Article by Stephanie Prendergast

[Alan1646]

I've been reading this article kindly posted by Helen http://www.pelvicpainrehab.com/blog/201 ... pn-or-pne/ , and I'm left with some questions. If, as she writes, " in fact, the only way to know with any certainty whether there was indeed an entrapment post-surgery is a post-operative finding of pain relief." does it mean that surgery is not helpful or appropriate if someone does not have entrapment?

Does it depend on the definition used of "entrapment"? And could the failure of some surgeries to achieve improvement be because those operated on didn't have entrapment?

I'm feeling very confused about this.

[Violet M]

I think the answer to all of those questions is "yes", Alan. I'm not sure there is actually a medically recognized definition of entrapment at this point although I think most people use it to refer to when the nerve is encased in scar tissue or being compressed by a ligament --a condition that can be surgically released. Can't remember -- did she say something like that in her article?

There have been people who reported back on PNE forums after surgery that the physician said they did not have an entrapment so basically the only benefit of the surgery was exploratory confirmation of no entrapment. Some of these people went to Prof Robert in Nantes, France early on. I'm wondering if that is part of the reason he eventually published the Nantes criteria for diagnosing nerve entrapment. I think it's important to try conservative therapies and to do a lot of diagnostics/differential diagnoses before surgery.

Violet

[Alan1646]

Thanks for the reply Violet.
This may be a stupid question, but if the nerve is stuck between ligaments, isn't there any massage therapy that could move it out?

I think she writes in the article that if the onset of PN is gradual it is unlikely to be PNE-I'm not sure what the evidence is for that:does anyone know?
I'm interested in this because the onset of my pain was very gradual, lasting over three months before I had serious pain when sitting.

I find the idea that the only benefit of surgery could be confirmation of non PNE quite disturbing as some people report increased pain after surgery - it's quite a risk to take.

[janetm2]

Aalan,
I was the case of my nerve beings quashed by the two extremely tight (main SS and ST) gaments and PT for months was getting me nowhere. My sitting pain started with twp rounds of levator ani muscle spasms which I had stopped wirh EGS treatments in 20007&2008. Then in 2010 I sat om a hard chair in pain but did not get up rught away and that flared everey thing and sitting went bad to worse. I had PNE decompression surgery because it was entrapped. Although the chair incident may have caused it I believeit was gradual from 2007 or even earlier I think I had some sitting pain. I probably confused you more but thought I would give you my experience for what it is worth. It is somewhat of a mystery in some ways and why it is hard to diagnose, treat, etc. Sorry you have to weave yourself through the maze but good luck and keep the questions going and we will try to help answer to sort it out.
Janet

[Violet M]

Thanks for the reply Violet.
This may be a stupid question, but if the nerve is stuck between ligaments, isn't there any massage therapy that could move it out?

I think she writes in the article that if the onset of PN is gradual it is unlikely to be PNE-I'm not sure what the evidence is for that:does anyone know?
I'm interested in this because the onset of my pain was very gradual, lasting over three months before I had serious pain when sitting.

I find the idea that the only benefit of surgery could be confirmation of non PNE quite disturbing as some people report increased pain after surgery - it's quite a risk to take.

Alan, If you go to the anatomy page on the pudendalhope.org website you will see that the SS ligament attaches to the ischial spine (bone) and the ST ligament crisscrosses it at the ischial spine. These are large ligaments and I don't think PT can cause a significant enough permanent change in their position to release the nerve. Some doctors call it the "ligamental grip" because the ligaments are essentially gripping the nerve. Some people have thickened or enlarged ligaments.

My onset was gradual so I don't agree with Stephanie on that point because I turned out to be entrapped. History and clinical exam are very important in the diagnosis. I agree that you should not have surgery just to rule out PNE. I think that before deciding on surgery you need to try conservative therapies first, have a lot of diagnostics that point toward PNE and rule out other causes, and be in enough pain that you are willing to take the risk as a last resort.

Violet

[Alan1646]

Thank you for your replies. What I have learned is that entrapment can be gradual and it's very difficult to know whether the cause of PN is entrapment of the nerve or some other source of irritation that can potentially be reduced or cured by means other than surgery. I've found it encouraging to read accounts on this forum of people whose pain has improved after many years without the need for surgery.