4 Pos. Diagnostic Symptoms/Not Nerve Block

[danmrie]

I have so many of the symptoms of PN. It started about a year and a half ago, and has only gotten worse. I have been seeing a specialist for this conditiion. PT notes extremely tight pelvic floor muscles, which have not been helped by physical therapy. The pudendal nerve is definitely affected, as noted by doctor, nurse practioner, and PT. Pain upon sitting started getting worse and worse, until I couldn't sit. Now if I attempt to sit, I feel mostly pelvic vibration (or like pins and needles) and numbness. I have severe constipation. I can feel a pull or tug from my rectum straight up to a nerve or muscle in the right labia. Discomfort is a 7!
Question is: I meet 4 out of 5 of the most important diagnostic criteria, and have other supporting symptoms that point to PN. The doctor did 1 unguided nerve block which provided no help at all.

Can anyone tell me if I didn't get relief from the 1 unguided nerve block, does that preclude PN or PNE? Help!

[Elmwood]

I'd like to know the same thing. I have tingling as well and the nerve blocks did no good. I had a ganglion impar block and a bilateral (buttocks) pudendal nerve block. Niether did any good. Ever since finding this site I assumed I had PN but now I'm not so sure.

[danmrie]

Hi: What did Dr. Conway tell you when the tests revealed normal nerve function?

[helenlegs 11]

Welcome danmrie,
I would say that one unguided nerve block can't really tell you anything. That has nothing to do with quantity just the fact that it was unguided. I have heard of some Dr's who do them unguided but I would much rather have a more precise effort, to make as sure as can be that it has hit the right spot.
This block is supposed to be such a good diagnostic tool, if it hasn't actually hit the target it is either a total waste of time,OR worse! you could end up with a medical report saying no PN when it was PN all along.
Did the Dr suggest having any more? 3 are often suggested. Got to say that I would prefer to get mine from someone who is going to do them guided.
Your treatment does seem to be excellent from a multidisciplinary approach, or have you located these specialists all individually?

As to the ganglion impar block Elmwood I saw this;

Ganglion IMPAR is the last ganglion of the two chains of the sympathetic system coursing bilateral to the spine. It is located in front of the sarococcygeal joint, retroperitoneally. However, Oh et al have found that the position, shape and size of the ganglion Impar varies from person to person. This anatomic variability observed could be the cause of a potential block failure.

This could also be said about the course of the pudendal nerve, possibly even more so, as its route through the pelvis is a lengthy and tortuous. Even more reason for any block to be guided??
From what I read, the ganglion impar block is used for chronic pelvic pain (CPP), a more diffuse, poorly localised pelvic pain than pain caused by problems affecting the pudendal nerve.
A pudendal diagnosis would come under the wider umbrella of CPP, but it would then be a much more specific pain area; the path of the pudendal nerve. Even though its path can differ slightly from person to person it always ends up in the same places.
The hope is that this ganglion block will stop the pain signals from much of the whole pelvic area, which is after all what we would want.
However, it could not indicate if it was the pudendal nerve or if it was some other tissue/structure/nerve in the pelvic area that was causing the problems.
A properly targeted pudendal nerve block should be able to of course.

A piriformis shot would be able to rule the piriformis muscle in or out of the pain equation. Seemingly with you Elmwood it has been ruled out so at least that can narrow the cause of the problem down somewhat, but it definitely can't rule the pudendal nerve out of the equation.

I think the fact that the ganglion impar block didn't work was just a shame, a bit of bad luck. reference back to the red coloured text.
Really they are not by nature diagnostic tools. They are used to give pain relief and are not designed to discover where or what in the pelvis the pain is related to. Rather they know the pain is in the pelvis (somewhere) and they are just trying to stop it.
Well this is my understanding of it. PLEASE someone correct me if wrong. It has been known
Take care all,
Helen

[janetm2]

Helen provided some great info again and beat me to the post - here is what I had and see no reason to update and may confirm some of Helen's info:
The unguided block not giving you relief I think says nothing. A guided or even unguided that gives relief leans toward saying you have PN and/or PNE. The unguided blocks were somewhat successful but the guided was full relief and it turns out I was entrapped and I had nerve decompression surgery. Diagnosis for me included the blocks but also previous constipation and long term sitting (8 hour work days plus evenings and weekends to avoid standing and walking due to chronic foot pain). It is not easy to diagnose this even with the symptoms and tests.
Janet

[Elmwood]

Thanks for responding to us.

My blocks were in fact guided. But I just had one (bilateral) block. Don't many doctors suggest a series of 3? My doctor said he would just do the one. Kind of frustrating because I go back and forth wondering if I have PN or not. I seem to have symptoms but without a definitive diagnosis its tough to get the proper treatment. Seems like Danmrie may be in the same boat. I guess one of those 3T mri's is the way to go. I have just been diagnosed with bilateral hip arthritis and went yesterday for an MRI of the hip to see what other damage I may have down there.

[carolynm]

It depends where anatomically the nerve block was performed. I definitely haVe PN but had a negative fluoroscope-guided block earlier this yr at the ischial spine. Nerve blocks are only part of the diagnostic workup. They are not foolproof.