Can a pudendal nerve block worsen chronic pelvic pain, according to reports from the National Institutes of Health (NIH) or pain management publications?

Pudendal Nerve Block for Chronic Pelvic Pain: Potential Risks and Outcomes

Pudendal nerve blocks can potentially worsen chronic pelvic pain in some patients, though they are generally considered a treatment option for certain types of pelvic pain. 1

Evidence on Pudendal Nerve Blocks

Benefits and Uses

• Pudendal nerve blocks are used diagnostically to confirm pudendal neuralgia and therapeutically to manage pelvic pain symptoms 2, 1
• When successful, blocks can provide pain relief through the combined effects of local anesthetics (immediate, short-term relief) and corticosteroids (delayed relief lasting 3-5 weeks) 3
• These blocks are particularly considered when pain is located in the distribution of the pudendal nerve 1

Potential Risks and Complications

• Not all pudendal nerve blocks provide complete pain relief, with varying degrees of effectiveness 3
• The quality of the block (number of nerve branches successfully anesthetized) correlates with pain reduction - incomplete blocks may provide inadequate relief 3
• In some cases, patients may experience worsening pain after the procedure (approximately 4% reported increased pain in one study) 3
• Pudendal nerve blocks should be used judiciously as part of a comprehensive treatment approach 1

Factors That May Contribute to Worsening Pain

• Procedural factors: Improper needle placement or technique may cause nerve irritation or damage 2
• Patient selection: Patients with complex pain conditions or central sensitization may respond poorly 1
• Incomplete anesthesia: Studies show that complete anesthesia of all six pudendal nerve branches occurs in only about 13.2% of patients 3
• Neuritis: Use of neurolytic agents on peripheral nerves can lead to neuritis, potentially creating symptoms more difficult to control than the original pain 4

Evidence from Recent Research

A 2025 systematic review and meta-analysis on pudendal neuralgia treatments found:

• All interventions (including nerve blocks) improved pain to some degree 5
• No treatment was clearly superior for pain relief 5
• Evidence quality was generally poor (95% of studies were Grade C) 5
• Patient populations were heterogeneous with non-standardized treatments and variable outcomes 5

Alternative Approaches for Chronic Pelvic Pain

For patients with chronic pelvic pain who may not respond well to pudendal nerve blocks:

• Physical therapy: Pelvic floor strengthening exercises may be beneficial for chronic pelvic pain 4
• Neuromodulation: For refractory cases, pudendal nerve neuromodulation with neurophysiology guidance has shown promising results in some patients 6
• Dorsal column stimulation: May be considered for chronic cystitis and chronic pelvic pain 4
• Pharmacologic options: Including anti-inflammatory drugs, muscle relaxants, SNRIs, antiepileptic drugs, and tricyclic antidepressants 4

Clinical Considerations Before Proceeding with a Block

• Proper patient selection is crucial - pudendal neuralgia should be confirmed through clinical evaluation 2, 1
• Use of imaging guidance (fluoroscopy or ultrasound) improves accuracy and safety 2
• Patient should be informed about the variable response rates and potential for symptom exacerbation 3
• Consider starting with less invasive approaches before proceeding to nerve blocks 1

Conclusion

While pudendal nerve blocks can be effective for many patients with pudendal neuralgia and chronic pelvic pain, there is a risk that they may worsen symptoms in some individuals. The decision to proceed with this intervention should be made after careful consideration of the patient's specific pain condition, with appropriate technique and monitoring to minimize adverse outcomes.