Evaluation of CT-Guided Pudendal Nerve Cryoneurolysis for the Treatment of Refractory Pelvic Pain

BackgroundPelvic pain caused by malignant and non-malignant etiologies can be treated by cryoneurolysis of the pudendal nerve(s). The purpose of this report is to assess the efficacy and safety of CT-guided pudendal nerve cryoneurolysis. Additionally, treatment outcomes were compared between malignant and non-malignant pelvic pain etiologies.MethodsPatients who underwent CT-guided pudendal nerve cryoneurolysis for intractable pelvic pain were retrospectively reviewed. Pre-procedural and post-procedural pain scores, supplemental analgesic use, and complications were assessed.ResultsA total of 30 patients underwent CT-guided pudendal nerve cryoneurolysis. Pre-treatment Visual Analog Scale (VAS) pain scores were significantly improved at 1 week (3.9 ± 2.1, P < 0.001), 1 month (4.6 ± 2.3, P < 0.001), 3 months (3.9 ± 2.2, P < 0.001) and 6 months (6.2 ± 3.4, P < 0.001) post-treatment. Pre-treatment morphine equivalents (ME) significantly decreased at 1 week (30 (range:0-216), P = 0.04) and 1 month (17.5 (range:0-216), P = 0.032) post-treatment. Both malignant and non-malignant cohorts demonstrated significant improvement of VAS score at all time points; however, there was no significant difference in numeric improvement or percentage improvement in VAS score between the 2 cohorts. No adverse events were observed.ConclusionCT-guided pudendal nerve cryoneurolysis is an effective and safe treatment modality in patients with refractory pelvic pain from both malignant and non-malignant etiologies.