Health Organization for Pudendal Education

Hi!

This article (see below) shows some promise for vaginal PN pain from blocks.

Blocks carried out at the Sacrial level not lower.

Anyone tried this? Did you better..worse...same??

I have a terrible stabbing pain (level 9-10) in vagina/urethra aggravated by almost anything...but **really** set off by bending and also standing.

Thank you!!

Sam

Transsacral S2-S4 nerve block for vaginal pain due to pudendal neuralgia.
Cok OY, Eker HE, Cok T, Akin S, Aribogan A, Arslan G.
Source
Department of Anesthesiology and Reanimation, Baskent University, School of Medicine, Ankara, Turkey. oyacok@yahoo.com
Abstract
Pudendal neuralgia is a type of neuropathic pain experienced predominantly while sitting, and causes a substantial decrease in quality of life in affected patients. Pudendal nerve block is a diagnostic and therapeutic option for pudendal neuralgia. Transsacral block at S2 through S4 results in pudendal nerve block, which is an option for successful relief of pain due to pudendal nerve injury. Herein is reported blockade of S2 through S4 using lidocaine and methylprednisolone for successful treatment of pudendal neuralgia in 2 patients with severe chronic vaginal pain. The patients, aged 44 and 58 years, respectively, were referred from the Gynecology Department to the pain clinic because of burning, stabbing, electric shock-like, unilateral pain localized to the left portion of the vagina and extending to the perineum. Their initial pain scores were 9 and 10, respectively, on a numeric rating scale. Both patients refused pudendal nerve block using classical techniques. Therefore, diagnostic transsacral S2-S4 nerve block was performed using lidocaine 1%, and was repeated using lidocaine 1% and methylprednisolone 80 mg after confirming block efficiency as demonstrated by an immediate decrease in pain scores. After 1 month, pain scores were 1 and 0, respectively, and both patients were free of pain at 6-month follow up. It is suggested that blockade of S2 through S4 using lidocaine and methylprednisolone is an effective treatment option in patients with chronic pudendal neuralgia when traditional pudendal nerve block is not applicable.
Copyright © 2011 AAGL. Published by Elsevier Inc. All rights reserved.

thank you for posting this

Thats good. I dont want think with this is junk PN Science. Very common, sad.

As some of you know, I'm from Mexico. A couple of weeks ago I came back from Houston, had my first block by the Houston team. It was bilateral, at the level of the ischial spine. Unfortunately I don't think it was successful. The block was done well, as I did get the area of the P nerve numbed. But, unfortunately I was still not able to sit without pain. My levels of pain did lower down somewhat. But I think that also had to do with a cocktail cream I was sold, a miracle cream applied rectally with all the known PN meds (ketamine, amitriptyline, Baclofen, and Diazepam, Gabapentin or pregabalin, or both, I don't remember . I stopped using the cream because it was making me feel strange. Then the pain came back as pre-block, and I've been like that ever since. I was told that if the pain came back at the same levels after 3 weeks, that I should return for a second block, now at alcock's. If symptoms do not improve afterwards I should consider surgery. I came back to Mexico, somewhat clueless. Was the block supposed to kill all the pain, in a diagnostic sense, to be considered successful...? Because if it was supposed to be like that, then I guess it didn't happen, and PN might not be the reason of my sufferings, let alone consider a PNE surgery….
Anyway back in Mexico, last week I went to an urologist. He put me on ultrasound, my prostate seemed normal; however, he then did a digital exam with prostatic massage which was extremely painful I even screamed my lungs out. He concluded that I had prostatitis III kind. Gave me a prostate muscle relaxer, changed me to gabapentin with tramadol, and, of course, the usual antibiotic, levofloxacin in this case. I have still not notice any significant improvement, but just a very little pain relief which might be because of the gabapentin/tramadol combo..
I then, under desperation, just focus on finding a pain specialist that specializes in pelvic pain, and mostly with women. I researched very hard, and found one. I went to see him immediately. To my surprise, he was very familiar with PN and other pelvic issues; for the first time I found a Dr here in Mexico that did not gave me the "look" while I was explaining my symptoms, odyssey and reasoning.
Anyway, after 2 consultations his conclusion is that the problem might not be originating at the known PNE spots (ischial spine, alcock), but actually up central. He explains that might be the reason why I have different pain areas, like the rectum, perineum, around sit bones, but also gluteus, and my thighs, where my but cheeks meet my legs, and this is somewhat on both sides, hips, etc. He says sometimes there might be some issue at this level, like a very small pinch, that might go unnoticed on a rather perfect MRI. He’s proposing a set of 2 blocks like these, Trans sacral S2-S4, and probably also one in the lumbosacral area. Meds will be just as the usual PNE block, with an analgesic and steroid, and under ct scan. If that doesn’t bring a significant relief, he’s talking about implanting a neuromodulator unit.
So now I’m just wondering if I should go back to Houston for the second at alcock, or just try these Trans sacral blocks here. It actually makes sense, even just for diagnostics, If my pain does go away with these, then I would be pretty sure that there might be another nerve involved, probably various. My insurance obviously covers these too.
Has anybody tried these yet?
Hmm…decisions, decisions….

