Peripheral Nerve Stimulation for Pudendal Neuralgia: A Technical Note

Abstract

Background Pudendal neuropathy is a chronic, disabling form of perineal pain that involves the pudendal nerve, a mixed somatic and autonomic nerve that originates from sacral nerve roots. Peripheral nerve stimulation of the pudendal nerve can be useful to decrease symptom burden in patients who have failed initial conservative treatment modalities. Methods In this manuscript, we describe an approach to the placement of a peripheral nerve stimulator for the treatment of pudendal neuralgia. We present a case of complex pelvic neuropathy and review the factors that lead to successful placement. Technical aspects of stimulator placement and ultrasound landmarks are reviewed. Results A lateral to medial approach with ultrasound guidance at the level of the ischial spine is likely to facilitate proper lead placement along the course of the pudendal nerve. Aftercare and adherence to postimplant activity restrictions–particularly avoiding use of the extremes of hip flexion and extension for four weeks—lead to the absence of lead migration. Conclusions Pudendal nerve stimulation is an emerging technique for neuromodulation of refractory pudendal neuralgia. Ultrasound-guided pudendal nerve stimulation is a viable technique for neuromodulation of pudendal neuralgia. Optimization of patient selection, ultrasound guidance, and proper adherence to postimplant activity restrictions may be helpful for long-term therapeutic success.

Pulsed Radiofrequency Application on Sacral Nerve Roots for Pudendal Neuralgia: Two Case Reports and Review of the Literature

“…A large retrospective study investigated CT-Guided pudendal nerve PRF with a success rate of more than 80% with a 3-months follow up(Wang C-L & Song T., 2022). The pudendal nerve stimulation has been successfully applied(Gregory NS, Terkawi AS, Prabhakar NK, Tran JV, Salmasi V & Hah JM., 2020). The sacral neuromodulation and the spinal cord neuromodulation are considered treatments of last resort when the other options, including nerve decompression, have failed to provide adequate pain control.…”

Neuromodulation of the Response to Neuropathic Pain in Chronic Diseases

“…Finally, Pérez-Neri and colleagues analyzed the therapeutic potential of low-intensity, high-intensity focused ultrasound neuromodulation for the management of neuropathic pain, which is especially useful in a group of chronic pain syndromes with a restricted response to conventional drugs [ 8 ]. The information presented is relevant, as it shows that low-intensity focused ultrasound may modify some mechanisms involved in neuropathic pain processes such as modulation of ion channels, glutamatergic neurotransmission, cerebral blood flow, inflammation and neurotoxicity, neuronal morphology and survival, nerve regeneration and remyelination, as well as minor side effects [ 9 ]. The authors propose that more clinical trials on safety and efficacy are needed, despite the evidence provided on the potential therapeutic use of low-intensity, high-intensity focused ultrasound for the management of neuropathic pain.…”