Treatments include behavioral modifications, physical therapy, analgesics and other medications,<unk>  nerve block, and surgical nerve decompression. A newer form of treatment is pulsed radiofrequency. Most medical treatments are intended for symptomatic relief, such as pain. If symptoms are not managed through this standard of care, surgery is considered. Nerve protection This is a form of self treatment to keep pressure off the<unk>  nerve. It involves avoiding any activities that may increase pain in the pelvic area. A seat cushion with the center area removed may be used to provide relief and prevent further pain. A 2021 systematic review of preventative and therapeutic strategies found that cyclists who take precautions in maintaining proper posture may prevent the development of a more severe disorder. It is also suggested that using a wider seat when cycling could prevent damage to the nerve, but more evidence is necessary to show long-term benefit. Physical therapy Mobilization of the nerves and muscles in the pelvic region is a proposed way to treat symptoms associated with a nerve<unk> . An example of this is neural mobilization. The goal of neural mobilization is to restore the functionality of the nerve and muscles through a variety of exercises involving the lower extremities. Exercises to specifically target the<unk>  nerve would be determined based on the anatomical layout of the nerve. It is important to note that evidence is limited to show support for this therapy. Another possible treatment for nerve<unk> s in the pelvic region would be stretching and strengthening exercises. A treatment plan would be determined by a physical therapist to specifically manipulate the<unk>  nerve through a variety of stretches. Strengthening exercises may also be recommended to relieve the excessive pressure caused by the<unk> , but there is currently limited evidence to support this choice of therapy. Medications There are numerous pharmaceutical treatments for neuropathic pain associated with<unk>  neuralgia. Drugs used include anti-epileptics (like gabapentin), antidepressants (like amitriptyline), and palmitoylethanolamide. Often times polypharmacy is used with consideration of medication history and side effects. Injections One way to identify and alleviate pain associated with the<unk>  nerve is a "CT-guided nerve block." During this procedure, "a long-acting local anesthetic (bupivacaine hydrochloride) and a corticosteroid (e.g. methylprednisolone) are injected to provide immediate<unk>  anesthesia." A<unk>  nerve block can be inserted from several different anatomical locations including: transvaginal, transperitoneal, and perirectal. A reduction in pain following this injection is typically felt quickly. The most common side effect of a<unk>  nerve block is injection site irritation. Relief from chronic pain may be achieved through this procedure due to the reduced inflammation from the steroid medication, and "steroid-induced fat necrosis" which "can reduce inflammation in the region around the nerve" to lessen strain on the<unk>  nerve. This treatment may alleviate symptoms for up to 73% of people. Treatment of<unk>  by nerve block is not often prescribed due to "discomfort associated with the local injections as well as the risk of injuring critical structures." Pulsed radiofrequency This can be used instead of<unk>  nerve perineural injections. In recent years, Pulsed radiofrequency (PRF) is starting to become more common for managing chronic pain, and has shown to have long-term benefits and low problem occurrences. Pulsed radiofrequency has also been successful in treating a refractory case of<unk>  neuralgia, but additional research is needed to study the effectiveness of pulsed radiofrequency on treating<unk> .<unk>  Nerve Stimulation (PNS) was found to significantly decrease subjective pain levels in people with<unk>  neuralgia. A majority of people who underwent PNS reported "significant" or "remarkable" pain relief at 2 weeks after treatment. Ergonomics Various ergonomic devices can be used to allow an individual to sit while helping to take pressure off of the nerve. A few recommendations to decrease nerve compression while cycling include having soft, wide seat in a horizontal position and setting the handlebar height lower than the seat. There are also bicycle seats designed to prevent<unk>  nerve compression, these seats usually have a narrow channel in the middle of them. Additionally, other recommendations include wearing padded bike shorts, standing on pedals periodically, shifting to higher gears, and taking frequent breaks. For sitting on hard surfaces, a cushion or coccyx cushion can be used to take pressure off the nerves. Surgical Decompression surgery is a "last resort", according to surgeons who perform the operation. It is highly controversial, given that normal cadavers show the<unk>  nerve to be "entrapped" and attached, questioning the whole thesis of<unk> . According to supporters of the theory of<unk> , surgery is indicated when severe symptoms are present after exhausting all other forms of treatment. The surgery is also another option to confirm the diagnosis of<unk> . The surgery is performed by a small number of surgeons in a limited number of countries. The validity of decompression surgery as a treatment and the existence of<unk>  as a cause of pelvic pain are highly controversial. While a few doctors will prescribe decompression surgery, most will not. Notably, in February 2003 the European Association of Urology in its Guidelines on Pelvic Pain said that expert centers in Europe have found no cases of<unk>  and that surgical success is rare: There are several different approaches in order to perform a decompression surgery on the<unk>  nerve. The different access areas include: superior transgluteal, superior retrosciatic, inferior retrosciatic, medial transgluteal, inferior transgluteal and transischial entry. The transgluteal entry involves "neurolysis of the PN at the infrapiriform canal and transection of the sacrospinal ligament." Another point of entry which is described as a "perineal para-anal pathway", "follows the inferior rectal nerve to the Alcock’s canal." If nerve damage is discovered, other surgery options may be considered like a "neurectomy" or "neuromodulation".
Pudendal nerve entrapment
Nerve compression syndrome
Radiation-induced lumbar plexopathy
Peroneal nerve paralysis
Accessory nerve disorder
Urethral stricture
Median nerve palsy
Post-vasectomy pain syndrome