Abstract - Pudendal Neuromodulation for Pudendal Neuralgia

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Abstract - Pudendal Neuromodulation for Pudendal Neuralgia

Postby nyt » Fri Dec 18, 2015 10:40 am

Low Urin Tract Symptoms. 2015 Sep;7(3):138-42. doi: 10.1111/luts.12066. Epub 2014 Jul 8.

Pilot Study Exploring Chronic Pudendal Neuromodulation as a Treatment Option for Pain Associated with Pudendal Neuralgia.

Peters KM1,2, Killinger KA2, Jaeger C1, Chen C2.

Pudendal neuralgia can cause significant voiding and pain symptoms. We explored the effects of chronic pudendal neuromodulation (CPN) and nerve blocks on pain associated with pudendal neuralgia.
Patients with pudendal neuralgia and tined lead placed at the pudendal nerve were reviewed. History and initial improvement after lead placement were collected from medical records. Demographics, symptom characteristics and changes after various treatments were assessed by mailed survey. Descriptive statistics were performed.
Of 19 patients (mean age 54.8 years, 63% female), 6/19 (32%) had previous sacral neuromodulation. Before CPN, 18 patients had 77 nerve blocks (median six blocks per patient); most blocks (60/77; 78%) provided at least some relief. After lead placement, pain relief was complete in three patients, almost complete in three, significant/remarkable in 10, and small/slight in three. All 19 patients had a permanent generator placed. Five were ultimately explanted at (mean) 2.95 years: one had total symptom resolution, one had stopped using the device, and three lost efficacy. Survey respondents (n = 10) indicated that they had been experiencing pain for (median) 4.42 years before CPN. The most helpful pain treatment cited was medication for 6/10 and neuromodulation for 4/10; 8/9 rated neuromodulation as more helpful than nerve block, while one subject felt that the two treatments were equally helpful. Compared to sacral neuromodulation, 3/4 rated CPN as more effective for pain. Overall, 8/10 were satisfied with CPN; only 1/9 was mildly satisfied with nerve block.
Chronic pudendal neuromodulation can improve pain in patients with pudendal neuralgia.
2/07 LAVH and TOT 7/07 TOT right side removed 9/07 IL, IH and GN neuropathy 11/07 PN - Dr. Howard
6/08 Obturator neuralgia - Dr. Conway 11/08 Disability, piriformis syndrome - Dr. Howard
4/09 Bilateral obturator decompression surgery, BLL RSD - Dr. Howard
9/10 Removed left side TOT, botox, re-evaluate obturator nerve - Dr. Hibner
2/11 LFCN and saphenous neuralgia - Dr. Dellon 2/11 MRI with Dr. Potter - confirmed entrapment
5/11 Right side TG - Dr. Hibner 2012 Left side TG - Dr. Hibner
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Re: Abstract - Pudendal Neuromodulation for Pudendal Neuralg

Postby Amanda » Sat Dec 19, 2015 11:43 pm

Thanks nyt for posting this useful information about Neuromodulation for Pudendal Pain.
Even though its a small trial, it is good to see some positive results.
I do think this technology has a lot of room for improvement, obviously lead placement is crucial to the end result.
My leads are placed at L3/4 and are tunnelled to S1-S4 in order for me to have coverage in all areas of the pelvis.
Hopefully with further studies we may find more doctors using this method of helping pudendal patients.
PNE started 2003 following Vaginal Hysterectomy, pelvic floor repair and right oophorectomy; eventually after many tests had BilateralTG surgery Nantes 2004; following this tried many other treatments including 7 day epidural, ketamin infusions to no avail; Trialed and was implanted with a Neurostimulator in 2007- Dr Van Buyten Belgium, this has enabled me to manage my pain much better.
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Re: Abstract - Pudendal Neuromodulation for Pudendal Neuralg

Postby rickim2006 » Tue Mar 01, 2016 2:29 am

I am a physician and a patient suffering from PN- I had a neurostimulator placed by Dr. Ken Peters, author of the study. As with all his patients, I had an initial 3 day trial to see if neuromodulation would work. With the trial, my pain was significantly improved. However, once the permanent was implanted, I found limited if any benefit at all. I had it placed in Sept of 2013- I want to have it removed, but am afraid to have the surgery.
I am thinking of turning it on again to see if I get any new and better response.
I will keep you posted.
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Re: Abstract - Pudendal Neuromodulation for Pudendal Neuralg

Postby Violet M » Sat Mar 05, 2016 5:30 am

That's really unfortunate that you didn't have relief with the implant. If it's bothering you it might be worth having it removed but if it's not, I wonder if it is worth the risk of another surgery and possibly aggravating things further. That's a tough decision to make. Wishing you luck with it.

PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
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