Conservative Treatments

FIRST GET A DIAGNOSIS: Before you seek out treatment for any condition or disease,

it is imperative that you find out the diagnosis by a doctor using the five Nantes Criteria.

It can dangerous to receive treatments for something you may not even have. Also, there are unethical doctors who will be happy to give your weekly, bi-weekly steroid injections into your pudendal nerve, trigger point injections, and other procedures that can charge for an make considerable profits, no questions asked. You have one body. Protect yourself.

So the first thing anyone with pelvic floor or pelvic pain is to see your gynecologist for women and urologist for men to rule out common causes of pain with simple remedies. If you are having rectal pain, see your GP and get a referral to a rectal surgeon.

If all results are negative, the next step is to see a pain management doctor experienced treating pudendal neuralgia. They should give you enogh time during your first appointment to:

Take full medicall history
Perform complete internal and external exam (most will not do, ask for it)
Perform Diagnositic Anestheic Transgluteal Pudendal Nerve Block to confirm diagnosis.

If you are diagnosied with pudendal neuralgia, here is a list of conservative treatments. Many people with PN are cured by these means, but not all. Hopefully you will be one of the lucky ones. If not, do not despair. One of the objectives of this nonprofit is to make invasive treatments available, affordable, and improve them.

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Pelvic Floor Physical Therapy (PFPT) by an accredited pelvic floor physical therpaist. This is the gold standard treatment for pudendal neuralgia –

Internal vaginal, Internal rectal, and external.

Most PFPTs will run a cash business. I recommend going to one who

accepts insurance. There will be oversight by health insurance, your

doctor, and the hospital or university for whom they work. You will also be able to check notes and progress on MyChart. We have an entire menu dropdown on PFPT.

BOTOX - This works well with PFPT because paralyzing the pelvic

floor mucles, it will help you and your therapist relax your hypertonic

muscles that are irritating your pudendal nerve. This should be done

every four months, at least three times, by an expericned

urogynecologist or urologist. Some urogynecologist inject Botox

for men. We have an entire information sheet about Botox.

BLOCKS - These are done by pain management doctors.

(NOTE: The pudendal nerve block is a diagnostic tool only, not a treatment, one of the five Nantes Criteria,

Ganglion Impar Block - Helps some, not others, can cause more pain
Hypogastric Plexus Block - Need to research
Ilioinguinal and Iliohypogastric Block - Need to research

TRIGGER POINT Injections Women (into vagina) – Done in office while awake. Can be extremely painful. Depends on person. It is the same idea as PFPT but using needle with an anesthetic instead of PFPT's finger. You will bleed a bit for a day. Helps some women, does nothing for others.

TRIGGER POINT Injections Men - Need to Research

ORAL MEDICATIONS

We need double-blind studies (with placebo) to determine which medications are most effective and which have the most and intense side effects. We feel now it's like throwing spaghetti at the wall. Doctors prescribe them and see how they work. There are many medications so it's time consuming. Most of these medications will tend to make you tired, gain weight, or even a little foggy in the brain. It depends on how well a medication reduces your pain if it's worth the side effect. We need double-blind tests on these medications.

Tricyclics –

Amitriptyline/Elavil

Nortriptyline/Pamelor

Doxepin/Sinequan

Anticonvulsants: SNRIs –

Duloxetine/Cymbalta

pregabalin/Lyrica

Gabapentin/Neurontin

venlafaxine/Effexor

lamotrigine/Lamictal

Low Dose Naltrexone – (Compounded oral medications and suppositories are not covered by insurance)

Muscle relaxants –

Baclofen

Flexeril/cyclobenzaprine

Benzodiazepines – Be aware they are addictive but can help in the short-term if pain is uncontrolled. Speak to your doctor.

Xanax / Alprazolam (short-acting) 2 to 4 hours.

Ativan / Lorazepam (med-acting)

Valium / Diazepam (long-acting)

Ativan acts slower than Xanax, and the body removes it slower than it does Xanax.

This means that the effects of Ativan take longer to kick in but last for longer compared with those of Xanax. Because of this, people may take Ativan less frequently than Xanax.

Opioids – Highly addictive. Meant for acute, not chronic pain such as pudendal neuralgia. Speak to your doctor.

Vicodin/Hydrocodone, Percocet/Oxycodone, Nucynta/Tapentadol, Fentanyl (patch)

Suppository Medications – Compounded Suppositories are not covered by insurance

Vaginal Valium

Rectal Valium

Ketamine HCl 30 mg/Diazepam 1 mg/Lidocaine HCl 30 mg Vaginal Suppository

Rectal Gel - Diastat Rectal diazepam Gel – 2 syringes per box 5mg or10mg.

You can use two syringes (one box) per day. Covered by insurance.

Topical amitriptyline-ketamine for treatment of rectal, genital, and perineal pain and discomfort (not sure if covered). Ketamine will probably make you more drowsy/tired than diazepam (Valium) only, but it does work well for some who have posted.

Topical Lidocaine (covered by insurance)

NOTE: Almost all of these medications may make you tired. The first time you use them, do so at night or on a day that you don't work and do not drive.

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Pudendal Neuralgia Alliance

contact@pudendalneuralgiaalliance.org

Paid for by volunteer until 501c3 status granted by IRS