Open AccessSuccessful Treatment of Refractory Pudendal Neuralgia with Pulsed Radiofrequency
Author(s) -
Ellen E. Rhame
Publication year - 2009
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2009/12/633
Subject(s) - medicine , pulsed radiofrequency , oxycodone , anesthesia , pudendal nerve , gabapentin , acetaminophen , surgery , opioid , pain relief , receptor , alternative medicine , pathology
Pudendal neuralgia (PN) involves severe, sharp pain along the course of the pudendalnerve, often aggravated with sitting. Current therapies include medication management,nerve blocks, decompression surgery, and neuromodulation. The ideal management forPN has not been determined.We present a case of a female with 1.5 years of sharp, burning pain of the left glutealand perineal regions. She could not sit for longer than 10 to 15 minutes. Sacroiliacjoint, epidural, and piriformis injections did not improve her pain. She had tried physicaltherapy, occupational therapy, massage, and acupuncture but the pain persisted.Medication treatment with oxycodone-acetaminophen, extended release morphinesulfate, amitriptyline, and gabapentin provided only minor relief and she had failed othermultianalgesic therapy. She had been unable to work at her desk job for over a year. Shehad a positive response to 2 diagnostic pudendal nerve blocks with lidocaine that providedpain relief for several hours. This patient elected to undergo pulsed radiofrequency (PRF)of the left pudendal nerve in hopes of achieving a longer duration and improved painrelief. PRF was carried out at a frequency of 2 Hz and a pulse width of 20 millisecondsfor a duration of 120 seconds at 42 degrees Celsius. After the procedure she reportedtolerating sitting for 4 to 5 hours. Her multianalgesic therapy was successfully weaned.At 5 months follow-up she felt motivated to return to work. One and a half years afterthe procedure the patient is only taking oxycodone-acetaminophen for pain relief andstill has good sitting tolerance. There were no procedure-related complications.To our knowledge PRF for the treatment of PN has not been reported elsewhere inthe literature. PRF is a relatively new procedure and is felt to be safer than continuousradiofrequency. Current literature suggests that PRF delivers an electromagnetic field,which modifies neuro-cellular function with minimal cellular destruction. We concludethat PRF of the pudendal nerve offers promise as a potential treatment of PN that isrefractory to conservative therapy.Key words: pudendal neuralgia, pulsed radiofrequency, pudendal nerve,neuromodulation