Pudendal neuralgia is a debilitating pain syndrome, and finding long-lasting
treatment modalities has been challenging in pain management. The pudendal
nerve 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 commonly
referred to as pudendal neuralgia. When conservative therapy does not provide
adequate pain relief and surgical procedures fail or are not viable options, central
and peripheral nerve stimulation can be effective treatment modalities. More
recent approaches to treatment include the use of peripheral nerve stimulation
through the use of an electrical lead placed next to the pudendal nerve in the
ischioanal fossa. Also, epidural stimulation of the conus medullaris and pulsed
radiofrequency ablation of the pudendal nerve have been shown to be effective
in small patient populations. We present the case of a 36-year-old woman
who sustained pudendal nerve injury during a hysterectomy and subsequently
developed intractable pelvic pain and pudendal neuralgia. Conservative
treatment measures failed, but she obtained excellent results from peripheral
nerve stimulator therapy. Permanent implantation consisted of 4 tined Interstim
leads, individually placed into the bilateral S3 and S4 foramina. The patient has
been followed for approximately 4 years since her procedure, demonstrating
increased 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. This
is the first reported case of transforminal sacral neurostimulation providing
excellent relief of pudendal neuralgia related symptoms.
Key words: Pudendal neuralgia, sacral neurostimulation, peripheral nerve
stimulator, pelvic pain, nerve stimulation, interventional pain procedures, surgical
management of pain
Nerve stimulator guided pudendal nerve blockversus general anesthesia for hemorrhoidectomy
