1300 - Use of Radial Shockwave Therapy in the Management of Chronic Pelvic Pain

Case Diagnosis: Chronic pelvic pain (CPP) is a complex condition that may arise from various causes, one of which is pudendal nerve entrapment. This condition, known as pudendal nerve entrapment neuropathy, is characterized by neuropathic pain in the perineal region, dysuria, and pain radiating to the medial thigh. Radial shockwave therapy has emerged as an effective non-invasive option for the management of CPP, inducing analgesic and anti-inflammatory effects. Unlike focal shockwaves, radial shockwaves have broader superficial penetration and are used to treat conditions such as pudendal neuropathy, helping to improve circulation and reduce muscular tension in the affected area.

Case Description:

A 37-year-old male presented with a six-month history of neuropathic pain in the right retro-scrotal region, with VAS 9/10 and dysuria, associated with pudendal nerve entrapment neuropathy. Magnetic resonance imaging confirmed the diagnosis, showing entrapment-related neuritis with nerve thickening and increased STIR signal intensity at the level of the neurovascular canal. The patient was initially treated with pregabalin and pelvic floor therapy, without significant improvement, leading to the indication of radial shockwave therapy. Six sessions were performed using the BTL 6000 device, with parameters of 7–10 Hz frequency, 1.5–4.5 Bar intensity, and 2000 impulses per session, resulting in a reduction of pain to VAS 6/10.

Discussions:

Radial shockwave therapy has shown efficacy in reducing pain in neuropathic conditions, such as CPP associated with pudendal nerve entrapment. This non-invasive therapy represents a valuable alternative for the treatment of CPP, particularly in patients who do not respond to conventional therapies. In comparison, focal shockwaves are typically employed for deeper and more localized conditions.

Conclusions: In this case, radial shockwave therapy proved to be a useful and safe tool for the management of this pathology.