Failed guided block. Doc said additional ones won't help

[In2Me]

Hello,

On June 25th, I received an ultrasound guided pudendal block. Only one side of the nerve was injected, and apparently, the nerve was hit "spot on" due to the ultrasound providing a clear picture of the location. I had absolutely no benefit, and had a flare several days later- I'm still flared up, but I've had other stressors recently, so I'm not sure if the severe pain I'm in is from them (I kinda think so).

Anyway, the doc who did these said I should have felt "A dramatic benefit on the first day". I can assure you (and I informed him) that I had no benefit whatsoever. He said because I didn't have immediate benefit, it is pointless to do additional blocks. My question is, is this the stance of most doctors? I know many people get more than one. I wonder if the problem is perhaps not PN, but one of the other nerves of the pelvis? The doc who did the nerve block had many years' performing pudendal, as well as other, nerve blocks. I've heard many stories of people having a failed block, then getting another one or two after that. Is this physician accurate in his assessment?

Thanks,
In2Me

[Tiny Dancer]

Did they use the ultrasound with the needle in before they injected the steroid? If not of course they could have missed the spot. They didn't do this with me. They just took a picture before and guessed where it should go in. I think the flares that we get afterwards are partly due to the nerve being nicked.

[Celeste]

We just don't hear of people getting a cure from the steroid blocks if their nerve is entrappd. It is a thing we can try to feel we have done all we can to avoid surgery. I think it is more common for them to be a diagnostic indicator if you get a relief of pain from an anesthetic injection of something numbing like Marcaine. Some people do report a degree of relief or else relief that lasts weeks or months, but instantly from steroids? No. It causes a pain flare for about 10 days in most people.

I would talk to a PN specialist about this.

For what it's worth, I also had a steroid block to my wrist. I got a pain flare, no relief, and still ended up having surgery on it (which cured my tendinitis). I sometimes wonder if some people do react wonderfully to steroids. I know I am not one of them, based on how many injections I've had.

[Violet M]

Do you know if he was injecting at the alcock's canal or at the ischial spine? Some of the docs inject each place separately on different occasions although I've read that some inject a large volume in hopes that the medication will diffuse to both sites -- Hibner's team does this I think. My understanding is that if the nerve entrapment is higher up than the medication goes you might not get any pain relief. So, let's say he blocked the alcock's canal but your entrapment is up higher -- you would not have gotten any relief.

While the blocks are considered diagnostic, I have always understood that even blocks are not considered 100% accurate in making a diagnosis. But they don't often effect a cure either so I'm not sure you can draw any definite conclusions from your experience.

[In2Me]

Violet, I'm not sure of the name of the area, but I was injected in the cleft where my thigh meets my buttock (I am guessing this is Alcock's canal). I also only had one side injected. The doc said having a bilateral block increases the risk of fecal and urinary incontinence, and may not provide any additional diagnostic info (I forget why he has this opinion).

I guess you have a point about the entrapment being missed by the injection if it is in a different area than where the medication is going. I don't know how to tell if the nerve is "entrapped" vs severely irritated. I never had any severe trauma to the nerve- my understanding is that trauma is what leads to most entrapments. I also had an MRI that visualized my nerve, and the report said "no visible compression or entrapment of the pudendal nerve". However, this was not a 3T MRI, so I'm not sure if the result could potentially be inaccurate.

I am so miserable and nothing helps me for terribly long. I'm actually planning to get evaluated for a decompression surgery (still not entirely sure who with), because medical treatments and several rounds of PT have done nothing for me. I am going to Toronto next month to the Wasser, but I think I'm only seeing the gyn there, not the neurologist Allan Gordon (I bet it takes over a year to see him- miraculously, I was able to get an appt. w/ Dr. Elyse Levinsky, the gyn at Wasser, in only four months). She does not do the nerve tests, so I will probably have to pay for them if I don't want to wait several years (at least, I don't think she does them). I cannot afford to spend much more, and if I want to get a surgical intervention, I will probably have to sell my home or something to get the money. I suffer from severe suicidal depression due to constant pain, and I can't even take joy in the brief moments when my meds calm it down for a few hours. I was told by a couple of physicians that I'd always be sick, and I believe them. I am too complicated a case to be helped. I really don't think there is hope for me. For others, yes. For myself, no.

[hilary]

In2Me - maybe you dont have pudendal nerve problems maybe something else?

[Violet M]

Well, that's pretty discouraging for your doctors to say you will always be sick. I think it's too soon to take that for an answer. I was reading back over your history and noticed that PT from Liz Rummer helped. Are there any PT's in your area who might be willing to learn her techniques?

Have you considered getting on Dr. Hibner's wait list for a 2nd opinion at a future date?