Pain With No Objective Sensory Impairment?

[kia kaha]

This is fourth on the list of the 5 criteria for diagnostic criteria NANTES system.

Pain With No Objective Sensory Impairment

what exactly does this mean?
please hope someone can explain in laymans terms.

This is an essential clinical finding. The presence of a superficial perineal sensory deficit is highly suggestive of a sacral nerve root lesion, particularly involving the cauda equina nerve roots, or a sacral plexus lesion. These proximal lesions usually do not cause pain and present clinically with sensorimotor deficits, especially sensory loss and sphincter motor disorders. Several hypotheses can be proposed to explain this absence of objective sensory impairment. The compression may be insufficient to induce a lesion of the fibers of superficial sensation, as observed in the case of sciatica and many cases of carpal tunnel syndrome. It may also have an anatomical explanation, as several anatomical territories overlap at this level: the territory of the pudendal nerve, the territory of the posterior femoral cutaneous nerve and its inferior cluneal branches, and the territories of nerves arising from the first lumbar nerves (especially ilioinguinal and genitofemoral).8

is it saying that you NEED to have different sensory/sensations in the area that also experiences pain?

namaste

[catherine a]

Kia Kaha,

Send this text to WHRIA and ask them to explain in layman's terms. See if you get a response. They had the Nante's team here in Australia in Feb. this year.

See their website: www.whria.com.au. I can do it for you if you like then back to you.

Catherine

[kia kaha]

Thanks catherine.
I'll do it.

Yes, the speciliast I saw had been to that conference in Sydney and spoken with Vancaillie, as well as listened to the Nantes team.
He said they spoke about ten patients presenting with pudendal issues, and only 4 of them qualified for surgery.
My specialist seemes to think I don't fit the criteria because he says I dont have sensory differences.
(according to him with pin prick tests etc), even though he noted unusual stuff in my appointment with him december last year.
Along with me reporting numbness in pubic area, and disturbing creepy feelings/anti-arousal in ladies bits. plus more.

This is just all so bloody confusing for me!

[carolynm]

I have found the sensory component to only occur during a "flare", and it is usually a pins & needles sensation in left vulva. I presented initially to the ER with saddle numbness, and was ruled out for cauda equina syndrome. I don't th in we all have the sensory issues ALL the time.

Just my two cents!

Cm

[Violet M]

is it saying that you NEED to have different sensory/sensations in the area that also experiences pain?

No, I think it's saying the opposite -- that in the Nantes team experience if you have pudendal nerve entrapment, you typically do not have a loss of sensation (on the surface of the perineum http://medical-dictionary.thefreedictio ... m/perineum). You have pain if you have pudendal nerve entrapment.

As I understand it, they are saying that if you do have a loss of sensation, it's more likely you have a problem in the nerve roots in the spine or in the plexus of nerves just below the spine that's called the lumbosacral plexus -- not lower down in the traditional areas of nerve entrapment at the ischial spine and alcock's canal. Check out the anatomy page to understand this better. http://pudendalhope.org/node/13

But, remember pudendal neuralgia is not always caused by an entrapment. That article is discussing the symptoms of nerve entrapment specifically.

Does that explanation make sense? I mean -- is it in layman's terms enough to understand?

[helenlegs 11]

Yes it has taken me some time to get my head around what this exactly means too.
As I understand it (please correct me if wrong, as I have struggled) it means that if you do have sensory impairment, i.e. numbness ALONE in the pubic area it is probably due to spinal/cauda equina/plexus problems.
So a patient may have this symptom of sensory impairment and as a result may also suffer from single or double incontinence and therefore be diagnosed with say cauda equina syndrome and not PN.
However there isn't usually a great deal or any? pain associated with these pathologies.
When there IS pain in the pubic area, whether that pain is accompanied by sensory impairment/numbness or not it is an indication of PN.
I know I have numbess and I am more numb on one side than the other (labia major) I do have other areas of constant numbness but think this is the only pudendal nerve area that would be affected.
I think that Jacques Beco does the pin prick test to establish sensory impairment which he says is a pointer to PN but additionally pain must be a symptom as well. Of course some people have pain without any sensory impairment and have PN, but there must be some pain.
Helen

[kia kaha]

Kia Kaha,

Send this text to WHRIA and ask them to explain in layman's terms. See if you get a response. They had the Nante's team here in Australia in Feb. this year.

See their website: http://www.whria.com.au. I can do it for you if you like then back to you.

Catherine

here is the reply I received..

Thank you for your e-mail. I will try my best to explain what Pain With No Objective Sensory Impairment
means.

The bottom line is that when the pudendal nerve is 'entrapped' it does cause pain but does not cause LOSS of function, especially loss of sensory function. Sensation can be subdivided into touch, temperature and vibration. All these functions can be tested clinically with a brush, cold or warm cotton bud and a tuning fork. So what we do in practice, is examine the patient to make sure that the sensory function of the perineum (in the region innervated by the pudendal nerve) does indeed present with no deficit, before we entertain the possibility of pudendal nerve entrapment.

Hope that helps.

Thierry

so the specialist I saw last week said he doubted Pudendal issues because I do not have sensory impairment, so Theirrys reply, and of Helens, says that no impairment is a positive indication.
And yes, I do have abundant PAIN !

[helenlegs 11]

I don't think he is right either. From what the Nantes Criteria states PAIN is the essential feature. Sensory impairment isn't always present.

If you take a look at this http://www.pudendalhope.org/sites/defau ... NTubbs.pdf
In this medical report it says. . .. . . .The pudendal nerve is predominantly responsible
for perineal innervation and consists of 3 terminal
sensory branches.11,12 The inferior rectal branch supplies
the integument around the anus and communicates with
the PBPFCN.2 This communication between the PFCN
and the pudendal nerve is believed to be one of the reasons
that sensory impairment is usually not seen with entrapment of the pudendal nerve.10

the ref 10 is to The Nantes Criteria.
Take care,
Helen