The American Academy of Pain Medicine      Annual Meeting Home Page     
23rd Annual Meeting
February 7-10, 2007
New Orleans, LA

2006 American Academy of Pain Medicine
 


Thursday, February 8, 2007
117

Selective Sacral Nerves Stimulation for Pudendal Nerve Entrapement Syndromes

Samer Narouze, MD, MS and Amgad Abdou, MD. Cleveland Clinic Foundation, Cleveland, OH, USA

Introduction:

Sacral nerve stimulation was reported to be effective in managing voiding disorders related to chronic pelvic pain. We present two cases of intractable pudendal neuropathy that were effectively controlled with selective sacral nerve stimulation through a dorsal percutaneous transforaminal approach.

Case #1: 67-year-old woman with 20 year history of genital pain that started insidiously with no known initiating incident. The pain is described as burning and twisting sensations reaching 10/10 when she is sitting. The Pain is localized to the clitoris and the immediate surrounding area. Multiple treatment modalities have been exhausted. She had pudendal nerve block with total relief for three days. She also failed a SCS trial as well as intrathecal medications. After a successful trial, the patient underwent bilateral S3 lead implant via dorsal percutaneous S3 transforaminal approach. Medtronic Interstim tined leads were chosen to overcome the problem of lead migration as they have tines designed to deploy as a fixation system. The patient did obtained complete relief of her pain.

Case #: 2 84-year-old woman presented with the complaint of perineal pain of almost 30 years duration. She failed multiple treatment modalities. She had a complete relief after a diagnostic bilateral S3 and S4 nerve roots block. She underwent bilateral S3 lead implant after a successful trial. Three months later, she is still has excellent relief.

Discussion:

The diagnosis of pudendal neuropathy is mad if at least two out of the following three criteria were met: typical symptoms, abnormal electrophysiological test, and positive response to pudendal nerve block. Selective sacral nerves stimulation is an effective treatment for pudendal neuropathy. Among the several approaches available for sacral nerve stimulation, the transforamenal approach seems to overcome the problem of lead migration with better coverage.


References: 1. Anesthesiology Clin North America 2003; 21:785-795. 2. Am J Phys Med Rehabil 2003; 82:479-484. 3. Neuromodulation 2006; 9(3): 229-233.
Funding: None

Samer Narouze, MD, MS
Nothing to disclose.