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
THE ROLE OF ANTIOXIDANT SUPPLEMENTATION IN REDUCING THE ENDOMETRIOSIS RELATED CHRONIC PELVIC PAIN IN WOMEN
