Nerve blocks using lidocaine and corticosteroids can provide wonderful relief but they are only rarely a permanent fix. As such, they are or should be regarded as more of a diagnostic tool than a potential cure. Of course, the nerve could simply be permanently killed using alcohol instead of anesthetics, but that is a drastic solution and almost draconian given the development of the pudental nerve surgery.

It seems to me that the second set of injections, focused as they were upon the pelvis as well as elsewhere was a huge clue that the pudental nerve is at least partially causative. Just why the radiologist did not repeat the more successful administration on the third round is quite beyond me. It would appear, though, that he/she inadvertently created a control for placebo effect in his first and third administrations.
Google French surgery pudental entrapment, something like that and I’m certain you’ll locate the folks I’ve spoken of. And please, stay with this patient and try hard. Also, remember that, like most pelvic pain issues, the gender of the patient should be irrelevant. The idea that the medical profession has countenanced Women’Health as a de facto specialty beyond even the Ob-Gyn specialty has more and more struck me as a violation of federal law.

The interventional radiologist has attempted 3 series of nerve blocks, in which the patient received exactly 1 month of relief after the second series. After the third set, the patient was experiencing several side effects that prevented continuation of the nerve blocks. The only difference in the second procedure is that the doctor did several blocks directly in the groin area rather than just the spinal area.

In addition to the blocks, the patient was given many medications for trial purposes from the interventional radiologist. These medications have either not helped or caused the patient to have poor reactions. Medications tried: Gabapentin, Lyrica, Robaxin, Zanaflex, , Amitriptyline, Savella, and Lodine.

Recently the patient underwent a colonoscopy to further evaluate the bowel wall thickening and inflammation findings on the previous abdominal CT’s, in which the findings were also negative.

Currently, the patient is taking Vicoprofen and Lodine to manage the pain, however, over the past week (since starting the Lodine) the patient’s pain has increased. Before the Lodine was started the patient would wake up in very mild pain that would only increase with the normal aggrivators as before: sitting, driving, standing too long, too much physical activity. Whereas now, the patient wakes up to similar, moderate to severe, pain that she went to sleep to.

Patient states that this pain is present if she takes her pain medications the previous night or not. She states that the pain meds help in reducing the pain long enough to help her fall asleep, but unlike previously, even after rest, the pain is still moderate to severe where only the Vicoprofen seems to help manage.

Side Note: Pt hasn’t been working since March 2010 due to the pain interfering with her “every attempt to do anything that involves more than just a few minutes in one position”. She is highly eager to “return to work and life in general”. Patient states that the only way she is able to get anything done is after the Vicoprofen has been taken, and then that only lasts for a couple of hours. The patient still has complaints of fatigue, but that is the only other complaint besides pain. The pain location has not changed much and currently includes: right groin, hip, right vaginal, right genitalia, right pelvic (to midline), right upper backside thigh (about three finger width from buttocks crease), and right sided lumbar/sacroiliac joint running down to lower buttocks. Pt states that there are four specific points of tenderness along the line running down her back side… to the right of L4-5 area, Sacroiliac joint, just to the right of the mid sacrum, and just below(bottom inner crease of buttocks) and to the right of the coccyx.

It seems that all of the above suggestions have been looked at and been unfounded. I believe that the plan after trying the Lodine, was to go in for one last set of nerve blocks (including the groin area) and it is unknown from there. Any additional help or ideas would greatly be appreciated!

Thanks for your time, interest, ideas, comments, and help.