Chronic pudenal neuralgia treatment with method of pulsed radio frequency (PRF)




perineal pain, pudendal neuralgia, pulsed radiofrequency, interventional pain management, PRF


Pudendal neuralgia is a pronounced pain in pudendal nerve dermatomes, most often aggravated in the sitting position. This condition is characterized by such symptoms as pain in the perineum, genitals, anus. The onset of pudendal nerve neuralgia can occur after surgery, cycling, trauma or without a provocative factor. Today, there is no ideal method for treating pudendal neuralgia. Treatment includes medication, blockade, decompressive surgery, or radiofrequency intervention.

The article presents the clinical case of a patient who received a stable positive result due to radiofrequency pulse ablation (PRF) of the pudendal nerves after unsuccessful long-term conservative treatment. 44 years age patient complained of a pronounced pulling and throbbing pain in the perineum from the anus to the pubis, which was strengthened in the sitting position. The manifestation of the disease occurred several years ago for no apparent reason. Over time, the pain acquired signs of neuropathic, that is, burning and baking, sometimes unbearable.

Conservative treatment included non-steroidal, anti-inflammatory drugs, physiotherapy procedures, massage and antidepressants. But it turned out to be ineffective: the patient’s condition worsened, she was forced to resign from the work (office clerk). After a comprehensive examination (MRI, SCT, ultrasound, physical examination), a diagnosis was established: chronic neuropathy of the pudendal nerves. Under the fluoroscopic and ultrasound-guided treatment-diagnostic block of the pudendal nerves. Received a positive result – for the duration of the action of the anesthetic pain was stopped. After this a pulse radiofrequency ablation of the pudendal nerves was performed at a frequency of 2 Hz (20 millisecond pulses) at 42°C, duration 120 seconds.

Observation for 2 months confirmed the correctness of the chosen strategy. The pain significantly decreased, reaching a level of temporary discomfort, the patient returned to professional activity. The success of the treatment in such way: from medical-diagnostic block under X-rays and ultrasound-control to destructive radio-frequency procedures.

Author Biographies

Б. Б. Павлов, “Neuromed” clinic, Kyiv


К. С. Новакович, “Neuromed” clinic, Kyiv

PhD, neurosurgeon 


  1. Benson, J., Griffis, K. “Pudendal neuralgia, a severe pain syndrome.” American Journal of Obstetrics and Gynecology 192 (2005): 1663–8.
  2. Ploteau, S., Perrouin-Verbe, M.-A., Labat, J.-J., et al. “Anatomical variants of the pudendal nerve observed during a transgluteal surgical approach in a population of patients with pudendal neuralgia.” Pain Physician 20 (2017): 137–43.
  3. Antolak, S. Jr, Antolak, C., Lendway, L. “Measuring the quality of pudendal nerve perineural injections.” Pain Physician 19 (2016): 299–306.
  4. Valovska, A., Peccora, C.D., Philip, C.N., et al. “Sacral neuromodulation as a treatment for pudendal neuralgia.” Pain Physician 17 (2014): 645–50.
  5. Racz, G.B., Ruiz-Lopez, R. “Radiofrequency procedures.” Pain Practice 6 (2006): 46–50.
  6. Petrov-Kondratov, V., Chhabra, A., Jones, S. “Pulsed radiofrequency ablation of pudendal nerve for treatment of a case of refractory pelvic pain.” Pain Physician 20 (2017): 451–4.
  7. Wu, H., Groner, J. “Pulsed radiofrequency treatment of articular branches of the obturator and femoral nerves for the management of hip joint pain.” Pain Practice 7 (2007): 341–4.
  8. Mikeladeze, G., Espinial, R., Finnegan, R., et al. “Pulsed radiofrequency application in treatment of chronic zygapophyseal joint pain.” The Spine Journal 3 (2003): 360–2.
  9. Abejon, D., Santiago, G., Fuentes, M.L., et al. “Pulsed radiofrequency in lumbar radicular pain: Clinical effects in various etiological groups.” Pain Practice 7 (2007): 21–6.
  10. Shah, R.V., Racz, G.B. “Pulsed radiofrequency lesioning of the suprascapular nerve for the treatment of chronic shoulder pain.” Pain Physician 6 (2003): 503–6.
  11. Ploteau, S., Cardaillac, C., Perrouin-Verbe, M.-A., et al. “Pudendal neuralgia due to pudendal nerve entrapment: warning signs observed in two cases and review of the literature.” Pain Physician 19 (2016): 449–54.
  12. van Zundert, J., Bravbant, S., Van de Kelft, E., et al. “Pulsed radiofrequency treatment of the gasserian ganglion in patients with idiopathic trigeminal neuralgia.” Pain 104 (2003): 449–52.
  13. van Zundert, J., Lame, I.E., de Louw, A., et al. “Percutaneous pulsed radiofrequency treatment of the cervical dorsal root ganglion in the treatment of chronic cervical pain syndromes: A clinical audit.” Neuromodulation 6 (2003): 6–14.
  14. Martin, D.C., Willis, M.L., Mullinax, L.A., et al. “Pulsed radiofrequency application in the treatment of chronic pain.” Pain Practice 7 (2007): 21–5.
  15. van Zundert, J., Patijn, J., Kessels, A., et al. “Pulsed radiofrequency adjacent to the cervical dorsal root ganglion in chronic cervical radicular pain: A double blind sham controlled randomized clinical trial.” Pain 127 (2007): 173–82.
  16. Cahana, A., van Zundert, J., Macrea, L., et al. “Pulsed radiofrequency: Current clinical and biological literature available.” Pain Medicine 7 (2006): 411–23.
  17. Sluijter, M.E., van Kleef, M. “Pulsed radiofrequency [comment].” Pain Medicine 8 (2007): 388–9.
  18. Sluijter, M.E., Cosman, E.R., Rittman, W.B., van Kleef, M. “The effects of pulsed radiofrequency fields applied to dorsal root ganglion – a preliminary report.” Pain Clin 11 (1998): 109–17.
  19. Cosman E.R. Jr, Eng, M., Cosman E.R. Sr. “Electric and thermal field effects in the tissue around radiofrequency electrodes.” Pain Medicine 6 (2005): 405–24.
  20. van Zundert, J., de Louw, A.J.A., Joosten, E.A.J., et al. “Pulsed and continuous radiofrequency current adjacent to the cervical dorsal root ganglion of the rate induces late cellular activity in the dorsal horn.” Pain Physician 12 (2009): 633–8.
  21. Hamann, W., Abou-Sherif, S., Thompson, S., Hall, S. “Pulsed radiofrequency applied to dorsal root ganglia causes a selective increase in ATF3 in small neurons.” Pain 10 (2006): 171–6.



How to Cite

Павлов, Б. Б., & Новакович, К. С. (2018). Chronic pudenal neuralgia treatment with method of pulsed radio frequency (PRF). REPRODUCTIVE ENDOCRINOLOGY, (40), 76–79.



Interdisciplinary problems

Most read articles by the same author(s)