Health Organization for Pudendal Education

As I posted in a previous post I had a bilateral nerve block with Dr. Chapman on Feb 26. Since then I've had back pain and hip pain radiating to my ankles. I spoke to the dr and was told though uncommon it can happen but should go away within a few more days. That was last week. Well I'm still in tons of pain and today I stated experiencing new pains and I'm very upset abt it and don't know what to do. I've had coccyx pain in the past but not like this and now the pain spread to the area surrounding the coccyx plus I'm having labia pain which I haven't had in a really really long time. I don't know what to do I'm going crazy! And this is besides all the "normal" pain I've been having for the past few years. I have an appointment with Dr. Chapman Mon but what am I to do until then?

Hi Shana,
I'm sorry you're still suffering from block after-effects. The flare really isn't all that uncommon and can last anywhere from a couple of days, to weeks, to a couple of months.
It took about 5 weeks for me to return to baseline pain after my first block. It was a couple of months after my second. The ischial tuberosity pain I incurred immediately after the second block never resolved.

shana wrote: I have an appointment with Dr. Chapman Mon but what am I to do until then?

Anything and everything you can to make yourself as comfortable as possible.
Hugs,
Karyn

Have you tried ice, Shana? Your docs should be prescribing you extra pain meds to get you through this flare-up also.

Violet

I'm not a big fan of ice, I find it so uncomfortable and a pain in the ass to deal with so I'm not good about doing it. With regard to pain meds, when I had my nerve block I didn't realize I'd be in so much pain afterwards so I didn't ask for any. When I spoke to the dr over the phone about my pain I was told he can't call in a prescription I need to have a written prescription or pharmacy won't fill it so I can come into office to pick it up. Problem is I live over an hrs drive from his office so I wasn't going to drive there just to pick up a prescription. He said he would give me tramadol so I got my PCP to give me a prescription to last me until Mon when I go back to the dr. The tramadol is helping take the edge off but does not take the pain away completely for now that will have to do as anything stronger makes me into a zombie and I can't deal with that right now

Shana

Hi Kayrn,
Just curious why did you have to undergo more nerve blocks if you had more pain after each one? I just had my first and feel worse than I did prior to the block. I have been scheduled for another in 5 weeks, but really don't want to go back to the clinic. What is the reason for pursuing the nerve blocks if they don't alleviate the pain? Also, I have read on the forums that there are pain specialists that use ultrasound guided nerve blocks. Mine was done under fluoroscopy and I just wonder if anyone can help me with more information on the difference between these two methods? Do I want to pursue another doctor for another block?
Thanks!

Hi Momma,
Welcome to HOPE!
The purpose of the nerve blocks are more for diagnostic purposes, rather than pain relief. Like you, I didn't react well to them. I had some numbness that lasted for a very short period of time, followed by weeks of unspeakable pain. After the second block, with even worse results, I tried a lidocaine infusion, which was completely ineffective.
Unfortunately, most PN Surgeon's protocol is (3) diagnostic blocks. It's just one of the hoops we have go through to get the PNE confirmed or ruled out. It's my hope that someone will re-evaluate the value of this protocol in the near future.
My blocks were also done under fluoroscopy, so I don't really have any info about US. Hopefully, someone else will ...
I completely understand how you feel about not wanting to go back. I felt the same way. However, I do know of many people who had better results with their second block, than their first. If you still have another bad pain flare after the second, please speak openly to your PM and explain your reservations.
I hope you're feeling better (back to baseline) soon!

shana wrote:I'm not a big fan of ice, I find it so uncomfortable and a pain in the ass to deal with so I'm not good about doing it.

Me, too!

I had 2 blocks, the first one with no relief that second with total relief but only for a short period of time, after both my pain got much, much worse and I started with new and worsening symptoms that have not gone away. After the second one I spoke to Dr. Conway and he told me not to bother having a third one, so I'd suggest you ask your doctor, or a doctor who specializes in PN before undergoing more blocks especially if they are not helping or causing more problems.

Shana

I think the series of 3 nerve blocks required before surgery came from the protocol used to treat carpal tunnel syndrome. If you aren't headed for surgery, I don't see a good reason to have more than one block into the ischial spine and one into the alcock's canal unless the first one really helped you. Some docs will put a large volume of anesthetic in and do both the ischial spine and alcock's at once.

Fluoroscopy uses x-ray imaging so they can only do the nerve blocks at the ischial spine (at the ligamental grip) using that bony prominence as a guide as to where to place the nerve block. There is a little bit of radiation involved. For the alcock's canal they would have to use another method such as CT imaging. I'm not a big fan of CT imaging due to the amount of radiation involved.

Ultrasound uses no radiation and depending on the capabilities of the equipment may be able to image the nerve itself. If you have a choice, go with the ultrasound but I wouldn't travel a long distance just to have ultrasound instead of fluoroscopy.

Violet