By Dr. Janaki Natarajan, MD
One of the treatments we offer at Pelvic Rehabilitation Medicine is a series of nerve block injections for pelvic pain relief. This is done in conjunction with trigger point injections, pelvic floor physical therapy, suppository medications, and if indicated, an oral neuromodulator.
One of the largest groups of patients we treat with injections are women suffering from Endometriosis. Endometriosis is an inflammatory disease process characterized by the presence of endometriotic-like tissues that promote an inflammatory environment in your abdomen and pelvis. This inflammation irritates the nerves in that region thereby leading to possible bowel, bladder, sexual dysfunction, and an overall heightened sensitivity to pain.
What Are Nerve Injections for Endometriosis?
To treat the pelvis and the inflammation we see with endometriosis patients; we need the treat the whole pelvic floor. We essentially are taking a trip around the pelvis and treating the nerves that innervate the muscles in the pelvic floor, abdominal core, inner thigh, and genitalia. These nerves include but are not limited to the pudendal nerve and its branches, branches of the posterior femoral cutaneous nerve, ilioinguinal nerve, and genitofemoral nerves.
Some common questions that are asked…
What is a nerve block for pelvic pain?
A nerve block is when a combination of anesthetic or numbing medication (Lidocaine or Bupivacaine) and steroid (dexamethasone or kenalog) is injected near specific nerves to temporarily block the signals traveling along that nerve for the purpose of pain relief.
A nerve block is not permanent and will usually provide numbness to the region for several hours.
WHAT ARE THE RISKS AND SIDE EFFECTS OF A PELVIC NERVE BLOCK?
Overall, nerve blocks are generally safe and have only minor risks which may include:
- Damage to the nerve or surrounding structures – this is greatly minimized when using ultrasound or x-ray guidance, which is what we do at PRM
- Infection – greatly minimized when using sterile technique
- Minor bleeding
- Allergic reaction to medications
- Temporary numbness to the leg if medication spreads to the sciatic nerve
- minor flare or temporary worsening of usual pain and/or symptoms, that will calm down within 1-2 days
- Mild injection site soreness
- Vasovagal response (passing out)
- Temporary flushing and/or insomnia (usually related to steroid if used in injectate)
- Permanent skin changes
- Temporary increase in blood sugars (caution used but not contraindicated in diabetics)
DOES THE PROCEDURE HURT?
At PRM, our unique outpatient, nonoperative, minimally invasive ultrasound guided approach to the pelvis is the first of its kind in the country. Our pelvic nerve and muscle treatments, also called ultrasound-guided pelvic peripheral nerve blocks and trigger point injections, can be an important part of a patient’s pelvic floor treatment.
The nerve block injections and pelvic floor trigger point injections that we do at PRM are external (rather than done from an internal vaginal approach) and done under sterile technique with ultrasound guidance in the office setting.
The treatments are generally well tolerated and only take a few minutes. A brief initial localized burning sensation from the anesthetic may be felt along with pressure sensation that resolves within a few minutes. Post-procedure ice is applied for 10-15minutes and then patients are out the door back to their normal daily routines. If any minor soreness is experienced afterwards an anti-inflammatory medication (i.e. Motrin or Aleve) with food along with a warm bath is recommended.
After 3-months, our patients are experiencing a decrease in pain by 50%, a 35% increase in functional ability in intercourse, bowel movements and bladder function, and seeing improvement in absenteeism and presenteeism at work and in their lives. That’s our goal: get patients back to their lives.