Please confirm that an ethics committee approval has been applied for or granted: Not relevant

Background and Aims We describe the case of a patient that underwent a series of nerve blocks and pulsed radiofrequency of the ilioinguinal/iliohypogastric nerves for the treatment of chronic pelvic pain. National guidelines in the United Kingdom, NICE clinical guideline 193 (NG193)4, do not recommend interventions in Chronic Primary Pain conditions such as CPP.

Methods She experienced dyschezia and right sided pelvic pain radiating down to the leg, severe enough to keep her awake at night. The pain began after numerous gynaecological surgeries for endometriosis. The patient had baseline pain which was described as 5/10 as well as intense flare-ups described as 9/10 pain. Between December 2018 and August 2022, the patient underwent 5 right sided ultrasound-guided ilioinguinal/iliohypogastric nerve block plus pulsed radiofrequency procedures.

Results Of the five procedures, four had an extremely positive effect. Each procedure bar one, which was less effective, resulted in up to 80% reduction in pain and reduction in the frequency of flare ups. The repeat blocks with pulsed radiofrequency offered effective pain management that lasted for 9-12 months. As a result, the patient experienced significant improvement in quality of life.

Conclusions This patient’s clinical history, gave us reason to suspect ilioinguinal/iliohypogastric neuralgia and hence proceeding with the initial diagnostic and therapeutic intervention, to which she responded very well. At every point the patient was consented fully and made aware that they were out of national guidance. The patient continues to receive excellent benefit from an intervention that she receives annually and opts to have the intervention despite the risks reiterated.