Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

Background and Aims Postherpetic neuralgia (PHN) is a common and painful complication of acute herpes zoster. In some cases, it is refractory to medical treatment. Sacral dermatomal involvement occurs in only 3% of patients with PHN. Although rare, these patients can suffer from severely agnozing and disabling pain.

Methods Case report

Results A 45 year old female visited our clinic with severe intermittent pain in her perineium and urinary incontinence. She had herpes zoster on anal and genital area before 3month earlier. The pain was burning and stiningng with numeric rating scale(NRS) 7 in pain intensity. The patinet took PO medication of neruoapthic pain, but little effect at all. In our clinic, we performed several interventional treatments such as caudal epidural block, ganglion impar block and sono-guided bilateral pudendal nerve block(PNB). The last one, PNB, she said best effect and effect last more longer than other intervention. After 2nd trial, we decided to do pulsed radiofrequency ablation(PRF) on both side of pudendal nerve. and after 2week, her symptom of urinary incontinence was subside and pain was significnatly reduced with NRS 1~2 which last for 8month.

Conclusions The PNB under image-guidance has lead to a minimal patient discomfort, an increase in patient safety and a favorable outcome. Conventional RF can cause permanent nerve damage by neuroablative thermocoagulation. On the other hand, PRF produces the same voltage fluctuations in the lesion of the target without thermocoagulation. So, PRF is safe and there are few reports of adverse effects. To get a successful outcome, multiple cycles should be performed.