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Treating Pelvic Nerve Pain

Common Treatments for Pelvic Nerve Pain and Pelvic Neuropathy

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Updated September 10, 2009

Treatment for pelvic nerve pain can vary, depending on the diagnosis and how severe the pain is. In general, pelvic nerve pain is either treated with medication, nerve blocks, surgery or a combination of approaches.

Medications That Treat Pelvic Nerve Pain

  • NSAIDs - though they may be prescribed for chronic pelvic pain associated with nerve dysfunction, NSAIDs such as aspirin and ibuprofen are generally effective only if swelling is the cause of pelvic nerve pain.
  • Tricyclic antidepressants – depression medication such as amitriptyline (Elavil) may be used to control the symptoms of pelvic nerve pain. TCAs help change the way neuropathic pain is interpreted by the brain, and can also help regulate sleep.
  • Anticonvulsants – certain anti-seizure medications such as gabapentin (Neurontin) and pregabalin (Lyrica) are also effective in the treatment of neuropathic pain, such as pelvic nerve pain.
  • Opioids – opioids have been shown to be effective in controlling pelvic nerve pain, however their long-term use does come with some risks in certain populations. Some examples are codeine, fentanyl and tramadol (Ultram).

Nerve Blocks for Pelvic Nerve Pain

Nerve blocks can be useful tools both for diagnosing pelvic nerve pain and for treating it. In fact, nerve blocks are often done to localize the “problem nerve.” If they are successful at relieving pain temporarily, the same nerve can be blocked permanently to control pelvic nerve pain.

Nerve blocks can be helpful in treating chronic pelvic pain caused by neuralgia, though the evidence is somewhat limited. Nerve blocks can be effective for some types of nerve pain, such as those caused by nerve damage during surgeries; however, the effects are not always permanent in all people.

Surgery for Pelvic Nerve Pain

For some people, surgery is required to reduce the symptoms of neuropathic pelvic pain. Some examples include:

  • Laparoscopy – a laparoscopy is a surgery that is done either for diagnostic or treatment purposes by making small incisions in the abdomen and working with small instruments and cameras. Laparoscopies for pelvic nerve pain can be used for pelvic nerve decompression, removal of nerve adhesions and pelvic nerve ablation.
  • Nerve ablation – nerve ablation involves destruction of part or all of the nerve(s) causing pelvic pain.
  • Sacral neuromodulation – in sacral neuromodulation, a pulse generator is used to apply a current to certain areas of sacral nerves that may cause pelvic nerve pain. This technique may work well for certain types of pelvic nerve pain, however its long term ability to manage pain are still under investigation.

A "Multimodal Approach" for Pelvic Nerve Pain

Evidence suggests that using more than one approach to treat chronic pelvic nerve pain is more effective than using one specific treatment modality. Recent literature suggests using a combination of pain medications, nerve blocks and physical therapy. It also emphasizes strong psychological support, to manage potential anxiety and depression that is often brought on by living with chronic pelvic pain.

Coping with Pelvic Nerve Pain

It may take time, as well as some trial and error to find a treatment that helps control your pelvic nerve pain. In the meantime, here are a few things you can do.

  • Keep a pain journal. Record your pain episodes, including its intensity, the time of day and what you are doing. It may be helpful to include your feelings in this pain journal as well.
  • Talk to someone. Find someone who can listen, or who knows what you are going through. The chronic pain forum is a great place to start.
  • Don’t give up. Diagnosis and treatment of pelvic nerve pain may take some time, but that doesn’t mean it will never happen. Talk to your doctor and do some research on your condition. Being an advocate for yourself can help keep your pain from controlling you.

Sources:

C. Fitzgerald, R. Morabito, S. Zaslau. Sacral Neuromodulation Unsuccessful For Pain Control After Failed Radical Cystectomy For Chronic Pelvic Pain. The Internet Journal of Pain, Symptom Control and Palliative Care. 2008 Volume 6 Number 1

McDonald, John S. The Enigma of Chronic Pelvic Pain: A Focus on Pudendal Neuropathy. The Pain Practitioner. Spring 2009, pp 17-18.

National Guideline Clearinghouse. General Treatment of Chronic Pelvic Pain. Accessed 9/1/09. http://www.guideline.gov/summary/summary.aspx?doc_id=12612

National Pain Foundation. Pelvic Pain: Medications. Accessed 9/1/09. http://nationalpainfoundation.com/articles/275/medications

National Pain Foundation. Pelvic Pain: Surgery. Accessed 9/1/09. http://nationalpainfoundation.com/articles/278/surgery

Possover M. Laparoscopic Management of Neural Pelvic Pain in Women Secondary to Pelvic Surgery. Fertility and Sterility. 2009 Jun;91(6):2720-5.

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