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Chronic Perineal Pain: Analyses of Prognostic Factors in Pudendal Neuralgia

Pereira, Augusto MD, PhD*; Pérez-Medina, Tirso MD, PhD*; Rodríguez-Tapia, Ana MS; Rutherford, Steffi MS; Millan, Isabel MS; Iglesias, Enrique MD, PhD*; Ortiz-Quintana, Luis PhD§

Clinical Journal of Pain:
doi: 10.1097/AJP.0000000000000013
Original Articles

Objectives: To establish the prognostic factors and outcomes of patients with pudendal neuralgia (PN).

Materials and Methods: A total of 51 patients with PN treated at the Puerta de Hierro University Hospital of Madrid between January 2011 and June 2012 were included in this study. Patients were compared in relation to pain intensity and response to the first-line treatment of neuropathic pain. Univariate and multivariable Cox regression analyses were used.

Results: The median for patients’ age, duration, and intensity of pain evaluated by visual analogue scale were 40.9, 3.6, and 7.6 years, respectively. Among 45 patients, there were 19 good responders to first-line treatment for neuropathic pain and 26 nonresponders. The 19 responders measured their improvement at 47%. Tramadol was used for nonresponding patients, 30.8% of whom expressed a 35% improvement. Analysis of 45 patients with PN demonstrated that the pain intensity was associated with dorsal clitoris nerve damage (15.4% vs. 52.2%; P=0.035; odds ratio 4.5; 95% confidence interval [CI], 1.11-18.1) and with sensory deficit at the S2-S4 dermatome map (57.7% vs. 87%; P=0.05; odds ratio 3.7; 95% CI, 0.80-16.8). The pain located at the dorsal clitoris nerve was a significant prognostic factor for having no response to the first-line treatment of neuropathic pain (28% vs. 53%; P=0.033; odds ratio 4.5; 95% CI, 1.06-19.6).

Discussion: A mixed analgesic ladder for chronic pain showed improvement in 73% of the patients with PN. Pain restricted to the dorsal clitoris nerve and small fibers in the S2-S4 dermatome were classified as bad prognostic factors. A longer duration of pain was also correlated with a worse prognosis.

Author Information

*Department of Gynecologic Surgery, Puerta de Hierro University Hospital

Department of Gynecology and Obstetrics, College of Medicine, Autonoma University

Statistics Department, Puerta de Hierro University Hospital, Madrid, Spain

§Department of Gynecologic Surgery, Gregorio Marañón University General Hospital, Madrid, Spain

The authors declare no conflict of interest.

Present address: Augusto Pereira, MD, PhD; Luis Ortiz-Quintana, PhD; Department of Gynecologic Surgery, Gregorio Marañón University General Hospital, Madrid, Spain.

Reprints: Augusto Pereira, MD, PhD, Department of Gynecologic Surgery, Gregorio Marañón University General Hospital, C/Maiquez, 7. Madrid 28009, Spain (e-mail:

Received December 11, 2012

Accepted August 2, 2013

© 2014 by Lippincott Williams & Wilkins