Recommendations on the management of pudendal nerve entrapment syndrome: A formalised expert consensus

Background Since the development and publication of diagnostic criteria for pudendal nerve entrapment (PNE) syndrome in 2008, no comprehensive work has been published on the clinical knowledge in the management of this condition. The aim of this work was to develop recommendations on the diagnosis a...

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Veröffentlicht in:European journal of pain 2022-01, Vol.26 (1), p.7-17
Hauptverfasser: Levesque, Amélie, Bautrant, Eric, Quistrebert, Virginie, Valancogne, Guy, Riant, Thibault, Beer Gabel, Marc, Leroi, Anne‐Marie, Jottard, Katleen, Bruyninx, Luc, Amarenco, Gerard, Quintas, Lara, Picard, Pascale, Vancaillie, Thierry, Leveque, Christine, Mohy, Frédérique, Rioult, Bruno, Ploteau, Stéphane, Labat, Jean‐Jacques, Guinet‐Lacoste, Amandine, Quinio, Bertrand, Cosson, Michel, Haddad, Rebecca, Deffieux, Xavier, Perrouin‐Verbe, Marie‐Aimée, Garreau, Claire, Robert, Roger
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container_issue 1
container_start_page 7
container_title European journal of pain
container_volume 26
creator Levesque, Amélie
Bautrant, Eric
Quistrebert, Virginie
Valancogne, Guy
Riant, Thibault
Beer Gabel, Marc
Leroi, Anne‐Marie
Jottard, Katleen
Bruyninx, Luc
Amarenco, Gerard
Quintas, Lara
Picard, Pascale
Vancaillie, Thierry
Leveque, Christine
Mohy, Frédérique
Rioult, Bruno
Ploteau, Stéphane
Labat, Jean‐Jacques
Guinet‐Lacoste, Amandine
Quinio, Bertrand
Cosson, Michel
Haddad, Rebecca
Deffieux, Xavier
Perrouin‐Verbe, Marie‐Aimée
Garreau, Claire
Robert, Roger
description Background Since the development and publication of diagnostic criteria for pudendal nerve entrapment (PNE) syndrome in 2008, no comprehensive work has been published on the clinical knowledge in the management of this condition. The aim of this work was to develop recommendations on the diagnosis and the management of PNE. Methods The methodology of this study was based on French High Authority for Health Method for the development of good practice and the literature review was based on the PRISMA method. The selected articles have all been evaluated according to the American Society of Interventional Pain Physicians assessment grid. Results The results of the literature review and expert consensus are incorporated into 10 sections to describe diagnosis and management of PNE: (1) diagnosis of PNE, (2) patients advice and precautions, (3) drugs treatments, (4) physiotherapy, (5) transcutaneous electrostimulations (TENS), (6) psychotherapy, (7) injections, (8) surgery, (9) pulsed radiofrequency, and (10) Neuromodulation. The following major points should be noted: (i) the relevance of 4+1 Nantes criteria for diagnosis; (ii) the preference for initial monotherapy with tri‐tetracyclics or gabapentinoids; (iii) the lack of effect of opiates, (iv) the likely relevance (pending more controlled studies) of physiotherapy, TENS and cognitive behavioural therapy; (v) the incertitudes (lack of data) regarding corticoid injections, (vi) surgery is a long term effective treatment and (vii) radiofrequency needs a longer follow‐up to be currently proposed in this indication. Conclusion These recommendations should allow rational and homogeneous management of patients suffering from PNE. They should also allow to shorten the delays of management by directing the primary care. Significance Pudendal nerve entrapment (PNE) has only been known for about 20 years and its management is heterogeneous from one practitioner to another. This work offers a synthesis of the literature and international experts' opinions on the diagnosis and management of PNE.
