Pulsed Radiofrequency of the Sacral Dorsal Root Ganglia as a Potential Rescue Therapy for Refractory Chronic Pelvic...

BACKGROUND Chronic pelvic pain (CPP) is a prevalent, multifactorial condition with neuropathic, visceral, myofascial, and psychogenic components; a subset of patients remain refractory to multimodal pharmacotherapy and conventional interventional procedures. Pulsed radiofrequency (PRF) of the dorsal root ganglia (DRG) is a minimally invasive neuromodulatory technique that can attenuate pathological nociceptive transmission while preserving neural integrity. We describe 3 patients with severe, treatment-refractory CPP of predominantly neuropathic origin who underwent sacral DRG PRF as rescue therapy. CASE REPORT Case 1 was a 46-year-old man with a 7-year history of neuropathic penile pain following circumcision. Case 2 was a 54-year-old woman with an 11-year history of urethral burning pain and urgency after anal sphincterotomy. Case 3 was a 39-year-old woman with an 18-year history of CPP related to interstitial cystitis, vulvodynia, and pelvic floor myofascial dysfunction. All 3 had failed extensive pharmacological, nerve block, and neuromodulation therapies. Bilateral PRF of the S2-S4 DRG produced reductions in pain intensity (Numeric Rating Scale, NRS) of 55.6-62.5% at 3 months, partially sustained at 6 months (42.9-50.0%), with parallel improvements in neuropathic pain scores, quality of life, and reduced analgesic use, without procedure-related complications. CONCLUSIONS In these 3 refractory CPP cases, sacral DRG PRF was associated with clinically meaningful, although partially attenuating, symptomatic improvement. Given the small, uncontrolled sample, these findings represent preliminary clinical observations suggesting possible benefit in carefully selected patients and should be regarded as hypothesis-generating rather than evidence of established clinical effectiveness.