Open AccessRole of 3 Tesla MR Neurography and CT-guided Injections for Pudendal Neuralgia: Analysis of Pain Response
Author(s) -
Jimmy Ly,
Kelly M. Scott,
Yin Xi,
Oganes Ashikyan,
Avneesh Chhabra
Publication year - 2019
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/2019.22.e333
Subject(s) - medicine , pudendal nerve , magnetic resonance neurography , lumbosacral plexus , neuralgia , pelvic pain , neuropathic pain , magnetic resonance imaging , anesthesia , radiology , surgery
Background: Magnetic resonance neurography (MRN) has an increasing role in the diagnosisand management of pudendal neuralgia, a neurogenic cause of chronic pelvic pain.Objective: The objective of this research was to determine the role of MRN in predicting improvedpain outcomes following computed tomography (CT)-guided perineural injections in patients withpudendal neuralgia.Study Design: This study used a retrospective cross-sectional study design.Setting: The research was conducted at a large academic hospital.Methods:Patients: Ninety-one patients (139 injections) who received MRN and CT-guided pudendal blockswere analyzed.Intervention: A 3Tesla (T) scanner was used to evaluate the lumbosacral plexus for pudendalneuropathy. Prior to receiving a CT-guided pudendal perineural injection, patients were given painlogs and asked to record pain on a visual analog scale.Measurement: MRN findings for pudendal neuropathy were compared to the results of the CTguided pudendal nerve blocks. Injection pain responses were categorized into 3 groups – positiveblock, possible positive block, and negative block.Statistical Tests: A chi-square test was used to test any association, and a Cochran-Armitage trendtest was used to test any trend. Significance level was set at .05. All analyses were done in SASVersion 9.4 (SAS Institute, Inc., Cary, NC).Results: Ninety-one patients (139 injections) who received MRN were analyzed. Of these 139injections, 41 were considered positive (29.5%), 52 of 139 were possible positives (37.4%), and46 of 139 were negative blocks (33.1%). Of the patients who had a positive pudendal block, nosignificant difference was found between the MRN result and the pudendal perineural injectionresponse (P = .57). Women had better overall response to pudendal blocks, but this response wasnot associated with MRN findings (P = .34). However, positive MRN results were associated withbetter pain response in men (P = .005). Patients who reported bowel dysfunction also had a betterresponse to pudendal perineural injection (P = .02).Limitations: Some limitations include subjectivity of pain reporting, reporting consistency,absence of a control group, and the retrospective nature of the chart review.Conclusion: Pudendal perineural injections improve pain in patients with pudendal neuralgiaand positive MRN results are associated with better response in men.Key words: MRI, MRN, CT injection, pudendal neuralgia, pudendal nerve, pelvic pain, chronicpelvic pain, pudendal neuropathy