343 posters, 5 videos, 2 audios, 18 topics, 33 sessions, 263 authors, 202 institutions
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24th Annual Pain Medicine Meeting 2025
November 13-15, 2025| JW Marriott Austin, Austin, Texas
2193420
Pudendal Nerve Stimulator Provides Long-Term Relief from Persistent Urethral Discomfort
Poster Presenter
Authors
Affiliations
Part of Topic
Medically Challenging Cases
INTRODUCTION
•Chronic pelvic pain (CPP) has a high global prevalence and financial cost to healthcare.1,2
•Pudendal neuralgia is implicated in many cases of CPP.3
•Current literature on pudendal peripheral nerve stimulators primarily addresses urologic complaints, with little on their efficacy addressing CPP.
PATIENT PRESENTATION
•PMHx:
o36yoF w/hx retroperitoneal liposarcoma s/p surgical resection. Had recurrence three years later now s/p ex-lap and radiation therapy.
•HPI:
oOutpatient clinic w/ 7/10 low back pain, urethral pain, and left anterior thigh pain persisting for several years despite multidisciplinary treatment
oModerate relief w/ Oxycodone 15mg Q6H, Morphine 30mg BID, Amitriptyline 75mg QHS
•DDX:
oPelvic floor hypertonicity leading to pudendal neuralgia
INTERVENTION AND RESULTS
•Interventions:
oTrial L fluoroscopic pudendal nerve block w/ 90% improvement in leg pain, 100% in urethral pain lasting 8 months.
oConfirmatory pudendal nerve block (Figure 1) w/ 100% relief.
oPudendal PNS (300 micron MicroLead 2.0 by SPRINT PNS) fluoroscopic implantation
•Results:
o>75% pain improvement, continues to this day
oEliminated morphine from pain regimen.
oPNS removed 2 months later given symptom resolution
DISCUSSION
•Pudendal Nerve Block Literature Review:
oHas utility in pudendal neuralgia diagnosis and treatment.4
oAssociated w/ reduced opioid needs and fewer episodes of unacceptable pain.5
oRisk of waning efficacy, only 25% of patients w/ relief after 6 months.6
•Pudendal PNS Literature Review:
oNo robust literature on pudendal PNS implantation for CPP.
oLimited study of PNS implantation for pudendal neuralgia w/ 5 of 13 patients reporting >50% improvement.7
•Our Case: Pudendal nerve block and PNS insertion enabled relief and opiate wean.
Placement of chronic pudendal nerve stimulator resulted in > 6 months of sustained relief from CPP and facilitated weaning of daily opiates.
REFERENCES
1.Ahangari A. Prevalence of chronic pelvic pain among women: an updated review. Pain Physician. 2014;17(2):E141-E147.
2.Collett B. Visceral pain: the importance of pain management services. Br J Pain. 2013 Feb;7(1):6-7. doi: 10.1177/2049463713480138. PMID: 26516492; PMCID: PMC4590154.
3.Ghoneim AA, Mansour SM. Comparative study between computed tomography guided superior hypogastric plexus block and the classic posterior approach: A prospective randomized study. Saudi J Anaesth. 2014;8(3):378-383. doi:10.4103/1658-354X.136625.
4. Li J, Liu H, Qin K, Liu M, Yang H, Li Y. Efficacy and safety of pudendal nerve block for postoperative analgesia of hemorrhoids: a systematic review of 7 randomized controlled trials. Ann Palliat Med. 2021;10(2):2283-2292. doi:10.21037/apm-20-2109.
5.Knox MC, Thiruthaneeswaran N, Zhong G, et al. Efficacy and safety of the pudendal nerve block as a component of multimodal analgesia for cervical brachytherapy. Clin Transl Radiat Oncol. 2025;54:101001. Published 2025 Jun 27. doi:10.1016/j.ctro.2025.101001.
6.Ran J, Lu F, Xu L, et al. Efficacy of ganglion impar block combined with pudendal nerve pulsed radiofrequency for pudendal neuralgia management-a randomized clinical trial. Trials. 2024;25(1):316. Published 2024 May 13. doi:10.1186/s13063-024-08152-3.
7.Hoang Roberts L, Vollstedt A, Volin J, McCartney T, Peters KM. Initial experience using a novel nerve stimulator for the management of pudendal neuralgia. Neurourol Urodyn. 2021;40(6):1670-1677. doi:10.1002/nau.24735.