Difficult decision, I feel much emapthy for you because I am struggling with similar problems.
There is another posibility, that your pain is related to general pelvic myoneuropathy, (which has been previously named chronic prostatits IIIB), of course that pudendal nerve plays a role within this mechanism, but is not the sole culprit...
Difficult to make proper diagnosis.

I agree with Flyer ..... it's hard to say. I never had complete pain relief with any of my nerve blocks. Unfortunately, sometimes it's a matter of trial and error to see what helps. Glad you found a doctor who knows something about this. I wonder if they would like to be listed on the HOPE website.

Take care,

Violet

That's interesting, so none of the blocks offered you any temporal relief for the pain, how did they affect in your diagnosis to consider the PNE surgery? I tought one should feel relief even if for a couple of hours to confirm that the P nerve is the source of the problems and might be entrapped...?

I rode lots of bikes, not good. I have tried Labral hip surgeries, both hips, coil embolization pelvic, internal pt, all types of nutty prostrate drugs all with no luck. I saw two supposed pn experts in the mid Atlantic, marvel and dellon and they did nothing other than take $700 each. My issue is not one sided like classic pn. For last year a pain doc here suggested all this is coming out of sacral irritation and I have had 4 sessions with injections to that area with steroids and once prolotherapy. One steroid injection gave me 5 glorious days where I went to wedding and sat and danced with no pain. It did not last but it was big indicator. I am now going to try his last injection trick schlerothrapy or scarring the sacral nerves with salts to try and calm them down. The prolotherapy was similar and that felt like being hit with a bat. I am 60 yo male that has has this for three years now.best drug for me is tramadol . Good luck fellow former biker

I met a pain specialist, his theory is that my problem is pain reflected from the lumbar -sacral area because of the butt impact i had on my motorcycle. He says my spine looks normal because it just went back to that state after compressing during the hit (Im still young he says), but the nerve roots got in trauma and they have not recovered from inflamation since. He also says that this is why situations like these are often misdiagnosed, spine looks normal on the MRI. He's PNE aware, but he says that in order for it to be, the block that was done to me in Houston should have worked, the pain should had gone even for a couple of hours. He also says its very difficult , if not uncommon to get PNE bilaterally, and its just more common in cyclists because the bike seats put preassure on the nerve against the ischial spine. He was very hands on thorough,and clinical when he determined this. He found some hot spots by pressing hard on L5-S2. He told me he's as treated many cases as mine, some that had surgery without success, even one that had surgery in the US 3 times because of some peripheral nerve crossing through his leg, that was thought to be compressed.
He also says this might be a reason why I also have strange pains in other areas besides that of PN, like the glutes, butt cheek, hips, etc. All these nerves originate in the same spot he says, and he's right. Im scheduled for blocks in the area this sunday and praying like crazy. He says the outcome should be good, that my spine looks healthy. We'll see

I have had a caudel block which targets the sacral nerves did nothing but cause numbness down my leg. Then had a coccyx injections which again did nothing. In my opinion these shots are a joke but when when your in non stop pain you will do anything for relief. I hope and pray you get a better response then I did.