Pudendal neuralgia (PN) involves severe, sharp pain along the course of the pudendal
nerve, often aggravated with sitting. Current therapies include medication management,
nerve blocks, decompression surgery, and neuromodulation. The ideal management for
PN has not been determined.
We present a case of a female with 1.5 years of sharp, burning pain of the left gluteal
and perineal regions. She could not sit for longer than 10 to 15 minutes. Sacroiliac
joint, epidural, and piriformis injections did not improve her pain. She had tried physical
therapy, occupational therapy, massage, and acupuncture but the pain persisted.
Medication treatment with oxycodone-acetaminophen, extended release morphine
sulfate, amitriptyline, and gabapentin provided only minor relief and she had failed other
multianalgesic therapy. She had been unable to work at her desk job for over a year. She
had a positive response to 2 diagnostic pudendal nerve blocks with lidocaine that provided
pain relief for several hours. This patient elected to undergo pulsed radiofrequency (PRF)
of the left pudendal nerve in hopes of achieving a longer duration and improved pain
relief. PRF was carried out at a frequency of 2 Hz and a pulse width of 20 milliseconds
for a duration of 120 seconds at 42 degrees Celsius. After the procedure she reported
tolerating sitting for 4 to 5 hours. Her multianalgesic therapy was successfully weaned.
At 5 months follow-up she felt motivated to return to work. One and a half years after
the procedure the patient is only taking oxycodone-acetaminophen for pain relief and
still has good sitting tolerance. There were no procedure-related complications.
To our knowledge PRF for the treatment of PN has not been reported elsewhere in
the literature. PRF is a relatively new procedure and is felt to be safer than continuous
radiofrequency. Current literature suggests that PRF delivers an electromagnetic field,
which modifies neuro-cellular function with minimal cellular destruction. We conclude
that PRF of the pudendal nerve offers promise as a potential treatment of PN that is
refractory to conservative therapy.
Key words: pudendal neuralgia, pulsed radiofrequency, pudendal nerve,
neuromodulation
Pulsed Radiofrequency: Current Clinical and Biological Literature Available
