Fang H, Zhang J, Yang Y, et al. Clinical effect and safety of pulsed radiofrequency treatment for pudendal neuralgia: a prospective, randomized controlled clinical trial. J Pain Res. 2018 Oct 16;11:2367-2374. eCollection 2018. (Original study)

Background: Pudendal neuralgia is an intractable pain related to the pudendal nerve. The clinical effect and safety evaluation of pudendal neuralgia were investigated by pulse radiofrequency (PRF) treatment of pudendal nerve.

Patients and methods: Eighty patients who were diagnosed with pudendal neuralgia were randomly divided into PRF group (PRF and pudendal nerve block [NB]) and NB group. After surgery, the patients were followed up to evaluate the visual analog scale (VAS) score and the Patient Health Questionnaire score on the postoperative day and at 2 weeks, 1 and 3 months. Meanwhile, the patients' efficacy assessment and the usage of pain medication were also recorded for 3 months during follow-up. All the surgical complications were recorded.

Results: A total of 77 patients were followed up, 38 in the PRF group and 39 in the NB group. On the postoperative day, the VAS scores was significantly decreased in both groups than before (P<0.01), whereas there was no statistical difference within the two groups (P>0.05). However, the VAS score of PRF group was significantly lower than that of NB group in 2 weeks, 1 and 3 months after surgery, respectively (P<0.01). In the meanwhile, the Patient Health Questionnaire score of PRF group was also significantly lower than that of NB group (P<0.01) in 3 months after the operation. The clinical effective rate of PRF group was 92.1% in 3 months after surgery, while this rate was only 35.9% in the NB group. The postoperative analgesic usage of PRF group was superior to that of NB group (P<0.01). No severe adverse events were observed in either group.

Conclusion: Compared with the single NB treatment, pudendal nerve PRF combined with NB therapy could provide more long-lasting relief from pain symptoms of pudendal neuralgia and improve the depression symptoms in patients.

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Physician rater

This is an interesting study of effectiveness of radio frequency ablation vs block for pudendal nerve neuritis. Though a Small sample size, the results indicate a clinically significant improvement in pain and quality of life, including depression. This study is highly relevant for pain management specialists, and of some interest to primary care providers for what may be an underdiagnosed and treated condition.
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