278: PUDENDAL NEURALGIA

CONDITION/DISORDER SYNONYMS

• Pelvic pain

• Pudendal neuropathy (PN)

• Pudendal nerve entrapment (PNE)

ICD-9-CM CODE

• 353.8 Other nerve root and plexus disorder

ICD-10-CM CODES

• G54.8 Other nerve root and plexus disorders

• R10.2 Pelvic and perineal pain

PREFERRED PRACTICE PATTERN

• 5F: Impaired Peripheral Nerve Integrity and Muscle Performance Associated With Peripheral Nerve Injury¹

KEY FEATURES

Description

• Pain, burning, numbness, paresthesia in the gluteal, perineal, and/or genital area

• Entrapment and injury to the pudendal nerve in Alcock canal

• Alcock canal (musculo-osteo-aponeurotic tunnel) between sacrotuberous and sacrospinous ligaments, in the absence of organic disease

Essentials of Diagnosis

• “Nantes Criteria”²

  • Pain should be limited to the innervation territory of the pudendal nerve.

  • Excludes any pain that is limited to the coccygeal, pelvic, or gluteal areas.

  • Pain is predominantly experienced while sitting.

  • Pain rarely awakens the patient at night.

  • No objective sensory impairment can be found even in thepresence of paresthesia on clinical examination.

    • Presence of a sensory defect should prompt investigations to exclude diseases of the sacral nerve roots and the cauda equina.

  • Pain should be relieved by anesthetic infiltration of the pudendal nerve.

    • This is an essential criterion, but it lacks specificity as pain related to any perineal disease may be relieved by pudendal nerve block.

General Considerations

• Frequently misdiagnosed

• Chronic pain condition

• Urogenital pain disorders are frequently associated with pain and other musculoskeletal impairments in nearby body areas; especially back, pelvic, hip, groin regions

Demographics³

• Few epidemiologic data found in the literature

• Mean time to diagnosis is 4 years, ranging from 1 to 15 years

• More prevalent in women; 7 of 10 patients are women

CLINICAL FINDINGS