Ano-perineal pain can be due to pudendal neuralgia. Treatment techniques include medications, steroid injections, neuromodulation, and decompressive surgery. We present a case involving a novel method for treating perineal pain using pulsed radiofrequency (RF) of the pudendal nerve.

Case:

A 41 year old female presented with 1.5 years of sharp, burning pain in the left gluteal and perineal region that prevented the patient from sitting for longer than 10 minutes. MSContin, Percocet, nabumetone, and pregabalin only provided minor relief. The patient had previous pudendal nerve blocks with lidocaine that reliably produced 80% relief lasting only a few hours. The patient eventually elected to undergo pulsed RF of the left pudendal nerve. An RF needle was inserted transvaginally and directed towards the posteromedial aspect of the ischial spine through the sacrospinous ligament. Sensory stimulation at 50 Hz produced paresthesias that corresponded to the patient's pain complaint. Pulsed mode RF lesioning was carried out at a frequency of 2 Hz and a pulse width of 20 milliseconds for a duration of 120 seconds. At four months post procedure the patient required only amitriptyline and occasional Percocet for pain control.

Discussion:

The pudendal nerve is a somato-sensory nerve derived from the L4-S2 nerve roots. Pulsed radiofrequency delivers a low temperature electrical field; thus, providing non-neurolytic lesioning. It is believed that the RF electrical field modifies the neuro-cellular function without nerve destruction. There is also thought to be a potential thermal neurolytic effect at 42-45 degrees centigrade. Due to the non-destructive nature of this technique, neuropathic pain conditions can be treated without fearing further neuritic injuries. Thus, pulsed RF lesioning of the pudendal nerve may safely provide relief in patients suffering from intractable perineal pain.