Comparing Treatments for Pudendal Neuralgia: A Systematic Review

Friday, October 25, 2024

8:20 AM – 8:24 AM EDT

Location: Independence Ballroom A-D (Meeting Level 4)

Figure 1

Table 1

Table 1 .docx

Objectives: To systematically review the literature to compare improvement in pain after various interventions for pudendal neuralgia.

Methods: DATA SOURCES: MEDLINE, EMBASE, and clinicaltrials.gov were searched through July 28, 2023.

Our population included patients diagnosed with pudendal neuralgia, ideally by Nantes criteria. Our interventions were procedural treatments of pudendal neuralgia, including surgery such as pudendal nerve decompression and neuromodulation, injections with local anesthetics and/or corticosteroids, and pulse radio frequency procedures. Each intervention was examined individually and compared to others when possible. Outcomes collected include improvement in pain (on VAS scale and other instruments), quality of life improvement, and functional improvements. All reported adverse events were collected. Abstracts were doubly screened, full text articles were doubly screened, and accepted articles were doubly extracted. Quality of studies was assessed using GRADE criteria.

Results: The literature search identified 510 abstracts; 179 full-text papers were retrieved and assessed in detail. In total, we included 34 studies that met eligibility criteria. We categorized the studies into 14 surgeries (10 nerve decompression, 3 neuromodulation and 1 combined nerve decompression to neuromodulation), 12 injections, and 7 pulse radio frequency procedures. 59% of studies used Nantes criteria in selecting patients. 85% of the studies were Grade C. 5.8% were Grade B and none were Grade A. (Table 1) Where possible, study results were compared with a random effects REML model. Not all studies were included secondary to a lack of data. Overall, given the limitations due to study design and high heterogeneity, all procedures appear to provide relief to a similar extent with an overall mean difference of 2.73 (1.77, 3.69), p< 0.001. On subgroup analysis, surgery with decompression appears to provide the greatest relief (4.18 (2.82, 5.54), p < 0.001) and injections the least 1.91 (0.55, 3.27), p = 0.01, but group differences were not statistically significantly different, p = 0.07.
(Figure 2)

Conclusions: There are many treatment approaches to pudendal neuralgia in the literature, but overall, the evidence includes heterogeneous patient populations, non-standardized treatments, poor quality studies and variable pain measurement instruments. Surgical decompression, surgical neuromodulation, injections and radiofrequency ablations, all improved pain from pudendal neuralgia at 3-6 month follow up with no statistically significant difference between groups. Long term follow-up is not available in most studies. Adverse events were inconsistently reported but more frequent in the surgical decompression group.

Disclosure(s):

Julia Maron, BFA: No financial relationships to disclose

Sarah E. Andiman, MD: No financial relationships to disclose

Vani Dandolu, MPH: No financial relationships to disclose

Elizabeth Drugge, PhD, MPH: No financial relationships to disclose

Cara L. Grimes, MD: No relevant disclosure to display

Ryan Cosgro, BA: No financial relationships to disclose

MegAnne Vasey, n/a: No financial relationships to disclose

Michelle Sciarrino, BA: No financial relationships to disclose

Ashley Sacks, BS: No financial relationships to disclose

Catherine A. Toal, BA: No financial relationships to disclose

Devora Loike-Weinstein: No financial relationships to disclose

Sumaita Mahmood, BS: No financial relationships to disclose

David Baruch, BS: No financial relationships to disclose

Presenting Author(s)

Julia Maron, BFA

Medical Student
New York Medical College
Bronx, New York, United States

Disclosure(s): No financial relationships to disclose

Co-Author(s)

SA

Sarah E. Andiman, MD

Assistant Professor
Yale School of Medicine
New Haven, Connecticut, United States

Disclosure(s): No financial relationships to disclose
VD

Vani Dandolu, MPH (she/her/hers)

Department Chair Obgyn
Metropolitan Hospital
New York, New York, United States

Disclosure(s): No financial relationships to disclose
ED

Elizabeth Drugge, PhD, MPH

Assistant Professor
New York Medical College
Darien, Connecticut, United States

Disclosure(s): No financial relationships to disclose
Cara L. Grimes, MD (she/her/hers)

Associate Chair of Research
New York Medical College/ Westchester Medical Center
Valhalla, New York, United States

Disclosure(s): No relevant disclosure to display
RC

Ryan Cosgro, BA

Medical Student
New York Medical College
White Plains, New York, United States

Disclosure(s): No financial relationships to disclose
MV

MegAnne Vasey, n/a

Medical Student
New York Medical College
White Plains, New York, United States

Disclosure(s): No financial relationships to disclose
MS

Michelle Sciarrino, BA

Medical Student
New York Medical College
Valhalla, New York, United States

Disclosure(s): No financial relationships to disclose
AS

Ashley Sacks, BS (she/her/hers)

Medical Student Researcher
New York Medical College
New York, New York, United States

Disclosure(s): No financial relationships to disclose
CT

Catherine A. Toal, BA

Medical Student
New York Medical College
White Plains, New York, United States

Disclosure(s): No financial relationships to disclose
DL

Devora Loike-Weinstein

M.D. Candidate
New York Medical College
Teaneck, New Jersey, United States

Disclosure(s): No financial relationships to disclose
SM

Sumaita Mahmood, BS

Medical Student
New York Medical College
Queens Village, New York, United States

Disclosure(s): No financial relationships to disclose
DB

David Baruch, BS (he/him/his)

Medical Student
New York Medical College
Englewood, New Jersey, United States

Disclosure(s): No financial relationships to disclose