Sacral Neuromodulation as a Treatment for Pudendal Neuralgia

Pudendal neuralgia is a debilitating pain syndrome, and finding long-lastingtreatment modalities has been challenging in pain management. The pudendalnerve has sensory and motor functions, and influences autonomic functions.Thus, entrapment or damage of this nerve can have multiple serious implications.The constellation of symptoms which result from injury to this nerve is commonlyreferred to as pudendal neuralgia. When conservative therapy does not provideadequate pain relief and surgical procedures fail or are not viable options, centraland peripheral nerve stimulation can be effective treatment modalities. Morerecent approaches to treatment include the use of peripheral nerve stimulationthrough the use of an electrical lead placed next to the pudendal nerve in theischioanal fossa. Also, epidural stimulation of the conus medullaris and pulsedradiofrequency ablation of the pudendal nerve have been shown to be effectivein small patient populations. We present the case of a 36-year-old womanwho sustained pudendal nerve injury during a hysterectomy and subsequentlydeveloped intractable pelvic pain and pudendal neuralgia. Conservativetreatment measures failed, but she obtained excellent results from peripheralnerve stimulator therapy. Permanent implantation consisted of 4 tined Interstimleads, individually placed into the bilateral S3 and S4 foramina. The patient hasbeen followed for approximately 4 years since her procedure, demonstratingincreased function as she is able to stand and sit for prolonged periods of time.She has returned to her usual daily activities, including horseback riding. Thisis the first reported case of transforminal sacral neurostimulation providingexcellent relief of pudendal neuralgia related symptoms.Key words: Pudendal neuralgia, sacral neurostimulation, peripheral nervestimulator, pelvic pain, nerve stimulation, interventional pain procedures, surgicalmanagement of pain