Chronic pudenal neuralgia treatment with method of pulsed radio frequency (PRF)

Abstract

Pudendal neuralgia is a pronounced pain in pudendal nerve dermatomes, most often aggravated in the sitting position. This condition is characterized by such symptoms as pain in the perineum, genitals, anus. The onset of pudendal nerve neuralgia can occur after surgery, cycling, trauma or without a provocative factor. Today, there is no ideal method for treating pudendal neuralgia. Treatment includes medication, blockade, decompressive surgery, or radiofrequency intervention. The article presents the clinical case of a patient who received a stable positive result due to radiofrequency pulse ablation (PRF) of the pudendal nerves after unsuccessful long-term conservative treatment. 44 years age patient complained of a pronounced pulling and throbbing pain in the perineum from the anus to the pubis, which was strengthened in the sitting position. The manifestation of the disease occurred several years ago for no apparent reason. Over time, the pain acquired signs of neuropathic, that is, burning and baking, sometimes unbearable. Conservative treatment included non-steroidal, anti-inflammatory drugs, physiotherapy procedures, massage and antidepressants. But it turned out to be ineffective: the patient’s condition worsened, she was forced to resign from the work (office clerk). After a comprehensive examination (MRI, SCT, ultrasound, physical examination), a diagnosis was established: chronic neuropathy of the pudendal nerves. Under the fluoroscopic and ultrasound-guided treatment-diagnostic block of the pudendal nerves. Received a positive result – for the duration of the action of the anesthetic pain was stopped. After this a pulse radiofrequency ablation of the pudendal nerves was performed at a frequency of 2 Hz (20 millisecond pulses) at 42°C, duration 120 seconds. Observation for 2 months confirmed the correctness of the chosen strategy. The pain significantly decreased, reaching a level of temporary discomfort, the patient returned to professional activity. The success of the treatment in such way: from medical-diagnostic block under X-rays and ultrasound-control to destructive radio-frequency procedures.

Keywords

• perineal pain
• pudendal neuralgia
• pulsed radiofrequency
• interventional pain management
• prf