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. 2022 Jan;26(1):7-17.
doi: 10.1002/ejp.1861. Epub 2021 Oct 13.

Recommendations on the management of pudendal nerve entrapment syndrome: A formalised expert consensus

Amélie Levesque  1 , Eric Bautrant  2 , Virginie Quistrebert  1 , Guy Valancogne  3 , Thibault Riant  4 , Marc Beer Gabel  5 , Anne-Marie Leroi  6 , Katleen Jottard  7 , Luc Bruyninx  7 , Gerard Amarenco  8 , Lara Quintas  9 , Pascale Picard  10 , Thierry Vancaillie  11 , Christine Leveque  2 , Frédérique Mohy  12 , Bruno Rioult  4 , Stéphane Ploteau  13 , Jean-Jacques Labat  1 , Amandine Guinet-Lacoste  14 , Bertrand Quinio  15 , Michel Cosson  16 , Rebecca Haddad  8 , Xavier Deffieux  17 , Marie-Aimée Perrouin-Verbe  1 , Claire Garreau  18 , Roger Robert  4
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Recommendations on the management of pudendal nerve entrapment syndrome: A formalised expert consensus

Amélie Levesque et al. Eur J Pain. 2022 Jan.

Abstract

Background: Since the development and publication of diagnostic criteria for pudendal nerve entrapment (PNE) syndrome in 2008, no comprehensive work has been published on the clinical knowledge in the management of this condition. The aim of this work was to develop recommendations on the diagnosis and the management of PNE.

Methods: The methodology of this study was based on French High Authority for Health Method for the development of good practice and the literature review was based on the PRISMA method. The selected articles have all been evaluated according to the American Society of Interventional Pain Physicians assessment grid.

Results: The results of the literature review and expert consensus are incorporated into 10 sections to describe diagnosis and management of PNE: (1) diagnosis of PNE, (2) patients advice and precautions, (3) drugs treatments, (4) physiotherapy, (5) transcutaneous electrostimulations (TENS), (6) psychotherapy, (7) injections, (8) surgery, (9) pulsed radiofrequency, and (10) Neuromodulation. The following major points should be noted: (i) the relevance of 4+1 Nantes criteria for diagnosis; (ii) the preference for initial monotherapy with tri-tetracyclics or gabapentinoids; (iii) the lack of effect of opiates, (iv) the likely relevance (pending more controlled studies) of physiotherapy, TENS and cognitive behavioural therapy; (v) the incertitudes (lack of data) regarding corticoid injections, (vi) surgery is a long term effective treatment and (vii) radiofrequency needs a longer follow-up to be currently proposed in this indication.

Conclusion: These recommendations should allow rational and homogeneous management of patients suffering from PNE. They should also allow to shorten the delays of management by directing the primary care.

Significance: Pudendal nerve entrapment (PNE) has only been known for about 20 years and its management is heterogeneous from one practitioner to another. This work offers a synthesis of the literature and international experts' opinions on the diagnosis and management of PNE.

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References

REFERENCES

    1. Amarenco, G., Kerdraon, J., Bouju, P., Le Budet, C., Cocquen, A. L., Bosc, S., & Goldet, R. (1997). Treatments of perineal neuralgia caused by involvement of the pudendal nerve. Revue Neurologique, 153(5), 331. https://www.ncbi.nlm.nih.gov/pubmed/9296167
    1. Bautrant, E., de Bisschop, E., Vaini-Elies, V., Massonnat, J., Aleman, I., Buntinx, J., & Uglione-Céas, M. (2003). Modern algorithm for treating pudendal neuralgia: 212 cases and 104 decompressions. J Gynecol Obstet Biol Reprod (Paris), 32(8 Pt 1), 705-712. https://www.ncbi.nlm.nih.gov/pubmed/15067894
    1. Beco, J., Seidel, L., & Albert, A. (2018). Endoscopic transperineal pudendal nerve decompression: Operative pudendoscopy. Surgical Endoscopy, 32(8), 3720-3731. https://doi.org/10.1007/s00464-018-6239-4
    1. Benson, J. T., & Griffis, K. (2005). Pudendal neuralgia, a severe pain syndrome. American Journal of Obstetrics and Gynecology, 192(5), 1663-1668. https://doi.org/10.1016/j.ajog.2005.01.051
    1. Bergeron, S., Khalifé, S., Dupuis, M. J., & McDuff, P. (2016). A randomized clinical trial comparing group cognitive-behavioral therapy and a topical steroid for women with dyspareunia. Journal of Consulting and Clinical Psychology, 84(3), 259-268. https://doi.org/10.1037/ccp0000072

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