Treatment of Chronic Pelvic Pain Syndrome with Neuropathic Perineal Pain in the Pudendal Nerve Distribution
This protocol covers chronic pelvic pain syndrome presenting as neuropathic perineal pain localised to the distribution area of the pudendal nerve, where there is objective evidence of nerve injury — a pattern characteristic of pudendal neuralgia.
Clinical scenario
Neuropathic perineal pain in the distribution area of the pudendal nerve, arising from nerve damage, with evidence of nerve injury. Pudendal neuralgia — the most frequently described form of this type of nerve damage — must be distinguished from primary perineal pain syndrome, which does not share the same nerve-damage aetiology.
Approach
Management follows well-established neuropathic pain guidelines. The protocol centres on neuromodulatory pharmacotherapy — agent selection, sequencing, and the full regimen are detailed in the structured protocol.
Complete treatment algorithm available via the link below.
References
Condition
- Primary perineal pain syndrome should be distinguished from pudendal neuralgia, which is a specific disease associated with perineal pain that is caused by nerve damage.
- In the literature, pudendal neuralgia is the most often mentioned form of nerve damage.
Treatment
- Use standard approaches for the management of neuropathic pain.
- Neuropathic pain guidelines are well-established.
- Amitriptyline is the most used at doses from 10-75mg/day (sometimes rising to 150mg/day).
- Pregabalin is a commonly used neuromodulator with good evidence of efficacy in some neuropathic conditions.
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