Therapeutic Efficacy of Ultrasound-Guided High-Voltage Long-Duration Pulsed Radiofrequency for Pudendal Neuralgia

Pudendal neuralgia (PN) is a complex disease with various clinical characteristics, and there is no treatment showing definite effectiveness. This study is aimed at evaluating the clinical efficacy of ultrasound-guided high-voltage long-duration pulsed radiofrequency (PRF) for PN. Two cadavers (one...

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Published in:Journal of neural transplantation & plasticity 2021, Vol.2021, p.9961145-8
Main Authors: Ji, Feng, Zhou, Shuzhuan, Li, Caixia, Zhang, Yongyan, Xu, Hua
Format: Article
Language:English
Subjects:
Adult
Aged
Care and treatment
Electric stimulation therapy
Fecal incontinence
Female
Foreign bodies
Health aspects
Humans
Ligaments
Male
Medical research
Medicine, Experimental
Middle Aged
Neuralgia
Pain
Pain Management - methods
Pain Measurement
Patients
Pudendal Nerve - physiopathology
Pudendal Neuralgia - physiopathology
Pudendal Neuralgia - therapy
Pulsed Radiofrequency Treatment - methods
Quality of life
Radiation
Treatment Outcome
Ultrasonic imaging
Ultrasonography, Interventional - methods
Veins & arteries
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Zhou, Shuzhuan
Li, Caixia
Zhang, Yongyan
Xu, Hua
description Pudendal neuralgia (PN) is a complex disease with various clinical characteristics, and there is no treatment showing definite effectiveness. This study is aimed at evaluating the clinical efficacy of ultrasound-guided high-voltage long-duration pulsed radiofrequency (PRF) for PN. Two cadavers (one male, one female) were dissected to provide evidence for localization of the pudendal nerve. Patients diagnosed as PN who failed or were intolerant in regular medication were screened for diagnostic local anesthesia block of the pudendal nerve before recruitment. Twenty PN patients were enrolled in this study. In the PRF procedure, the needle tip was inserted medially into the internal pudendal artery under ultrasound guidance. The position of the PRF needle tip was then adjusted by the response of the pudendal nerve to the electrical stimulation within the pudendal area (42°C, a series of 2 Hz, and 20 ms width pulses that lasted for 900 s). Alleviation of pain was assessed by the visual analogue scale (VAS) and sitting time pretreatment and on 7 d, 14 d, 1 m, 2 m, 3 m, and 6 m posttreatment in outpatient follow-up or by telephone interview. Two patients were lost due to intervention-irrelevant reasons. Patients showed significantly decreased VAS scores on 7 d after RFP, compared with pretreatment status (7.0±0.9 vs. 3.2±1.7, P
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This study is aimed at evaluating the clinical efficacy of ultrasound-guided high-voltage long-duration pulsed radiofrequency (PRF) for PN. Two cadavers (one male, one female) were dissected to provide evidence for localization of the pudendal nerve. Patients diagnosed as PN who failed or were intolerant in regular medication were screened for diagnostic local anesthesia block of the pudendal nerve before recruitment. Twenty PN patients were enrolled in this study. In the PRF procedure, the needle tip was inserted medially into the internal pudendal artery under ultrasound guidance. The position of the PRF needle tip was then adjusted by the response of the pudendal nerve to the electrical stimulation within the pudendal area (42°C, a series of 2 Hz, and 20 ms width pulses that lasted for 900 s). Alleviation of pain was assessed by the visual analogue scale (VAS) and sitting time pretreatment and on 7 d, 14 d, 1 m, 2 m, 3 m, and 6 m posttreatment in outpatient follow-up or by telephone interview. Two patients were lost due to intervention-irrelevant reasons. Patients showed significantly decreased VAS scores on 7 d after RFP, compared with pretreatment status (7.0±0.9 vs. 3.2±1.7, P&lt;0.001). The efficacy remained steady till the end of 6 months, with a final remission rate of 88.9%. Sitting time also significantly lengthened following PRF (7 d, 14 d, 1 m, 2 m, 3 m, and 6 m vs. pretreatment, all P&lt;0.05). Only short-term ipsilateral involuntary convulsion of the lower extremity was reported in one patient, who recovered within 12 h. Six patients were treated with nonsteroidal drugs for a short time. All patients stopped taking medication finally. In conclusion, the ultrasound-guided high-voltage long-duration PRF approach not only reduced the pelvic pain caused by PN but also improved the quality of life by extending sitting time without nerve injury.