Intervaginal PN Block? PN & Piriformis & lateral nerve pain

[JenM]

Hello,

I go for my pre-op on Monday (3/4/2013) with Hibner for a intervaginal nerve block. I have had two (2) previous blocks done trans gluteus. Both hit the nerve but there was no temporary or long term relief. Did botox in 2010 + 1 yr PT.

When Botox wore off Piriformis when into spasm. Muscle relaxors do little. Dry needling helped piriformis drop so limp is not noticeable. Have had Pelvic ultrasond/MRI done and Fluroscopy and ultrasound guided trigger point injections to nerve blocks. No relief.

Light touch to right side of body now intermittantly causes near blinding pain. I had EMG done 2 weeks ago and it is abnormal but no clinical specifics yet.

Anatomically the split in the pudendal nerve makes the block seems sensible. This blocks requires full sedation.

I am terrified that messing with the nerve will further anger the piriformis and further upset a yet to be diagnosed nerve issue.

I was told the transvaginal is rather new -- has anyone had this done, and if so, do you have piriformis syndrome?

I want to be hopeful, but I am really scared. I wish I had found this page 4 years ago. Thank you to all for your insights.

[nyt]

"Transvaginal is rather new" - I'm not sure what you mean. Do you mean administering the pudendal nerve block transvaginally or the botox? If you mean the pudendal nerve block that has been done for many years by ob/gyn doctors during the 2nd stage of labor. I want to say over 50 years but I would have to find the original journal publication if you really want to know how long. If you mean the botox, as far as I know Dr. Hibner was the first to administer botox transvaginally and he has been doing it several years now and has done 100's of them. Dr. Howard in Rochester, NY is now administering botox transvaginally and uses Dr. Hibner's protocol.

I've had piriformis syndrome for 5.5 years and Dr. Howard has done trigger point injections into my the piriformis for about 4.5 years with Marcaine. Dr. Hibner has done botox on me I think 5 times, might be 6 over the last 2.5 years with transvaginal pudendal block. I know not everyone on the forum has been helped by the botox and some have been made worse. Fortunately, for me I have done quite well with it all. Dr. Hibner has not botoxed my piriformis but hopefully when I have my botox again in a couple of weeks he will be able to. He does the piriformis botox under US guidance so they have to plan ahead if he is going to inject the piriformis.

Trigger points can be extremely stubborn to get rid of and if you have an unhappy nerve that keeps causing the muscle to spasm then you end up with a viscious cycle. If you have any thing specific you want to ask me just PM me.

[JenM]

Hello,
Thanks for the response. Did internal Botox in 2010. Ended major spasm that was debilitating (following internal PT of course). Next procedure is transvaginal nerve repair/block with scelorization of surrounding veins as engorgement is causing further restriction of nerve and accompanying pain. Other nerve blocks did not work. I was told by resident that last examined me at St. Joes that this nerve approach was new and that people got better, slightly better, or stayed the same, no adverse. The combination of Piriformis syndrome with SIJ issues were dismissed. Since pain on touch from upper ribcage to calf is getting worse, I am very concerned to touch anything in the nervous system.

Hibner told me that he had not done botox injections in the piriformis and that he was imaging to see if he could.

Reading everything here I am wondering if I have an underlying labral tear. MRI of Hip by physiatrist shows large femur head relative to hip capsule and hip does catch.

Does anyone have lateral pain one side (side of spasm/neuralgia) that it intermittent 10 pain with persistent 2-3 pain that is triggered by light touch? If so do you have a diagnosis or at least something that is effective. have done topical RX pain, use the B&O suppositories, and OTC pain killers.

I am so grateful to find this forum and not thing that I am out of my mind with a cluster of what appeared to be unrelated symptoms.

[Violet M]

Does anyone have lateral pain one side (side of spasm/neuralgia) that it intermittent 10 pain with persistent 2-3 pain that is triggered by light touch? If so do you have a diagnosis or at least something that is effective. have done topical RX pain, use the B&O suppositories, and OTC pain killers.

Hi Jen,

I don't know the exact area of your pain but lateral pain can be due to meralgia paresthetica.

http://www.hopkinsmedicine.org/neurolog ... etica.html
(link that shouldn't expire: http://tinyurl.com/cvjv9ej)

Some of us find that ice works about as well as any oral pain killers.

I had an unguided transvaginal pudendal nerve block -- months after PNE surgery. It wasn't a new procedure and didn't require sedation so I'm thinking it must be different than what you are going to have. It helped a little bit temporarily. I also had piriformis syndrome that slowly faded after PNE surgery.

Best,

Violet

[helenlegs 11]

This type of allodynia, pain at the slightest touch, can be due to the nerve response to pain being set at the wrong level, especially when there has been a painful problem, which can set off this central sensitization giving inappropriate pain responses.
Cognitive behavioral therapies can help significantly in this situation. Even if there is some continuing pathology that requires resolution and treatment cognitive therapies can still help enormously.
It may be that when things do calm down and you get a truer pain response to the problem you will be able to determine an actual cause better.
I have piriformis pain from a fall and subsequent lump (haematoma) in the muscle ANY physiotherapy work on that muscle will produce added pain and nerve pain symptoms. Does the same happen when you have piriformis work?
Hope this helps,
Take care,
Helen