Treatment Philosophy

Excel Pain and Spine is a privately-run practice owned and operated solely by physicians that have trained, taught, and researched at the top pain medicine institutions in the country.

Our physicians are regarded experts in the pain management field and remain involved with teaching new and advanced treatments to practicing physicians, residents, medical students, and fellows across the county.

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Treatments - Pudendal Nerve Block


A Pudendal Nerve block is a procedure using x-ray or ultrasound guidance to treat symptoms of genital, tailbone (coccyx), and/or rectal pain (pudendal neuralgia) by blocking the nerve impulses. Injecting the area around the pudendal nerve with a local anesthetic (lidocaine) and steroid will give immediate temporary relief of genital, rectal, and/or tailbone (coccyx) pain. Repeating the injections can eliminate or substantially reduce the pain in many patients. In some cases, a more permanent block can be considered. This is performed using a radiofrequency ablation process.


What conditions are treated with Pudendal Nerve Blocks?
A pudendal nerve block is mainly used to treat the condition characterized by symptoms of genital and/or rectal pain (pudendal neuralgia) caused from pudendal nerve entrapment as it passes through the pelvic region. It can also become inflamed through local trauma such as a stretch injury, but often the reason for the inflammation is due to obesity, tight clothing, weight gain, or pregnancy. Patients with diabetes are more susceptible to this condition.

How is the procedure performed?
Our team will help position you to make sure the procedure can be completed with the least amount of discomfort for you. The skin is cleansed with a sterilizing solution (chlorhexidine) and a sterile drape is placed. A local anesthetic medication typically (Lidocaine) is given to numb the skin. Next, fluoroscopy (x-ray) or ultrasound is used to find the target. A thin needle is directed to the desired location. A local anesthetic and/or steroids are then injected. During the entire procedure you will be constantly monitored by our team. After the injection a small bandage is placed on your skin. You will be given time after the procedure to make sure you feel good and are not having side-effects before leaving the clinic.

What medication is injected?
The injection includes a combination of anesthetic (lidocaine or bupivacaine) and steroid (cortisone, Kenalog or dexamethasone). The local anesthetic will be responsible for the immediate relief and the steroid is used to provide more long-term relief.

Does the procedure hurt?
The procedure is typically well tolerated. A localized burning sensation from the anesthetic is commonly felt and is usually the most uncomfortable part of the process. During the procedure a pressure sensation is often experienced this typically resolves within a few minutes. Minor soreness for a week after the procedure is normal.

How long does the procedure take?
The procedure typically takes about 15 minutes to perform. Please plan on being at the clinic for about 1 hour to allow for pre and post-procedural safety protocols.

How quickly will I get relief?
It can take up to a week for the steroid medicine to reduce pain and inflammation. Our team will follow-up with you and determine the need for any future injections.

How long can I expect the relief to last?
Every patient is different. Most patients get reduced pain lasting 2-4 months. Some patients can get relief lasting greater than a year.

How often can the procedure be repeated?
Depending on results and providers discretion the injections may be repeated up to 3-4 times per year for sustained pain relief.

Will the steroid injection result in more health problems long term?
There is minimal absorption from steroid injections to other areas of the body. For this reason, many of the side effects that occur with systemic steroid usage do not occur with local steroid injections. The systemic side effects of weight gain, osteoporosis (thin bones), and increased blood pressure typically do not occur with steroid injections.

Can I have the injection if I have diabetes?
Yes. It is important to control your blood sugar before and after the injection. Diabetic patients may experience a temporary increase in blood sugar which should resolve in a few days after the procedure.

What are the risks and side effects?
Risks and side effects are minimal and serious complications are rare. We take every precaution to ensure safety. Potential risks may include but are not limited to: vasovagal response (passing out), new or increased pain, infection, bleeding, permanent skin changes, allergic or unexpected drug reaction with minor or major consequences, and unintended nerve injury.

Pre-Procedure Information

Please let us know if you have an active infection, are using antibiotics, or are using blood thinners.

Should I take my normal medications as scheduled?
Yes. Continue taking your prescribed medications prior to procedure.

What if I am on a blood thinner or Aspirin?
Anticoagulation is often stopped for a short period of time prior to injection. Please speak with your primary physician if you take blood thinners to make sure that you can safely stop taking these medications.

Do I need a driver?
Yes. For your safety we require a driver to ensure safe return home.

Can I eat the day of the procedure?
It depends on the location. We recommend eating a light meal if the injection is done in our clinic. If the procedure is done at the surgery center then you must fast for at least 8 hours prior to the procedure.

Can I get sedation or anesthesia?
Most patients do well without sedation. Light sedation with oral medications is sometimes provided at the provider’s discretion.

What if I am pregnant?
There are serious potential risks to an unborn fetus when exposed to imaging studies, including x-ray and fluoroscopy. If there is any chance you may be pregnant, please postpone this procedure until it can be confirmed that you are not pregnant as it is not safe to do during pregnancy.

What should I wear?
We recommend light loose-fitting clothes. Sometimes we will ask you to change into a gown.

Post-Procedure Information

When can I drive after the procedure?
We recommend resuming driving the next day.

What can I do if I am sore or have pain after the procedure?
Ice packs can be applied to the area for 20 minutes per hour. Over the counter Tylenol and Motrin can be used to aid with any discomfort.

What are my restrictions after the procedure?
Typically, you may resume light activities on the same day following your procedure. Physical therapy can be re-started within 24 hours. We recommend returning to work the day after the procedure.

When can I shower?
Showering the day of the procedure is allowed. For 24 hours you are asked to refrain from submerging or swimming in water. Keep the bandage on for one day.

When do I come back for a follow-up visit?
We follow-up with all of our patients after their procedures. We typically see patients back in 2-4 weeks.

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