Presented at the 2012 AAPM Annual Meeting « Back

Pulsed Radiofrequency Lesioning of Pudendal Nerve in Patient with Chronic Pelvic Pain: A Case Report

Salim Ghazi, MD, ghazi.salim@mayo.edu¹, Michael Derr, DO¹, (1) Mayo Clinic Florida, Jacksonville, Florida

Introduction/Statement of the Problem: A 34-year-old female was seen in an outpatient pain clinic for treatment of chronic pelvic pain. Her symptoms started 5 years previously with no clear etiology. She had an extensive work-up and treatments at other institutions with no benefit. Previous injections included caudal epidural, superior hypogastric plexus, sacroiliac joint, saccrococcygeal nerve, and ganglion impar. The patient had undergone a trial of spinal cord stimulation, taken different medications and completed a pelvic floor physical therapy program with little benefit. Her activities of daily living were greatly affected. The pain localized deep to the sacrococcygeal area bilaterally. Symptoms worsened with sitting, standing, or walking. Assessment/Results: The patient was diagnosed with chronic pelvic pain, consistent with pudendal neuralgia. She underwent bilateral pudendal nerve blocks and received 90% pain reduction, lasting the duration of the local anesthetic. A few weeks later the patient underwent pulsed radiofrequency lesioning of the bilateral pudendal nerves. The patient had excellent pain relief over the next 5 months. She was able to perform all her activities of daily living, returned to work, and resumed exercising. Three subsequent procedures have been done, each providing 5–6 months benefit. Conclusion: Chronic pelvic pain is a debilitating condition with limited treatment options. Pulsed radiofrequency lesioning of the pudendal nerve is a relatively new technique that has shown promise in patients with chronic pelvic pain. Further prospective, controlled studies evaluating the outcomes of pulsed radiofrequency lesioning of the pudendal nerve need to be pursued. References: 1)Benson J, Griffis K. Pudendal neuralgia, a severe pain syndrome. American Journal of Obstetrics and Gynecology 2005; 192:1663-1668 2)Rhame E, Levy K, et. al. Successful Treatment of Refractory Pudendal Neuralgia with Pulsed Radiofrequency. Pain Physician 2009; 12(3):633-8. 3)Racz GB, Ruiz-Lopez R. Radiofrequency procedures. Pain Practice 2006; 6:46-50

Funding: None