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Chronic Pelvic Pain

Mrmr Soliman on March 2, 2017 at 2:40 pm
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    • Mrmr SolimanMrmr Soliman
      Member
      Joined: Feb 23, 2017
      Posts: 1
      #23906

      I would like to ask you about management of chronic pelvic pain. The patient had been suffering 3years ago she was diagnosed as having pudendal nerve entrapment by nerve conduction study after running through a lot of investigation (MRI spine and pelvis,CT abdomen which revealed nothing) she is suffering from pain increasing with sitting and referred to the vagina anterior, to the anas posterior and also now to the inner aspect of the thigh she underwent nerve block under image twice and radiofrequency ablation without considerable improvement. Now she is on gabpenten150 twice daily but the pain is getting worse. I would like to ask you sir if there is any thing else which can be done for her. Sorry for your interruption, Thank you Dr for your kind care.

      • Fabricio Dias AssisFabricio Dias Assis
        Participant
        Joined: Sep 6, 2016
        Posts: 5
        #24234

        At first you should look for any area of entrapment of the nerve, which could happen many times. A MRI neurography of the sciatic and pudendal nerves could help. If you find an entrapment zone than you can do an ultrasound guided hydrodissection of the nerve with 15 to 20 cc of Ropi 0,2% + steroid. Sometimes you should repeat it 2 or 3 times.
        If you do not find anything or you don’t get a satisfactory pain relief you can try sacral retrograde spinal cord stimulation.
        Good luck!

        • Pankaj SurangePankaj Surange
          Member
          Joined: Aug 10, 2016
          Posts: 1
          #24235

          If the RF is done under fluoroscopic guidance, i would suggest to do it under Ultrasound guidance. Sacral stimulation is another option if that fails.

          • Italo PisaniItalo Pisani
            Member
            Joined: Apr 26, 2017
            Posts: 0
            #44830

            Hello Dr Soliman,

            It is true that nerve entrapment of the pudendal nerve could be the initial cause, and in that case the simple blockages plus radiofrequency have not been entirely satisfactory, I would consider a pain maintained by the sympathetic nervous system, and at the pelvic level would suggest the infiltration is diagnostic of the hypogastric plexus or even easier of the impar ganglion … I personally would start with the latter because of its ease and low risk saludos

            • Burton EngelBurton Engel
              Participant
              Joined: Sep 26, 2017
              Posts: 0
              #44831

              Have you considered a ganglion impar bock as an adjuvant? Given the chronicity and region this could be a helpful and lower risk consideration- if I am understanding your case correctly. Best of luck to you, Sir.

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