cortisone nerve block

[Jackson]

Hi,

Anyone had experience/success with cortisone nerve blocks for pudendal neuralgia? And if so has anyone had or ever heard of increased pain from a nerve block? I've read on another site that this is possible

[susibee]

Hi Jackson,

Search through posts under the forum heading "Nerve Blocks." Cortisone (same as "steroid") is often used in a nerve block along with an anesthetic (similar to novacaine). The anesthetic is to block the nerve and can serve the purpose of diagnosis -- in other words, if you go numb after the block and your pain disappears, this helps determine that it is in fact your pudendal nerve causing you pain. Of course, the numbness wears off.

The steroid/cortisone is given as an anti-inflammatory to try to calm down the nerve and reduce some pain on a longer-term basis. Honestly, there hasn't been huge success with steroids giving longer-term pain relief in pudendal neuralgia. There have been patients who have gotten permanently worse after steroid injections. There are also some patients who get better for a period of time.

For diagnosis purposes (although I personally think pudendal neuralgia can be diagnosed clinically -- without injections), you can get an anesthetic shot only and avoid the steroid.

(Maybe this thead can be moved to the "Nerve Block" forum?)

[Jackson]

Thanks for the info. Most helpful. Bit scary, the permanently worse bit. Okay I'll look at the other forum for posting. Thanks again. I guess even an anesthetic or botox nerve block could make things permanently worse too if the nerve is knicked or is it just a case of the cortisone causing the permanent worsening?

[susibee]

It would be unusual in a radiologically guided injection to hit the actual nerve. The anesthetic or steroid injection is meant to go in the vicinity of the nerve and using CT or some other radiology, this should be possible.

Botox is not a nerve block. Botox is injected into muscles that are felt to be spasming and causing pain. The Botox paralyzes the muscle for a while.

Dr. Dellon (a peripheral nerve surgeon) told me that he doesn't believe in using steroids around nerves; he thinks the steroid can damage the nerve.

[Jackson]

Thanks for that. I'm on a learning curve. This sort of info.is a great help.

[Violet M]

Hi Jackson,

Yes, I've had pudendal nerve steroid injections but if I had it to do over again I might have just one marcaine (anesthetic) injection for diagnostic purposes unless I was headed for surgery and my surgeon absolutely required that I try steroid injections first. If the PN physicians had some good hard data to back up the argument in favor of nerve blocks then I might change my mind but so far, I haven't seen the data published.

I've been moderating the forum for seven years and it's pretty rare to hear from anyone who's had permanent relief from a nerve block. I have probably heard of more people getting long term worsening of symptoms from nerve blocks than of people who have had significant improvement so I tend to agree with Dr. Dellon, based on the descriptions of experiences I've heard from people who got worse. However, it's possible that many people who get better may not come to the forum and post.

Some of the physical therapists believe that nerve blocks can cause additional scar tissue to form. I think it is also possible (although unusual) for the nerve to be nicked by the needle even with image guidance because with most image guidance, the nerve itself is not seen but the surrounding structures are used a a guide and each of us has a slightly different anatomy so it's difficult to determine the EXACT location of the nerve. During one of my nerve blocks, the pudendal blood vessel which is right next to the nerve was nicked which meant the medication could not be delivered to the target area and I was only able to receive medication on one side. So, even with image guidance, it's not an exact science, unfortunately.

Violet M

[Jackson]

Hi Violet,

So if your pudendal blood vessel was nicked did this cause leakage of cortisone into the blood stream. i presume if it did you would have some systemic affects. And even if a cortisone nerve block is placed correctly do you/ others know of any side effects , apart from a pain flare? After all the cortisone is in the body

Jackson

[Violet M]

Jackson, when the blood vessel was nicked the physician opted not to inject the cortisone -- essentially it was a wasted injection with no medication delivered.

Yes, there can be some side effects from the cortisone injection. Things I've heard of are several weeks of depression, pain flare-up as you mentioned, and possible damage to the nerve itself from several people who got worse (long-term) afterward.

[doggicam]

I was severely injured by a vaginal pudendal nerve block unguided. The injection caused a very large hematoma in my pelvis that took two years to resolve. I was unable to work for 6 months. Dr McDonald did the procedure (ucla). I have contacted other drs and pelvic pain centers that considers this to be experimental at best. Hope this helps

[Bathsheba]

I had two cat scan guided nerve blocks performed by Dr. Howard Richard at the UofMD. When I was in the CT room with him before the procedure, I asked him what he could actually see on the cat scan and he said "only the pudendal canal." They cannot see the nerves themselves which is why they want you awake during the procedure so you can tell them if you feel a twinge or sensation.

I agree with Violet that use of these blocks to diagnose PN or PNE is not necessary. In my case, I had damage caused by surgical trauma with symptoms that fit the criteria for diagnosing PN "to a T." I even had the "foreign object in rectum" as an early symptom of full blown PN.

Poking a needle around in the pudendal canal just doesn't sound right. If the nerve is already damaged, why damage it more? Dr. Marvel, a pelvic pain specialist, told me that he was sure I'd be cured by a series of up to 6 of these shots. Marvel referred me to Howard Richard, who does the shots. He charges $928 for each shot and gives no discount if you are uninsured (as I am). You do the math. Most of his patients are probably insured or on medicaid/medicare, so they don't pay much for each shot. This is a lucrative practice, but I am not sure anyone has ever been cured by these shots, more likely harmed.