as the way they were cured. It's subtle, but powerful.
(* - "cured" after a fashion; investigation of the surgical cures mostly shows there is still some level of dysfunction or pain)