Which should I do?

[dlb]

I have had one pudendal nerve block, which did not seem to work. My Urogynocologist has said she would refer me to a orthopedic dr. or a interventional radiologist...or I can go back to the pain clinic who gave me the pudendal nerve block and have them try again/or something else.
Does anyone have any advice...I'm really not sure what to do, or if there is an advantage to one over the other. I have an appointment with the pain clinic on Thursday to discuss why the nerve block didn't work and options...I am assuming they will suggest I come back to them to try again.
Right now I am on Gabapentin, a muscle relaxer (sorry, forgot name) and hydrocodone. Seems that regardless of what I take the pain does not go away. I am also in PT.
Any advice would be appreciated.
Thanks

[Faith]

How exactly was your nerve block done (i.e point of entry, any guidance used (ultrasound, xray, CT)?

[dlb]

It was done in my bottom and they had some type of xray machine they were watching it with. Although I could not see what was going on, when I laid down I could see it above me and they said they would use that to see where to go.

[Faith]

It's hard to say what exactly I would do in your case. How experienced in PN blocks was the pain doc who did your block? I highly doubt an orthopedic doc is going to know how to deal with PN, but I am sure there are some who are aware of it. If the interventional radiologist knows is more experienced in PN blocks then you might want to try him. It really depends on their experience and I would ask more questions about how exactly they do the blocks and where exactly they are injecting. Hopefully they are injecting at the ishcial spine under xray guidance or Alcock's under CT guidance.

I am not sure where exactly in the country where you live but if you are planning to see a PN specialist maybe you can get a block done there if you are worried that your local doctors do not know enough about PN to do the blocks appropriately.

When you say the block didn't work, did you get any relief at all after it, like while you were numb? And were you numb in the distribtution of the pudnedal nerve?

[dlb]

I think the Dr. was experienced in giving nerve blocks...but not sure how experienced she is with this problem. I went to see her today and she increased the Gabapentin, is referring me to a Integrated Health Clinic associated with the hospital/practice. I'm not sure how I feel about that or if I think that will really do any good. I told her that my PT said she thought it could be the obturator? she told me to come back in 6 weeks and if I have had no relief she can look into that. I had no relief from the pudendal nerve block...not even when it was numb. Basically she told me there are a lot of nerves in the pelvic area and that they all intertwine so it is hard to figure out where it might be. She also said it is hard to say if it is a muscle pinching a nerve because it is in spasm or a nerve in spasm causing the muscle spasm.
My Urogynocologist (who I consider my main dr. at this point) is the one who gave me the option of the interventional radiologist or the orthopedic. I don't think there is anyone in my area that is a specialist in PNE.
Really I feel like I get a lot of the run around....Right now all I have are the medications and PT...is it worth going to the interventional radiologist to see if they can get the pudendal nerve block right?

[carolynm]

dlb,
maybe if you tell us where you are located, someone on the forum will know someone in your area who is specialized in the PN blocks. Not too many people are familiar with them.

cari