Nerve Cryoablation for pelvic pain...

[neis]

Open mind always with this condition. Will watch this one to see if clinical trials are performed.

http://www.kcrg.com/content/news/New-Pr ... 73691.html

[carbonevo]

PN is pure scam bullshit theory which has not been confirmed by any clinical independent study. Couple of asshole surgeons around the world decided to make money out of desperate people by promoting this super scary diagnosis, when people read about it they freak out, their anxiety levels skyrocket and start to associate their symptoms with PN. Ofc their site defined PN by a wide variety of symptoms, wouldn't be surprised if they put headaches as symptom of PN!!!

I myself thought I have PN or PNE by reading their sites and all it required from me is a bit of relaxation, lowering stress and changing my outlook on the illness.. today I'm sitting in the office just fine without any pain.

BTW I can make a similar article to this one and claim that I cured thousands of people from PN...

[webslave]

Look, pelvic pain does involve the pudendal nerve inasmuch as this a significant pelvic nerve that carries a lot of pain signals in the penis/anus area. If you freeze it, then yes, you will affect pain perception in the penis area, even if the pain is coming from trigger points close to the penis (in theory perhaps).

I think the whole concept is interesting. Look at this case:

Freezing Nerves May Relieve Chronic Pain

By Mollie Bloudoff-Indelicato, Everyday Health Staff Writer

A surgical procedure called cryoablation damages nerves to provide relief from chronic pain.

Before the end of the day, Dr. William Moore had stabbed three people.

Dr. Moore, a radiologist at Stony Brook University Hospital in New York, specializes in cryoablation – a procedure that uses frozen needles to numb the nerves that cause chronic pain. In any given day, he performs multiple cryoablations, piercing his patients' skin and driving the needle inches into their bodies to apply the treatment.

“This particular technique has really worked very well because we’re going to the root of the nerve where it’s coming out of the spine,” Moore said.

Chronic nerve pain that interferes with normal life is a relatively common surgical complication affecting about 50 percent of patients who have chest operations, according to a 2008 National Institute of Health manuscript. While inside the body, surgeons can hit sensitive areas, causing the nerves to misfire and send pain signals to the brain. Once that neural pain pathway from the nerve to the brain has been established, it’s permanent, said David Hanscom, MD, an orthopedic surgeon at Swedish Neuroscience Institute in Seattle who specializes in chronic pain. Diseases, physical injuries and inflammation can also result in this type of condition.

When medication and therapy are unsuccessful and doctors are unable to remove the offending nerve – a dangerous and possibly fatal procedure – patients can opt to freeze it.

“In some cases, chronic pain can be incapacitating,” said Robert Suh, MD, a radiologist at the Ronald Reagan University of California Los Angeles Medical Center who also performs cryoablations. “It can be debilitating.”

Doctors use a pain scale to describe the severity of such symptoms. The scale runs from zero (no pain) to a 10 (extreme and disabling). When Gary Gluskin, Moore's first patient, has a chronic pain attack, his pain is beyond 10 – literally off the charts.

Cryoablation Provides Relief for Extreme Cases

Gluskin had surgery to remove infected tissue behind his lungs. The operation damaged six of his thoracic nerves, causing them to go haywire and send pain messages to the brain.

“I can deal with one or two [nerves] going off but when all six go off, the pain is just intense,” Gluskin said. It starts in his chest and sometimes it’s so unbearable he squirms on the carpet, lashing out at furniture. A desk falls into the hallway. A chair crashes to the floor. Some episodes like this last up to 20 minutes. “I can’t see you,” he added. “My eyes are open, but I only see white.”

Moore started practicing cryoablation in 2007 after meeting multiple patients like Gluskin who just weren’t getting better.

“When I met Gary, he hadn’t slept through the night in three to four years,” Moore said. “He was extremely unhappy, and I don’t think it’s unfair to say he was very depressed.”

Cryoablation stops the pain signal by physically damaging the nerve. Nerves are coated by sheaths of basic proteins called myelin. Without this protective outer layer, the nerve can’t communicate with the brain. Freezing the misfiring nerve actually destroys that myelin coating. The damage isn’t permanent – eventually the nerves will rebuild the myelin, but, until then, pain signals stop, and patients get some much-needed relief.

Gluskin has had 11 cryoablations, going in every six to eight months after his nerves have naturally repaired. The former real estate attorney is still on disability, but his pain score has gone down to a five. It’s high enough that he cannot return to work, but low enough that he can participate in his family’s life.

“They can’t undo the nerve damage, so it’s something I have to live with,” Gluskin said. “But it does work.”

No Pain, No Gain: Cryoablation Procedure is Painful

The practice of freezing nerves to reduce chronic pain has been around in various forms since the 1970s. Originally designed for terminal lung cancer patients to make dying less painful, cryoablation has only recently been adopted for use on otherwise healthy people. In the U.S., just a handful of doctors like Moore offer the procedure because it requires access to equipment and a specific skill set that most hospitals lack.

Cryoablation also takes a physical toll on those who opt in. When Gluskin goes for his treatments, which are paid for by his insurance, he must be restrained – tied to a CAT scan machine with surgical tape. Large canisters of helium and argon stand like attendees observing the routine. That’s when Moore brings out the needle, which, in but a moment, will be six inches deep within Gluskin’s back.

