The Nantes team is recommending steroids no longer be used in pudendal nerve blocks.
http://www.ncbi.nlm.nih.gov/pubmed/27465823
If you are thinking of having a pudendal nerve block, you might want to show this to your doctor.
Violet
Nantes Teams Study on Nerve Blocks
Nantes Teams Study on Nerve Blocks
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.
Re: Nantes Teams Study on Nerve Blocks
De Bisschop used Corticosteroids only (!) because it help to restore the cell wall impermeability compromised in inflamed nerve cells anso also told me that lidocayne is neuro-toxic (!)
2004 Urethral burnings, chronic prostatitis diagnosis, unuseful drugs. Lately added chronic pelvic contracture.
2011 Pudendal Neuralgia diagnosis, nerve blocks and oral drugs.
2013 Two neuromodulation surgeries.
2016 Possover negate Pudendal Neuralgia (no pain elicited on rectal exploration), says problem is more central but MRI- neurography show nothing.
2017 De Bisshop found Oedema/hyperpressure and neurological abnormal response on intrapiriform area, most on sx.
Failed injection blocks.
2011 Pudendal Neuralgia diagnosis, nerve blocks and oral drugs.
2013 Two neuromodulation surgeries.
2016 Possover negate Pudendal Neuralgia (no pain elicited on rectal exploration), says problem is more central but MRI- neurography show nothing.
2017 De Bisshop found Oedema/hyperpressure and neurological abnormal response on intrapiriform area, most on sx.
Failed injection blocks.
Re: Nantes Teams Study on Nerve Blocks
Bupivacaine (marcaine) would be a little better than lidocaine. https://www.ncbi.nlm.nih.gov/pubmed/16135351
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.
Re: Nantes Teams Study on Nerve Blocks
There has been some discussion between Dr. Antolak and Prof. Robert's team about the steroids in nerve blocks but I don't have access to reading these. If anyone has access to these journals I would be interested to hear a summary of the conversation if it's worthwhile.
https://www.ncbi.nlm.nih.gov/pubmed/28544719
https://www.ncbi.nlm.nih.gov/pubmed/28544720
Violet
https://www.ncbi.nlm.nih.gov/pubmed/28544719
https://www.ncbi.nlm.nih.gov/pubmed/28544720
Violet
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.
Re: Nantes Teams Study on Nerve Blocks
We have been saying for years on this forum that there aren't many patients who post here who have long-term relief from steroid nerve blocks and that there is a risk from getting worse from them. I think there might be some diagnostic value in nerve blocks containing marcaine, although even that is "iffy" because the block doesn't always hit the target, or it may infiltrate other areas of the pelvis. So, I will continue to repeat that I am not a big fan of nerve blocks. In Prof. Robert's article over 10 years ago he said don't get more than 3 steroid nerve blocks due to possible nerve damage. So we have been warned, and now his colleagues are saying no steroids at all.
Violet
Violet
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.
Re: Nantes Teams Study on Nerve Blocks
Hi Violet and Others,
Your post reminded me that I downloaded that exchange back in July and have been meaning to post it (I have access to a medical library). I attached it now. In a nutshell, Antolak and Chung list reasons why Labat and his colleagues may not have gotten an effect (e.g., injection was not in the best place, limitations in the way they measured the outcome), and Labat and his colleagues note that their results are based on a true experimental design (random assignment to conditions) that was double-blinded (i.e., the best way scientifically to assess the effect of a treatment) and that if Antolak and Chung want to draw conclusions about the effectiveness of their injection technique, they need to do such a test. I buy Labat and his colleagues' argument.
April
I just realized that the exchange I uploaded (from BJOG) is probably copyrighted, so I cannot post it, so I just removed it. If one of the moderators determines that posting is okay, let me know and I'll re-post.
April
Your post reminded me that I downloaded that exchange back in July and have been meaning to post it (I have access to a medical library). I attached it now. In a nutshell, Antolak and Chung list reasons why Labat and his colleagues may not have gotten an effect (e.g., injection was not in the best place, limitations in the way they measured the outcome), and Labat and his colleagues note that their results are based on a true experimental design (random assignment to conditions) that was double-blinded (i.e., the best way scientifically to assess the effect of a treatment) and that if Antolak and Chung want to draw conclusions about the effectiveness of their injection technique, they need to do such a test. I buy Labat and his colleagues' argument.
April
I just realized that the exchange I uploaded (from BJOG) is probably copyrighted, so I cannot post it, so I just removed it. If one of the moderators determines that posting is okay, let me know and I'll re-post.
April
Re: Nantes Teams Study on Nerve Blocks
Thanks, April. Your summary is perfect.
Violet
Violet
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.
Re: Nantes Teams Study on Nerve Blocks
Violet and all,
I'm not sure if this helps, but I thought I might contribute to the post. I saw Dr. André Mansano today in São Paulo (who is probably one of the most experienced doctors in Brazil regarding PN/PNE treatment) and I showed him this article. He told me he already knew the study, but in his opinion the problem was that the doctors used way too little steroids. In his view, NB with steroids are a good diagnostic and therapeutic option, specially if tried earlier in the symptoms.
Felipe.
I'm not sure if this helps, but I thought I might contribute to the post. I saw Dr. André Mansano today in São Paulo (who is probably one of the most experienced doctors in Brazil regarding PN/PNE treatment) and I showed him this article. He told me he already knew the study, but in his opinion the problem was that the doctors used way too little steroids. In his view, NB with steroids are a good diagnostic and therapeutic option, specially if tried earlier in the symptoms.
Felipe.
Re: Nantes Teams Study on Nerve Blocks
Thanks for that info, Felipe.
In Dr. Robert's original article on PNE he seems to recommend a conservative approach when it comes to steroids -- recommending that you don't have more than 3, so maybe Dr. Mansano is right, I don't know. I think it makes sense to at least try several nerve blocks before trying surgery but I think that steroids aren't completely without risk. They can cause tissue damage, especially when over-used.
How are you doing, Felpie? I'm glad you have some good physicians in your country.
Violet
In Dr. Robert's original article on PNE he seems to recommend a conservative approach when it comes to steroids -- recommending that you don't have more than 3, so maybe Dr. Mansano is right, I don't know. I think it makes sense to at least try several nerve blocks before trying surgery but I think that steroids aren't completely without risk. They can cause tissue damage, especially when over-used.
How are you doing, Felpie? I'm glad you have some good physicians in your country.
Violet
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.
Re: Nantes Teams Study on Nerve Blocks
Thanks for posting this information. It seems like there are very few who get long-term benefit from a nerve block.
For what it's worth, I had an MRI-guided nerve block by Jan Fritz at Johns Hopkins which included an anesthetic and steroid. I got about two weeks of sustained benefit from it. It's the only thing I have had in three years that gave me any relief so I am grateful for that even though it didn't last. I had two previous nerve blocks that were CT-guided and neither of them provided any benefit at all.
RC
For what it's worth, I had an MRI-guided nerve block by Jan Fritz at Johns Hopkins which included an anesthetic and steroid. I got about two weeks of sustained benefit from it. It's the only thing I have had in three years that gave me any relief so I am grateful for that even though it didn't last. I had two previous nerve blocks that were CT-guided and neither of them provided any benefit at all.
RC