Purpose: This study aims to evaluate the efficacy of pulsed and continuous radiofrequency ablation as therapeutic options for individuals suffering from refractory chronic pelvic neuropathy.
Materials and Methods: This retrospective cross-sectional study reviewed 78 patients with chronic refractory pelvic neuropathy who underwent 284 nerve radiofrequency ablation (RFA) procedures at a single tertiary care university hospital between October 2020 and April 2024. Patients were referred from a pelvic pain clinic and received perineural steroid injections for diagnostic confirmation and initial pain relief before ablation. Pudendal neuropathy was treated with pulsed RFA, while ilioinguinal and genitofemoral underwent continuous RFA.
Results: In this study, 78 patients with recalcitrant pelvic neuropathy underwent 284 pulsed radiofrequency procedures, resulting in significant pain relief and improved quality of life. For 49 patients with pudendal neuropathy, post-pRFA pain scores averaged 1.75 ± 2.21 out of ten, slightly lower than the pain score after the initial (1.85 ± 3.54) steroid injection, though not statistically significant (p=0.644). Pain relief lasted 12.65 ± 30.15 weeks post-pRFA, significantly longer than the initial (4.36 ± 9.13 weeks, p=0.0022) steroid injection, with significant quality of life scores (p< 0.0001) and decreased analgesic use at 6 weeks, 3 months, and 6 months (p=0.0124, p=0.0013, p=0.0017).
For 15 patients with ilioinguinal nerve pain, post-cRFA pain scores averaged 2.15 ± 1.98, with relief lasting 16.75 ± 21.35 weeks, significantly longer than steroid injection (5.30 ± 10.26 weeks, p=0.0041). Quality of life and analgesic use similarly improved over time (p< 0.0001, p=0.0187, p=0.0035, p=0.0023). In 14 patients with genitofemoral nerve pain, post-cRFA pain scores averaged 1.95 ± 1.82, with relief lasting 14.80 ± 25.92 weeks, significantly longer than steroid injection (4.85 ± 8.47 weeks, p=0.0035). Quality of life and analgesic use also showed significant improvements (p< 0.0001, p=0.0152, p=0.0029, p=0.0019).
Conclusion: Our findings demonstrate that RFA provides significantly longer pain relief and improved quality of life compared to traditional steroid injections for patients with refractory pelvic pain syndromes, particularly for pudendal, ilioinguinal, and genitofemoral neuropathies. These findings suggest that radiofrequency ablation is a promising therapeutic option for managing pain that is unresponsive to conventional treatments, offering a potential pathway for improved patient outcomes and reduced reliance on analgesics.
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