Category: Pain Rehabilitation; Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development); Neuroplasticity (includes neuroscience)
To investigate the efficacy of the use of dry needling therapy and neuromodulation in the treatment of pudendal neuralgia.
Design : Non-experimental before-after trial.
Setting : Private practice.
Participants (or Animals, Specimens, Cadavers) : Clinical disorder(s): pudendal neuralgia, CPPS
Eligibility criteria: 1. medical diagnosis of pudendal neuralgia or chronic pelvic pain syndrome that had not previously trialed dry needling as a treatment intervention 2. pain in the anatomical territory of the pudendal nerve 3. pain is worsened by sitting (though a distinguishing characteristic of this syndrome is that the pain is improved when sitting on the toilet or a donut pillow) 4. Abnormal myotomal assessment of sacral segments 5. No objective sensory loss on clinical examination
Number of participants: 5
Selection procedures: population-based sample
Interventions : Intervention: Perineural dry needling of the pudendal nerve and obturator internus muscle. One dry needle electrode placed in pudendal canal/Alcock's canal and a second dry needle electrode placed in ipsilateral obtuator internus muscle with application of electrical stimulation via one channel of Estim II unit for a duration of 15 minutes between 2-20Hz at an intensity that was determined tolerable by each subject.
Main Outcome Measure(s) : Primary outcome measures PFIQ-7, NRS and subjective report of sitting tolerance.
Results : All 5 subjects reported improved objective scores collected by the PFIQ-7 and NRS as well as subjective improvements in sitting tolerance.
Pudendal neuralgia is a difficult condition to diagnose and treat effectively. This poster presentation appears to be the first report of pudendal neuralgia successfully treated by neuromodulation of the pudendal nerve using dry needling. Larger scale studies should be undertaken to corroborate the effectiveness of this approach.
Kelly Sammis– Physical Therapist, Holistic Pelvic Health, Denver, Colorado