Health Organization for Pudendal Education

Does this article sound too good to be true? Have any of you had blocks at S2-S4?

J Minim Invasive Gynecol. 2011 May-Jun;18(3):401-4.
Transsacral s2-s4 nerve block for vaginal pain due to pudendal neuralgia.
Cok OY, Eker HE, Cok T, Akin S, Aribogan A, Arslan G.

Department of Anesthesiology and Reanimation, Baskent University, School of Medicine, Ankara, Turkey.

Pudendal neuralgia is a type of neuropathic pain experienced predominantly while sitting, and causes a substantial decrease in quality of life in affected patients. Pudendal nerve block is a diagnostic and therapeutic option for pudendal neuralgia. Transsacral block at S2 through S4 results in pudendal nerve block, which is an option for successful relief of pain due to pudendal nerve injury. Herein is reported blockade of S2 through S4 using lidocaine and methylprednisolone for successful treatment of pudendal neuralgia in 2 patients with severe chronic vaginal pain. The patients, aged 44 and 58 years, respectively, were referred from the Gynecology Department to the pain clinic because of burning, stabbing, electric shock-like, unilateral pain localized to the left portion of the vagina and extending to the perineum. Their initial pain scores were 9 and 10, respectively, on a numeric rating scale. Both patients refused pudendal nerve block using classical techniques. Therefore, diagnostic transsacral S2-S4 nerve block was performed using lidocaine 1%, and was repeated using lidocaine 1% and methylprednisolone 80 mg after confirming block efficiency as demonstrated by an immediate decrease in pain scores. After 1 month, pain scores were 1 and 0, respectively, and both patients were free of pain at 6-month follow up. It is suggested that blockade of S2 through S4 using lidocaine and methylprednisolone is an effective treatment option in patients with chronic pudendal neuralgia when traditional pudendal nerve block is not applicable.

Copyright © 2011 AAGL. Published by Elsevier Inc. All rights reserved.

PMID: 21545967 [PubMed - in process]

Violet,

Do you know where these docs practice? I would love to try a treatment like this as it seems that the source of my pn pain is in the sacrum which is hurting like the dickens these days. And to tell you the truth I am very wary of having a nerve block, needles, or injections in or around my private parts given how much they (too) hurt already.

Could you kindly post a link to the abstract as I'd like to copy it and discuss it with my neurologist/pain doctor, Dr. Gordon, next week.

Thanks again for everything, Violet, you are a gem!

Here's the link to the article http://www.ncbi.nlm.nih.gov/pubmed/21545967 but it looks like they are in Turkey. Probably any decent anesthesiologist could do this type of block but I think it would be best done under image guidance.

I just think their results sound too good to be true, especially if there is an entrapment at the ischial spine or alcock's canal but I could be wrong.

Violet M wrote:I just think their results sound too good to be true, especially if there is an entrapment at the ischial spine or alcock's canal but I could be wrong.

Hi Violet - I don't think you're wrong as far as entrapment is concerned. Based on the clip you posted, it appears the focus is Neuralgia and not entrapment. I could be wrong, too!
Warm regards,
Karyn

I had numerous s2-s4 blocks towards the beginning of my journey. At first, they helped for about 4-6 weeks but I never got any lasting benefit. I also had pulsed radio frequency at s2-s4 which was one of the worst things i had done treatment wise. Flared my pain for months and caused permamnent setback for me. I also noticed that after the second or third injection that the epidural blocks seemed to be worsening my sacral pain.

Merrie

My last pain doc gave me injections at S2-S4 and also pudendal nerve blocks at the same time - claimed he had success before with it. Not only did it not even numb my pudendal pain (made it much worse for about 6 weeks), I also found out he injected me with a steroid that can permanently damage nerves and cause an even worse condition than PN - adhesive arachonoditis. There are preservatives in the steroid injection - depo medrol, celestone, etc. - that inflame the spinal nerves. Then they start developing sticky adhesiveness. They use these steroids because they are cheaper - longer lasting. They are actually used to kill nerves. Just google it.

Thanks for the warnings, Merrie and Scaredgal. I knew it sounded too good to be true!