Health Organization for Pudendal Education

I've had pulsed RF several times to the pudendal nerve. It has made a significant difference in my case. Things aren't perfect, but they are better than they were when I was at my worst. I definitely recommend it. As far as I know, this procedure needs to have successful nerve blocks administered prior to being performed. This is for diagnostic purposes. If you don't respond to nerve blocks with pain relief, it is likely the procedure won't help you as the problem may likely not be the pudendal nerve that is causing the problem. Keep in mind, these should be done by guidance, not done blindly. Otherwise they could miss or hit the nerve.

Dr. Wright required one nerve block don't by himself..and 2 days later performed the prf. It was $2500 well spent. Insurance does cover the block but not the prf.

Cm

That's great that the PRF has worked so well for you, Carolyn!! What type of guidance does Dr Wright use for the block.. and for the PRF? Does he do it as an office procedure?

It was done at an outpatients surgery center. They used propofol to pur me under when inserting the needles, then wobe me up so I could feel the pulsating in the right areas. It was not uncomcortable. I flared for 1 mo afterward bu have had 4 decent months since. It is beginning to wear off, I cAn tell. Time for another!

Cm

Hi about Pulsed radio frequency, sounds like you must have a block that worked well in order for PRF to work?
To my knowledge over the past few years PN blocks have never done much for me. A doc I trust told me that for a block to work it should feel numb like novacaine..
My Pn blocks never did that ...all I felt was something that masked the pain a tiny bit so I could sit a little with less pain, but pain that I could still feel..Then in an hour or 2 when the lidocaine wore off ,full force pain was back,plus the pain of the needle for a day or 2.Thats what PN blocks have donemostly ...also from what I can tell the steriod which was supposed to release in a few days to a few weeks did not...at all.
This happened with most blocks...So should I assume that since PN blocks done various times didn't numb me,or give me relief that my problem may not be the PN?
Im asking for 2 reasons, one -cause I wish I could try the PRF as a pain reliever,
and 2---cause Im revisiting other causes for my severe anal rectal pain and bladder issues ....besides PN.

Physical therapy also has never done anything to relieve pain on a continuing basis.
Thx!
Kathy
P

hi
Just wanted to add ...my mris havae never shown entrapment per se...the only thing Potter found was the prominent varices abbutting branches of the PN..
Like others I had embolization done at Dr Potters suggestion.... with no change... tho the inteventional radiologist was only able to do one side at a time and wants me to come back to do the rest... my gut tells me that probably wont make a difference.
also I ve heard so many times that varices arent; the source of the pain, but the result of something else ... so overwhelmed with the all the reseach Ive done that I cant remember.
kathy

kathyd wrote:.So should I assume that since PN blocks done various times didn't numb me,or give me relief that my problem may not be the PN?

My understanding of the way blocks work is that if they make you numb in the distribution area of the pudendal nerve (saddle area) that means the medication came close enough to the target area (the pudendal nerve) to be considered an accurately delivered block. If you did not even get numb, then the medication may not have hit the right area. When Dr. Antolak gives nerve blocks he has you return in a little while to check to see if the block numbed the saddle area so he knows whether it hit the target area. If the block numbs the saddle area AND gives you pain relief, that is a positive diagnostic indicator of pudendal neuralgia. If it numbs the saddle area but you don't have any pain relief then the diagnosis of pudendal neuralgia is questionable. I hope that explanation makes sense.

When I had my blocks Dr. Antolak said I had very thick ligaments so it was difficult to hit the target area. I had some numbness/loss of sensation but I never had complete pain relief from them. Given the success I had from PNE release surgery I'm pretty certain PNE was the correct diagnosis. Also, when Dr. Bautrant did my surgery he said the ligaments were hardened/sclerosed which I'm guessing would have made it harder to deliver a good block.

So, Kathy, I'm afraid I haven't exactly answered your question because I can't say for sure in your case. If you never even had numbess from the nerve blocks it makes me wonder about the accuracy of them. But it sounds like you had quite a few of them so you would think some of them would have been accurate. Were they image guided? I don't know....it's a mystery. I knew one gal who had what's called a Morestin's nerve that comes directly from the nerve roots instead of from the main trunk of the pudendal nerve and innervates the anal area. In that case a traditional pudendal nerve block would not be effective for anal pain.

Violet

Kathyd,

I have tried the nerve block as well and I found much the same thing. Steroid injection as well, didn't really help me.
It certainly numbed most of my areas down there but failed to stop my burning rectal pain which is by far the worst of my symptoms of the lot. I have tried Physical therapy for a few months as well but if anything the rectal pain has been made worse. I do have pain in my right SIJ also. One of my MRIs showed edema from S2-S5 in my sacrum so perhaps it's worth looking into these nerves as well.

It seems unusual that multiple nerve blocks failed to stop your symptoms if the pain was coming from the pudendal nerve. You would assume on at least some of the occasions the nerve block would be accurate? I think a full lower back MRI might be a good idea too.

I also had an embolization for varices at the suggestion of Dr. Potter following my MRI. Unfortunately results were negative in my case as well.

Hi Folks
Thx for your replies..to answer your questions I can say that I never really got numb from any of the pudendal blocks. I felt a dulling of the pain a little due to the lidocaine, Then they always asked me to sit... I could for a little while but I could feel that pain underneath the slight "masking" of it from the block.. I would hope for numbness but never got it...Then a couple hours later ..pain back full force along with incision pain... To my knowledge the steriod never released..

I had a series of 3 blocks (to anal area) done by Dr Coady in July/august of this year...She didn't use CT guidance.. prefers to use her fingers..(tho all the other docs did use CT guidance.. Dr Coady also gave me some Botox to the area...I didnt feel much change after these blocks but.... weeks later close to Labor Day wknd I was able to attend a wedding and then take a family trip to Boston ( I laid on a mattress in the car) to get our son settled in college..Both these times my pain was down considerably loweer and I enjoyed myself immensely! ...So its possible that block helped but Can't say for sure, as determination to attend these events may have played some part

The only time I was numb was with a block to the inferior cluneal nerve and PCFN (Posterior Femoral Cutaneous nerve) given as diagnostic tool for the nerve section surgery i had ..Ironcially I felt numb enough to sit and comfortably eat out in a cafe..IT wore off in 3 hrs or so and the steriod never released but Dr Dellon still felt it was enough proof that ose nerves were my pain generators.. Sadly he was wrong as months after the surgery was done .. new pain in the anal area erupted ...as well the spot where he worked on --where the posterior right thigh attaches to the pelvic peri area.
I had other blocks to the pudendal and othe nerves in variosu (I think sympathetic nerves ) it 2009...that to my memory weren't heplfuf but then we were aiming to reduce bladder urge sensation...
In summary as you all said if the PN was the culprit wouldn't I have felt numbing at some point after trying several blocks?
Thanks for any opinion and for listening


What kind mystifies me also is that my anal rectal pain is not burning like most PN patients or Tarlov patients but intstead intesnse throbbing..It used to go away when I stood up and walked.. and let the area get exerciese. Now I have severe after pain,, after trying to sit for moments.... (ie).. today I finally got my hair cut as I was starting to look lke a wild witch,..I feel better morale wise, but boy does my area thobb!
About MRis just had new lumbar sacral one done.. and also had a bone scan (whole body) no edema no fracturse no mention of compression entrapment or scarring.
I do have a couple Tarlov cyst one larger one esp..I have looked in to these twice befoe and got nowhere, but I m pursuing it again. with a doc whose got experience.