Sympathetic Blocks for the Treatment of Chronic Pelvic/Perineal Pain Secondary to Recurrent Urinary Tract Infection

Author:

Pruthi Megha1,Chanana Gaurav2,Walia Meenu3

Affiliation:

1. Department of Pain and Palliative Medicine, Max Super Specialty Hospital, Ghaziabad, Uttar Pradesh, India

2. Department of Pain and Palliative Medicine, Max Super Specialty Hospital, Saket, New Delhi, India

3. Department of Medical Oncology, Max Super Specialty Hospital, Ghaziabad, Uttar Pradesh, India

Abstract

Interventional management of pain has been described as the 4th step of the WHO analgesic ladder and proves immensely useful for many refractory and resistant pains. Recurrent urinary tract infection (UTI) can lead to chronic pelvic and perineal pain, which are often refractory to analgesics including strong opioids, and requires centrally acting neuropathic pain medications, along with psychological and behavioral therapies, and may need interventional pain management. Sympathetic nerve blocks are indicated and can be used in management of visceral pain/cancer pain. A patient with cancer may experience pain due to cancer, side effects of its treatment, or a noncancer pathology. They are prone to recurrent infections including urinary tract, respiratory tract, bloodstream infections, among others, which become a common cause of morbidity and mortality in patients with cancer. In this case report, the authors present a case with advanced cancer in whom recurrent UTI led to chronic debilitating perineal pain which was successfully managed with superior hypogastric plexus and ganglion impar block highlighting the potential utility of these underutilized blocks in challenging situations of complex pelvic and perineal pains.

Publisher

Medknow

Reference24 articles.

1. Mechanisms of pain from urinary tract infection;Rosen;Int J Urol,2014

2. Urinary tract infection and inflammation at onset of interstitial cystitis/painful bladder syndrome;Warren;Urology,2008

3. Sympathetic nervous system and chronic bladder pain: A new tune for an old song;Charrua;Transl Androl Urol,2015

4. No. 164-consensus guidelines for the management of chronic pelvic pain;Jarrell;J Obstet Gynaecol Can,2018

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