Ganglion Impar Nerve Block

[jVan]

Hi all,

I'm probably going in for one of these in two weeks and am fishing for any personal experiences or advice people may be able to offer. Please share any stories, warnings, experiences, or complications that you may have experienced. I've found that doctors rarely do a good job explaining all the downsides of any procedure, tending to down-play complications.

After extensive research (I'm a biologist and have access to all the journal databases), it seems that impar blocks using a drug cocktail of steroids and analgesics without a neurolytic agent (e.g. phenol) are the most effective (and relatively safe) treatment available, and often provides from 65-100% relief of symptoms for almost two months. Also, no complications have been reported (although I'm sure they have occurred).

Please share thoughts or experiences.

Thanks!

[webslave]

Please keep us updated on your progress!

[Jay]

Hi,

I can't offer any personal experience, but my pain management doctor (head of the department at UoMiami) would like to do a ganglion impar block on me. He wants to perform the procedure at the same time as a caudal epidural steroid injection. The goal is pain relief, rather than diagnosis - ideally, everything will be numbed, making pinpointing anything problematic impossible. Only financial issues have held me back.

Once pain relief is reasonable, I am to return to physical therapy, where I will resume treatment of my pelvic floor dysfunction. This is our plan!

[jVan]

Good luck to you Jay.

Speaking financially, what is your difficulty? Do you not have insurance, or will the insurance not cover the procedure?

I am hoping that if pain relief is significant enough, therapy will not be necessary anymore and the muscles will eventually relax becuause the motor neurons are not being triggered excessively.

[Jay]

Hi,

Yes, the main difficulty is lack of insurance and personal funds. Since it's a University-based facility, treatment there isn't cheap. I believe the estimate was somewhere around $3000 for both shots, along with scanning to ensure proper needle placement.

I wouldn't hold your breath about the shots ending your condition. For those of us with muscular issues, it's often the case that we have to learn how to do that mentally and through PT, else it eventually resurfaces. You will hopefully get some relief out of it, though, and whether you pursue other options from there is up to you!

The only real risks I've heard of are the shots not lasting very long, or not working at all. Some people feel worse, but I haven't read such reports nearly as often. Any medical procedure carries potential risks, and I'd be wary of a doctor who denies that.

[jVan]

Thanks Jay,

As it happens, my Dr. (Dr. Sassano) was also head of pain management here at Shands in Gainesville, so I think I'm in good hands. He claims to have done thousands of these procedures. They probably know each other, and if not, should talk and compare techniques and results.

[Jay]

I've no doubt that he's likely telling the truth there. As the pain management specialty goes, nerve blocks seem to be the treatment du jour. Some doctors don't even prescribe, just blocks and other procedures.

You'll likely get your injection well before me, if you go through with it. Let us know how it goes!

[jVan]

Got the steriod block last thursday. The doctor is suggesting the possibility of doing chemical neurolysis as a more lasting solution, but I don't like the odds of developing neuritis (~10%), especially given my age (29) and the fact that this is usually reserved for terminal patients because of the risks. I've been reading about RF ablation, which seems to be much better and safer. Any thoughts?

I've posted my daily pain log since the block below, so you might know what to expect if your getting one of these done:

Thursday Afternoon (Post injection)
Sore injection point. Curious numbness/ache in rectum (somewhat worse than usual)
5

Friday
Still sore from injection point. Overall sensation about the same as before injection.
4

Saturday
Markedly less pain in the morning, but increased later in the day. Sphincter muscles are less ridged than usual, after palpatation.
3

Sunday
Very low stress day. Lay in bed watching TV.
2

Monday
Lower morning pain than usual. Stress throughout the day quickly brought back the normal sensations, which were just as constant as normal, but less intense. Had some sharp pain on the left side of penis, per usual. Tailbone area is still somewhat sore at point of injection.
3

Tuesday
Tailbone no longer sore. Pain is reduced.
2

[Jay]

Hi there,

Thanks for reporting back! I'm glad the procedure wasn't terrible on you. The steroid in the nerve blocks can take a while to really set in, so give it time. Your log seems to indicate a gradual decline in pain, which is probably a sign that it's successfully reducing inflammation.

I'm afraid I don't know enough about the other procedures to offer an opinion. I know you can't do chemical neurolysis or ablation on any part of the pudendal, as it will render you incontinent, but the ganglion impar seems much more open to procedures.

[jVan]

Hi there,

I'm afraid I don't know enough about the other procedures to offer an opinion. I know you can't do chemical neurolysis or ablation on any part of the pudendal, as it will render you incontinent, but the ganglion impar seems much more open to procedures.

Where did you hear this about the pudendal? I found a Doctor who does RF neurolysis and he wants to lyse my pudendal. Are you talking fecal or urinary incontinence?

I'm not too happy with the results from the ganglion block, the other two options are the pudendal and the superior hypogastric.

At the ganglion impar, the steroids seemed to work, but that is not very diagnostic. I went to this new doctor who did a diagnostic block (just analgesic) that didn't work well. The steroids may have been effecting other nerves.

[gmccormack]

I'm getting a hypogastic plexus nb in 2 weeks, from my understanding it can really target pelvic and testicle pain which are my nagging symptoms, that nerve cluster is responsible for a lot. I also read an article coming out of Childrens Hospital (Boston) where they have discovered a way for the benefits to last up "many" months, by adding liposomes. This is still in the clinical testing stage though.

Check it out...
http://www.childrenshospital.org/newsro ... el521.html

Jvan, if your block does work real well I would ask about it this, imagine getting a block that reduced pain say 75% for 4 months...

[jVan]

That'd be good, but RF can often last years. Safer than chemical neurolysis too, that why I'm doing it that way.

You didn't answer my question about the pudendal and incontinence though. I've do a thorough academic search of the literature and have found almost nothing about nuerolysis of the pudendal at all. For this reason it sounds dangerous (unstudied for some reason) to me, and I may ask for steriods at that location, and lysis at the ganglion. I haven't test blocked the superior hypogastric, so don't know if that would help. My pain is worst when sitting (by far the biggest trigger), so I'm pretty sure about the pudendal being the root cause, although pain is referred through the adjacent innervation.

[Jay]

Hi,

Keep in mind that this is all according to a layman's understanding. The pudendal nerve is made up of both sensory and motor fibers. This means that it's responsible for motor functions in addition to sensation. Destroy the nerve and those functions can no longer be fulfilled.

Ordinary blocks of the pudendal nerve are common. Women get them all the time during labor. Destruction of the nerve, I've never heard of.

[jVan]

gmccormack,

How did your superior hypogastric block work out?

Thanks,
Jvan