Session Information
Session Title: AA 2021 Virtual Posters - Pain and Spine Medicine
Session Time: None. Available on demand.
Disclosures: Michael S. Eaton, DO: No financial relationships or conflicts of interest
Case Diagnosis: Refractory pudendal neuralgia in setting of chronic spinal cord injury
Case Description: Spinal cord injury (SCI) can be devastating, resulting in loss of sensation and motor function. Additionally, SCI patients can experience various conditions, including pain is the rectal and pelvic areas. Treatment of SCI-related pain can be difficult due to involvement of potentially various etiologies. Pudendal nerve block (PNB) has been used commonly in regional anesthesia for perineal anesthesia during various obstetric procedures. Additionally, PNB has been used for management of various chronic pelvis pain, caused by pudendal neuralgia. We report a case of fluoroscopically guided pudendal block for treatment of refractory rectal pain. A 61 yr old male, history of T10 SCI, ASIA B was referred for evaluation. He complained of increasing pain that initially started as pressure in his rectal area. The patient had seen other providers, undergone treatment, including various neuromodulating and pain medications, as well as spinal injections and sympathetic blocks without much improvement. The pain was now constant, burning in nature.
Setting: Academic medical center, ambulatory surgery centerAssessment/
Results: Patient underwent a fluoroscopically guided bilateral PNB. He experienced complete resolution of his pain for over 3 months. Repeat injection resulted in 6 months of complete relief with pain returning fully at 9 months. Since, a third injection has been performed with successful management of his rectal pain to date.
Discussion: The etiology for pudendal neuralgia is multifactorial typically. However, pudendal nerve and sacral lower motor neuron involvement are significantly associated with chronic SCI and PNB can be performed to diagnose pudendal neuralgia and for long-term pain control if the test block is positive. Various techniques exist for PNB, including posterior approach with the aid of fluoroscopy.
Conclusion: We report a case of refractory rectal pain in a SCI patient with response to fluoroscopically guided PNB.
Level of Evidence: Level V
To cite this abstract in AMA style:
Eaton MS, Kim CH, Mead S, Nadherny W. Pudendal Nerve Block for Rectal Pain in Spinal Cord Injury [abstract]. PM R. 2021; 13(S1)(suppl 1). https://pmrjabstracts.org/abstract/pudendal-nerve-block-for-rectal-pain-in-spinal-cord-injury/. Accessed May 21, 2025.« Back to AAPM&R Annual Assembly 2021
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/pudendal-nerve-block-for-rectal-pain-in-spinal-cord-injury/