CT-guided neurolysis for cancer-related abdominal and pelvic pain

The superior hypogastric block (SHB) is an effective treatment for chronic or cancer-related pelvic pain. The CT-guided block offers the advantage of being able to visualize the target structure, soft tissue, disc, and bony structures to minimize complications. But CT has its own limitations such as being unable to visualize the needle at off angle, higher level of exposure to ionizing radiation, and longer procedure time compared to the fluoroscopy-guided procedure. Several variations to CT-guided techniques have been published. Each has its own advantages and disadvantages, but depending on the anatomical variations in spinal structure, any one of the techniques may be used. Fluoroscopy is used in the majority of superior hypogastric blocks because of the ease of use, availability, and quicker procedure times. The anterior approach to SHB using ultrasound guidance is useful technique in relieving pelvic pain in gynecological malignancies.

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Percutaneous CT-Guided Cryoablation of the Bilateral Pudendal Nerves for Palliation of Intractable Pain Related to Pelvic Neoplasms

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909119892003 ◽

2020 ◽

Vol 37 (8) ◽

pp. 619-623 ◽

Cited By ~ 2

Author(s):

John David Prologo ◽

Sivasai Manyapu ◽

Zachary L. Bercu ◽

Ashmit Mittal ◽

Jason W. Mitchell

Keyword(s):

Computed Tomography ◽

Pelvic Pain ◽

Pudendal Nerve ◽

Intractable Pain ◽

Pelvic Neoplasms ◽

Ct Guided ◽

Patient Demographics ◽

Pain Scores ◽

The Mean ◽

Mean Time

Objectives: The purpose of this report is to describe the effect of computed tomography–guided bilateral pudendal nerve cryoablations on pain and time to discharge in the setting of acute hospitalizations secondary to refractory pelvic pain from cancer. Methods: Investigators queried the medical record for patients who underwent pudendal nerve cryoablation using the Category III Current Procedural Technology code assignment 0442T or Category I code 64640 for cases prior to 2015. The resulting list was reviewed, and procedures performed on inpatients for intractable pelvic pain related to neoplasm were selected. The final cohort was then analyzed with regard to patient demographics, procedure details, technical success, safety, pain scores, and time to discharge. Results: Ten patients underwent cryoablation by 3 operators for palliation of painful pelvic neoplasms between June 2014 and January 2019. All probes were satisfactorily positioned and freeze cycles undertaken without difficulty. There were no procedure-related complications or adverse events. The mean difference in pre- and posttreatment worst pain scores was significant (n = 5.20, P = .003). The mean time to discharge following the procedure was 2.3 days. Conclusion: Computed tomography–guided percutaneous cryoablation of the bilateral pudendal nerves may represent a viable option in the setting of acute hospitalization secondary to intractable pain in patients with pelvic neoplasms.

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Cross-organ sensitization between the colon and bladder: to pee or not to pee?

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00272.2017 ◽

2018 ◽

Vol 314 (3) ◽

pp. G301-G308 ◽

Cited By ~ 14

Author(s):

Luke Grundy ◽

Stuart M. Brierley

Keyword(s):

Pelvic Pain ◽

Afferent Pathways ◽

Sensory Pathways ◽

Urinary Tract Disorders ◽

Symptom Profiles ◽

Close Proximity ◽

Painful Bladder ◽

Abdominal And Pelvic Pain ◽

Irritable Bowel ◽

Clinical Conditions

Chronic abdominal and pelvic pain are common debilitating clinical conditions experienced by millions of patients around the globe. The origin of such pain commonly arises from the intestine and bladder, which share common primary roles (the collection, storage, and expulsion of waste). These visceral organs are located in close proximity to one another and also share common innervation from spinal afferent pathways. Chronic abdominal pain, constipation, or diarrhea are primary symptoms for patients with irritable bowel syndrome or inflammatory bowel disease. Chronic pelvic pain and urinary urgency and frequency are primary symptoms experienced by patients with lower urinary tract disorders such as interstitial cystitis/painful bladder syndrome. It is becoming clear that these symptoms and clinical entities do not occur in isolation, with considerable overlap in symptom profiles across patient cohorts. Here we review recent clinical and experimental evidence documenting the existence of “cross-organ sensitization” between the colon and bladder. In such circumstances, colonic inflammation may result in profound changes to the sensory pathways innervating the bladder, resulting in severe bladder dysfunction.

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MR imaging in the triage of pregnant patients with acute abdominal and pelvic pain

Abdominal Imaging ◽

10.1007/s00261-008-9381-y ◽

2008 ◽

Vol 34 (2) ◽

pp. 243-250 ◽

Cited By ~ 75

Author(s):

Aytekin Oto ◽

Randy D. Ernst ◽

Labib M. Ghulmiyyah ◽

Thomas K. Nishino ◽

Douglas Hughes ◽

...

Keyword(s):

Mr Imaging ◽

Pelvic Pain ◽

Abdominal And Pelvic Pain

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300 When Do We Order CT to Assess Abdominal and Pelvic Pain? A Predictive Model of Computed Tomography Utilization in the Emergency Department

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2012.06.278 ◽

2012 ◽

Vol 60 (4) ◽

pp. S107

Author(s):

M. Holdsworth ◽

L.A. Ward ◽

D.W. Lowery-North ◽

K. Heilpern ◽

D. Houry ◽

...

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Predictive Model ◽

Pelvic Pain ◽

Abdominal And Pelvic Pain

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Role of 3 Tesla MR Neurography and CT-guided Injections for Pudendal Neuralgia: Analysis of Pain Response

January 2018 - Pain Physician ◽

10.36076/ppj/2019.22.e333 ◽

2019 ◽

Vol 4 (22;4) ◽

pp. E333-E344

Author(s):

Avneesh Chhabra

Keyword(s):

Study Design ◽

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Pudendal Nerve ◽

Pain Response ◽

Pudendal Neuropathy ◽

Pudendal Neuralgia ◽

Ct Guided ◽

Perineural Injection

Background: Magnetic resonance neurography (MRN) has an increasing role in the diagnosis and 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 improved pain outcomes following computed tomography (CT)-guided perineural injections in patients with pudendal 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 blocks were analyzed. Intervention: A 3Tesla (T) scanner was used to evaluate the lumbosacral plexus for pudendal neuropathy. Prior to receiving a CT-guided pudendal perineural injection, patients were given pain logs 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 – positive block, possible positive block, and negative block. Statistical Tests: A chi-square test was used to test any association, and a Cochran-Armitage trend test was used to test any trend. Significance level was set at .05. All analyses were done in SAS Version 9.4 (SAS Institute, Inc., Cary, NC). Results: Ninety-one patients (139 injections) who received MRN were analyzed. Of these 139 injections, 41 were considered positive (29.5%), 52 of 139 were possible positives (37.4%), and 46 of 139 were negative blocks (33.1%). Of the patients who had a positive pudendal block, no significant difference was found between the MRN result and the pudendal perineural injection response (P = .57). Women had better overall response to pudendal blocks, but this response was not associated with MRN findings (P = .34). However, positive MRN results were associated with better pain response in men (P = .005). Patients who reported bowel dysfunction also had a better response 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 neuralgia and positive MRN results are associated with better response in men. Key words: MRI, MRN, CT injection, pudendal neuralgia, pudendal nerve, pelvic pain, chronic pelvic pain, pudendal neuropathy

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