Treatment options for persistent pain following pudendal nerve decompression surgery

Proceedings of the 31st Annual Meeting of the International Urogynecological Association, Athens 2006

Jerome M. Weiss, M.D.

Pacific Center for Pelvic Pain and Dysfunction, San Francisco, California

Abstract

In general, patients expect some pain following decompression surgery. However, six months later when they continue to have severe flares that may eclipse their preoperative symptoms, they suffer desperation and depression. When nerve blocks provide no significant long term relief, we must look "outside the sensitive nerve" or "outside the box" for treatment answers. After evaluating and treating more than thirty post operative patients and approximately 200 that did not require surgery, some of these answers to the treatment questions have emerged.

Many of these post operative pain generators were actually preexisting myofascial dysfunctions that predisposed the nerve to injury and then remained a dominant problem following surgery. Others developed because of the effect that the sensitized nerve and/or surgical trauma had on the surrounding connective tissue, muscles, and ligaments. It is only after these extra neural causes are identified and treated that significant pain relief can be achieved.

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