Conventional PRF treatment has been used to treat pudendal neuralgia.  The Pulse makes the difference. The power output and the duration of the pulses is varied automatically by the radiofrequency generator to assure that the tip temperature does not rise above a set temperature point, 42 °C (= 107.6 °F) to assure that no tissue damage or coagulation occurs.

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Pulsed Radiofrequency Treatment (PRF) is NOT ablation (destruction) of the pudendal nerve.

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At what temperature does tissue damage occur?

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Once heat applied is 44 °C or above, tissue injury will occur. Above 44 °C but below 51 °C at the skin surface, the rate of thermal injury doubles with each degree increase in temperature. Temperature above 51 °C will cause almost immediate destruction of the epidermis.

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Because your sciatic nerve is close to your pudendal nerve, you may have temporary leg numbness and weakness after the procedure.

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There are mixed results for this procedure, but those we have talked to have had good pain relief from a few weeks up to 3 months. Some have even reported relief for up to 6 months. 

 

However, because there are no U.S. clinical studies, PRF is not covered by Medicare, any commercial insurance, or state Medicaid and there is some risk. This means people must pay cash for PRF. Based on talking to people have had PRF the cost per treatment averages $1,500 to $2,500.

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When it does work, it needs to be repeated to continue the pain relief effect. Most who suffer daily PN pain including ourselves, we would be happy with three months of pain relief a month. Once could work and return to most normal activities.

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PNA would like doctors to perform PRF within clinic studies to measure efficacy and safety instead of just performing undocumented treatments per patient. Medical publications showing medically significant pain relief and safety would allow the FDA to approve Pulsed Radiofrequency as an accepted treatment for pudendal neuralgia therefore making the treatment financially accessible to ALL people suffering chronic pudendal neuralgia pain because Medicare, commercial (work) insurance, and state Medicaid. It would not just be available for those with the financial means to pay cash out of pocket each time. Healthcare should be a human right, not a privilege in the U.S., the wealthiest country in the world.

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Medicare coverage is the benchmark for FDA approved procedures.  Make sure to do research before having Pulsed Radiofrequency treatment to your pudendal nerve(s).  Since is no FDA approved there will be some risk.

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The procedure is done Transgluteally using Ultrasound Guidance to locate the ischial spine as a landmark and then the pudendal nerve, the same way it is done for a pudendal nerve block. Figure below.

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There is a positive case series from The Netherlands for PRF published by Wiley-Blackwell Online.

Published online 2021 Feb 22.  PMCID: PMC8359332  1  

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"Pulsed Radiofrequency of Pudendal Nerve for Treatment in Patients with Pudendal Neuralgia.

A Case Series with Long‐Term Follow‐Up"

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CONCLUSION

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"In this case series, the effectiveness of repeated PRF in patients with PN after a median 4 years follow‐up is 89%. These patients assess their condition as (very) much better. It shows PRF is an effective, minimally invasive treatment with little side effects of PN in patients who did not respond to standard treatment. However, treatment should be repeated after 2 to 6 months. It is valuable to consider PRF as first‐line treatment in patients with a proven PN."

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See link below to read entire case series. 1

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Conflict of Interests

All authors have no conflicts of interest to declare.

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Acknowledgments

The authors received no financial or material support for the research, authorship, and/or publication of this article.

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As a library, National Library of Medical Science (NLM) provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health (NIH).
 

1  LINK to full study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8359332/ 

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