The needle is a 17-gauge, which is a little bit smaller than the one doctors use to draw blood. A mixture of helium and argon will flow through the needle, its tip frozen to anywhere between -238 degrees Fahrenheit and -274 degrees Fahrenheit. As the gasses pass through the needle their temperature immediately drops to freeze the nerves.

“It’s like somebody is taking the sharpest red hot poker you can ever get and jamming it into your body," Gluskin said. "That’s what it feels like. You see a whole bunch of stars and colors.”

In other words, getting rid of pain is a painful process.

Gluskin is given sedatives, but he has to be awake for the actual procedure to help Moore locate the nerve. When Gluskin screams in pain, Moore knows he’s on the right track.

“My wife sits outside the room, and she hears the yelling,” Gluskin said.

“I don’t think anyone can prepare you for the discomfort of the procedure,” said Sharon Gluskin, a respiratory therapist at Stony Brook Hospital and Gary Gluskin’s wife. "[But] at least they have something to offer so he can get back to something of a normal life.”

Cryoablation: Worth the Pain?

Not all patients are like Gluskin. Some don’t feel much, if any, discomfort during their procedures, according to Moore. The definition of pain varies from person to person. The placement of the nerve, the patient’s response to the treatment, and their level of tolerance will all affect how they react to cryoablation.

For many, the main problem is post-operative muscle spasms due to contact with a freezing needle. Despite the short-term risks, Moore has never had a patient report any long-term consequences. Although, any time you put a needle in a patient’s body, there is always a risk for bleeding, infection and punctured organs, but the odds of that are small, he added.

Gluskin is not afraid of complications, though it’s difficult for him to schedule appointments with Moore, knowing what he’ll have to go through. But as his body slowly starts to heal, the symptoms creep back and along come the blinding attacks.

“Gary is an extremely good example who comes back even though it’s excruciatingly painful,” Moore said. “If someone is willing to endure significant pain and get months of pain relief afterward it makes it worth it.”

Last Updated: 8/1/2013

http://www.everydayhealth.com/pain-mana ... -pain.aspx

[carbonevo]

But it isn't the root cause as their sites promote, shutting down this nerve is like numbing a part of your spinal cord that carries sensory motors from the pelvis, lower extremities or any other part of human body.

Interesting thing is if "freezing" this nerve would impact the functionality of the pelvis? as I know the pudendal nerve has other functions as arousal or urinary and bowel incontinence.

[Luxemburger1977]

Some more info here:
http://www.pelvicpainrehab.com/pudendal ... neuralgia/

How about ketamine infusions? Seems to be effective and non-invasive, although you have to plan six sessions over two weeks, then a refresher once in a while to keep the pain relief working ...
http://www.pelvicpainrehab.com/pelvic-p ... lvic-pain/

[webslave]

But it isn't the root cause as their sites promote, shutting down this nerve is like numbing a part of your spinal cord that carries sensory motors from the pelvis, lower extremities or any other part of human body.

Yes, it's not the root cause, so this will not be a permanent solution, the same way that nerve blocks are only temporary. I would also worry about nerve damage after numerous treatments.

Interesting thing is if "freezing" this nerve would impact the functionality of the pelvis? As I know the pudendal nerve has other functions as arousal or urinary and bowel incontinence.

You wouldn't want to freeze the nerve too high up, or anal function would be affected too. Prologo states that he only "freezes the portion [of the pudendal nerve] that runs in Alcocks’s canal". The rectal nerve exits before the Alcock's canal, but penile and clitoral function would definitely be affected, inter alia.

But there are other nerves in the area that would not be affected by this treatment, and which are even more involved in transmitting pain (including trigger point pain), such as the levator ani nerve, the perineal nerve, the inferior clunial nerve, etc. I think that's why this sort of treatment is so "hit and miss".

So in summary, this treatment :

1. May or may not freeze the nerve that is carrying your pain (and since the pudendal nerve is only one of many nerves into the pelvis, the chances are not high)
2. Has a temporary effect, at best
3. Can be excruciatingly painful
4. Is expensive ($3000-$4000 a time reportedly, and numerous treatments are required to maintain any improvement)

Some more info here:
http://www.pelvicpainrehab.com/pudendal ... neuralgia/

Warning flag is raised when a surgeon takes time to write back to a patient again and again. This is often an indicator of quack therapies. Arnon Krongrad comes to mind. The fact that he sees "God" guiding his work and bringing patients to him is another troubling feature.

How about ketamine infusions? Seems to be effective and non-invasive, although you have to plan six sessions over two weeks, then a refresher once in a while to keep the pain relief working ...
http://www.pelvicpainrehab.com/pelvic-p ... lvic-pain/

Warning: viewtopic.php?f=4&t=6007
The treatment is "low dose", so perhaps the warning does not apply. I would like to see a study of CPPS patients and ketamine.

[Luxemburger1977]

Well, unfortunately, women have so many more reasons to develop pelvic pain and, while treatment is probably easier for men, it seems it can be a real challenge for some women out there to find appropriate treatment. I think ketamine has to be seen as a sort of last resort option in medication before considering more invasive procedures. Treatment is low dose anyway, during six sessions of a few hours over a period of two weeks and under supervision of medical staff at all times. Definitely no option I would go for but for those who have tried everything else and find no relief, perhaps a way to get relief.
Anyway, here in Europe, the only (close) location where it is available is Cologne, Germany:
http://www.ketamin.de/

[Balenul]

All pudendal blocks did for me was a flare....