</description><identifier>ISSN: 2090-5904</identifier><identifier>ISSN: 0792-8483</identifier><identifier>EISSN: 1687-5443</identifier><identifier>DOI: 10.1155/2021/9961145</identifier><identifier>PMID: 34373690</identifier><language>eng</language><publisher>United States: Hindawi</publisher><subject>Adult ; Aged ; Care and treatment ; Electric stimulation therapy ; Fecal incontinence ; Female ; Foreign bodies ; Health aspects ; Humans ; Ligaments ; Male ; Medical research ; Medicine, Experimental ; Middle Aged ; Neuralgia ; Pain ; Pain Management - methods ; Pain Measurement ; Patients ; Pudendal Nerve - physiopathology ; Pudendal Neuralgia - physiopathology ; Pudendal Neuralgia - therapy ; Pulsed Radiofrequency Treatment - methods ; Quality of life ; Radiation ; Treatment Outcome ; Ultrasonic imaging ; Ultrasonography, Interventional - methods ; Veins &amp; arteries</subject><ispartof>Journal of neural transplantation &amp; plasticity, 2021, Vol.2021, p.9961145-8</ispartof><rights>Copyright © 2021 Feng Ji et al.</rights><rights>COPYRIGHT 2021 John Wiley &amp; Sons, Inc.</rights><rights>Copyright © 2021 Feng Ji et al. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). 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arteries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ji, Feng</creatorcontrib><creatorcontrib>Zhou, Shuzhuan</creatorcontrib><creatorcontrib>Li, Caixia</creatorcontrib><creatorcontrib>Zhang, Yongyan</creatorcontrib><creatorcontrib>Xu, Hua</creatorcontrib><collection>Hindawi Publishing Complete</collection><collection>Hindawi Publishing Subscription Journals</collection><collection>Hindawi Publishing Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>ProQuest Health &amp; 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plasticity</jtitle><addtitle>Neural Plast</addtitle><date>2021</date><risdate>2021</risdate><volume>2021</volume><spage>9961145</spage><epage>8</epage><pages>9961145-8</pages><issn>2090-5904</issn><issn>0792-8483</issn><eissn>1687-5443</eissn><abstract>Pudendal neuralgia (PN) is a complex disease with various clinical characteristics, and there is no treatment showing definite effectiveness. This study is aimed at evaluating the clinical efficacy of ultrasound-guided high-voltage long-duration pulsed radiofrequency (PRF) for PN. Two cadavers (one male, one female) were dissected to provide evidence for localization of the pudendal nerve. Patients diagnosed as PN who failed or were intolerant in regular medication were screened for diagnostic local anesthesia block of the pudendal nerve before recruitment. Twenty PN patients were enrolled in this study. In the PRF procedure, the needle tip was inserted medially into the internal pudendal artery under ultrasound guidance. The position of the PRF needle tip was then adjusted by the response of the pudendal nerve to the electrical stimulation within the pudendal area (42°C, a series of 2 Hz, and 20 ms width pulses that lasted for 900 s). Alleviation of pain was assessed by the visual analogue scale (VAS) and sitting time pretreatment and on 7 d, 14 d, 1 m, 2 m, 3 m, and 6 m posttreatment in outpatient follow-up or by telephone interview. Two patients were lost due to intervention-irrelevant reasons. Patients showed significantly decreased VAS scores on 7 d after RFP, compared with pretreatment status (7.0±0.9 vs. 3.2±1.7, P&lt;0.001). The efficacy remained steady till the end of 6 months, with a final remission rate of 88.9%. Sitting time also significantly lengthened following PRF (7 d, 14 d, 1 m, 2 m, 3 m, and 6 m vs. pretreatment, all P&lt;0.05). Only short-term ipsilateral involuntary convulsion of the lower extremity was reported in one patient, who recovered within 12 h. Six patients were treated with nonsteroidal drugs for a short time. All patients stopped taking medication finally. In conclusion, the ultrasound-guided high-voltage long-duration PRF approach not only reduced the pelvic pain caused by PN but also improved the quality of life by extending sitting time without nerve injury.</abstract><cop>United States</cop><pub>Hindawi</pub><pmid>34373690</pmid><doi>10.1155/2021/9961145</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-7959-9877</orcidid><orcidid>https://orcid.org/0000-0001-6330-1001</orcidid><orcidid>https://orcid.org/0000-0001-5104-5290</orcidid><orcidid>https://orcid.org/0000-0001-6777-7808</orcidid><orcidid>https://orcid.org/0000-0001-5607-7742</orcidid><oa>free_for_read</oa></addata></record>
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subjects Adult
Aged
Care and treatment
Electric stimulation therapy
Fecal incontinence
Female
Foreign bodies
Health aspects
Humans
Ligaments
Male
Medical research
Medicine, Experimental
Middle Aged
Neuralgia
Pain
Pain Management - methods
Pain Measurement
Patients
Pudendal Nerve - physiopathology
Pudendal Neuralgia - physiopathology
Pudendal Neuralgia - therapy
Pulsed Radiofrequency Treatment - methods
Quality of life
Radiation
Treatment Outcome
Ultrasonic imaging
Ultrasonography, Interventional - methods
Veins & arteries
title Therapeutic Efficacy of Ultrasound-Guided High-Voltage Long-Duration Pulsed Radiofrequency for Pudendal Neuralgia
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