Nerve Block Question(s)

[Violet M]

Clare, I didn't get much relief from the steroids but I did get flare-ups from them.

This is my understanding of nerve blocks but I could be wrong.

If you have pain going in and the nerve block relieves your pain that is diagnostic for PN but only if the distribution area of the PN (saddle area) has a loss of sensation/feeling of numbness.

Suppose you have pain, you get the nerve block and your pain is gone and your saddle area is numb. You had an accurately placed pudendal nerve block that relieved your pain so you most likely have pudendal neuralgia since your pain is relieved by an inaccurately placed block.

Suppose you have pain, you get the nerve block and your pain is gone but the area that is numb is your butt cheek and there is no numbness in the saddle area (PN distribution area). That means the anesthetic, usually Marcaine, did not get close enough to the pudendal nerve to numb it. You did not have an accurately placed pudendal nerve block. Something else is the source of your pain and you most likely don't have pudendal neuralgia.

Suppose you have pain, you get the nerve block and you have no pain relief but also no numbness in the saddle area. You had an inaccurately placed block and there is no diagnostic value to the block.

Suppose you have no pain going in, the saddle area is numbed and you still have no pain after the block. You had an accurately placed nerve block but you still don't know if it's PN because there was no pain relief -- you didn't have pain to begin with. I think it would be difficult to say you have a diagnosis of PN. I've heard it's best if you have pain going in, otherwise you can't really tell anything diagnostically from the nerve block. I suppose if you know you had an accurately placed block (because the saddle area got numb) and if you had a steroid that kicks in several days later lowering your pain levels then that could be diagnostic for PN. I wonder if the opposite is true too -- that if you have a flare-up from the steroid that could also be diagnostic for PN? It would only make sense, right?

Here's another one to add to your theory, Karyn. Some people have very thick, hard ligaments (I was one of them) so it's difficult to get the needle close enough to the nerve to place the medication accurately. That's what happened to me but I did get temporary partial relief from the nerve blocks.

Violet