Open AccessPudendal Entrapment Neuropathy: A Rare Complication of Pelvic Radiation Therapy
Author(s) -
Foad Elahi
Publication year - 2013
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.2013/16/e793
Subject(s) - medicine , pudendal nerve , pelvic pain , entrapment neuropathy , brachial plexopathy , surgery , lumbosacral plexus , sequela , neuralgia , neuropathic pain , brachial plexus , anesthesia , carpal tunnel syndrome
Pudendal nerve entrapment (PNE) is an uncommon cause of chronic pain. Pudendal nerveentrapment typically occurs when the pudendal nerve is fused to nearby anatomicalstructures or trapped between the sacrotuberous and sacrospinalis ligaments. Pudendal nerveentrapment can be caused by excessive bicycling, pregnancy, anatomic abnormalities, scarringdue to surgery, or as a sequela of radiation therapy. Radiation-induced peripheral neuropathyis usually chronic, progressive, and often irreversible. Radiation-induced pudendal neuropathyis much less common than the more familiar brachial plexopathy secondary to radiationtreatment for breast cancer. The prevalence of PNE, however, is increasing due to improvedlong-term cancer survival.Diagnosis of pudendal neuralgia is essentially clinical; no specific clinical signs or complementarytests are reliably confirmatory.A detailed pain history with correlative clinical examination is paramount for accurate diagnosis.Performance of a pudendal nerve block can serve as both a diagnostic and therapeutic tool.Utilization of various imaging studies, as well as the performance of an electrophysiologicalstudy with pudendal nerve motor latency testing, may yield valuable evidence in support of apudendal neuralgia diagnosis.We present the case of a 59-year-old man with stage IV prostate cancer, referred to the painclinic for chronic perineal and right sided pelvic pain. His pain began insidiously, approximately2 months after undergoing radiation treatment and chemotherapy 3 years prior. He wasultimately diagnosed as having a right sided pudendal entrapment neuropathy. His painwas refractory to all conventional treatment modalities; therefore we decided to pursueneuromodulation via a dorsal column spinal cord stimulator implant. Below, we describe thedecision making process for the diagnosis and treatment of his pudendal neuropathy.Key words: Pudendal nerve entrapment, neuralgia, neuromodulation, spinal cord stimulation.