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The aim of this work was to develop recommendations on the diagnosis and the management of PNE. Methods The methodology of this study was based on French High Authority for Health Method for the development of good practice and the literature review was based on the PRISMA method. The selected articles have all been evaluated according to the American Society of Interventional Pain Physicians assessment grid. Results The results of the literature review and expert consensus are incorporated into 10 sections to describe diagnosis and management of PNE: (1) diagnosis of PNE, (2) patients advice and precautions, (3) drugs treatments, (4) physiotherapy, (5) transcutaneous electrostimulations (TENS), (6) psychotherapy, (7) injections, (8) surgery, (9) pulsed radiofrequency, and (10) Neuromodulation. The following major points should be noted: (i) the relevance of 4+1 Nantes criteria for diagnosis; (ii) the preference for initial monotherapy with tri‐tetracyclics or gabapentinoids; (iii) the lack of effect of opiates, (iv) the likely relevance (pending more controlled studies) of physiotherapy, TENS and cognitive behavioural therapy; (v) the incertitudes (lack of data) regarding corticoid injections, (vi) surgery is a long term effective treatment and (vii) radiofrequency needs a longer follow‐up to be currently proposed in this indication. Conclusion These recommendations should allow rational and homogeneous management of patients suffering from PNE. They should also allow to shorten the delays of management by directing the primary care. Significance Pudendal nerve entrapment (PNE) has only been known for about 20 years and its management is heterogeneous from one practitioner to another. 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The aim of this work was to develop recommendations on the diagnosis and the management of PNE. Methods The methodology of this study was based on French High Authority for Health Method for the development of good practice and the literature review was based on the PRISMA method. The selected articles have all been evaluated according to the American Society of Interventional Pain Physicians assessment grid. Results The results of the literature review and expert consensus are incorporated into 10 sections to describe diagnosis and management of PNE: (1) diagnosis of PNE, (2) patients advice and precautions, (3) drugs treatments, (4) physiotherapy, (5) transcutaneous electrostimulations (TENS), (6) psychotherapy, (7) injections, (8) surgery, (9) pulsed radiofrequency, and (10) Neuromodulation. The following major points should be noted: (i) the relevance of 4+1 Nantes criteria for diagnosis; (ii) the preference for initial monotherapy with tri‐tetracyclics or gabapentinoids; (iii) the lack of effect of opiates, (iv) the likely relevance (pending more controlled studies) of physiotherapy, TENS and cognitive behavioural therapy; (v) the incertitudes (lack of data) regarding corticoid injections, (vi) surgery is a long term effective treatment and (vii) radiofrequency needs a longer follow‐up to be currently proposed in this indication. Conclusion These recommendations should allow rational and homogeneous management of patients suffering from PNE. They should also allow to shorten the delays of management by directing the primary care. Significance Pudendal nerve entrapment (PNE) has only been known for about 20 years and its management is heterogeneous from one practitioner to another. 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The aim of this work was to develop recommendations on the diagnosis and the management of PNE. Methods The methodology of this study was based on French High Authority for Health Method for the development of good practice and the literature review was based on the PRISMA method. The selected articles have all been evaluated according to the American Society of Interventional Pain Physicians assessment grid. Results The results of the literature review and expert consensus are incorporated into 10 sections to describe diagnosis and management of PNE: (1) diagnosis of PNE, (2) patients advice and precautions, (3) drugs treatments, (4) physiotherapy, (5) transcutaneous electrostimulations (TENS), (6) psychotherapy, (7) injections, (8) surgery, (9) pulsed radiofrequency, and (10) Neuromodulation. The following major points should be noted: (i) the relevance of 4+1 Nantes criteria for diagnosis; (ii) the preference for initial monotherapy with tri‐tetracyclics or gabapentinoids; (iii) the lack of effect of opiates, (iv) the likely relevance (pending more controlled studies) of physiotherapy, TENS and cognitive behavioural therapy; (v) the incertitudes (lack of data) regarding corticoid injections, (vi) surgery is a long term effective treatment and (vii) radiofrequency needs a longer follow‐up to be currently proposed in this indication. Conclusion These recommendations should allow rational and homogeneous management of patients suffering from PNE. They should also allow to shorten the delays of management by directing the primary care. Significance Pudendal nerve entrapment (PNE) has only been known for about 20 years and its management is heterogeneous from one practitioner to another. 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subjects Consensus
Human health and pathology
Humans
Life Sciences
Pain Measurement
Pudendal Neuralgia - diagnosis
Pudendal Neuralgia - therapy
Tissues and Organs
United States
title Recommendations on the management of pudendal nerve entrapment syndrome: A formalised expert consensus
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