title: Chronic perineal pain: analyses of prognostic factors in pudendal neuralgia.
abstract: OBJECTIVE
  To establish the prognostic factors and outcomes of patients with pudendal neuralgia (PN).
  
  
  METHODS
  A total of 51 patients with PN treated at the Puerta de Hierro University Hospital of Madrid between January 2011 and June 2012 were included in this study. Patients were compared in relation to pain intensity and response to the first-line treatment of neuropathic pain. Univariate and multivariable Cox regression analyses were used.
  
  
  RESULTS
  The median for patients' age, duration, and intensity of pain evaluated by visual analogue scale were 40.9, 3.6, and 7.6 years, respectively. Among 45 patients, there were 19 good responders to first-line treatment for neuropathic pain and 26 nonresponders. The 19 responders measured their improvement at 47%. Tramadol was used for nonresponding patients, 30.8% of whom expressed a 35% improvement. Analysis of 45 patients with PN demonstrated that the pain intensity was associated with dorsal clitoris nerve damage (15.4% vs. 52.2%; P=0.035; odds ratio 4.5; 95% confidence interval [CI], 1.11-18.1) and with sensory deficit at the S2-S4 dermatome map (57.7% vs. 87%; P=0.05; odds ratio 3.7; 95% CI, 0.80-16.8). The pain located at the dorsal clitoris nerve was a significant prognostic factor for having no response to the first-line treatment of neuropathic pain (28% vs. 53%; P=0.033; odds ratio 4.5; 95% CI, 1.06-19.6).
  
  
  CONCLUSIONS
  A mixed analgesic ladder for chronic pain showed improvement in 73% of the patients with PN. Pain restricted to the dorsal clitoris nerve and small fibers in the S2-S4 dermatome were classified as bad prognostic factors. A longer duration of pain was also correlated with a worse prognosis.
authors.affiliation: *Department of Gynecologic Surgery, Puerta de Hierro University Hospital †Department of Gynecology and Obstetrics, College of Medicine, Autonoma University ‡Statistics Department, Puerta de Hierro University Hospital, Madrid, Spain §Department of Gynecologic Surgery, Gregorio Marañón University General Hospital, Madrid, Spain.
authors.forename: Augusto
authors.initials: A
authors.lastname: Pereira
authors.forename: Tirso
authors.initials: T
authors.lastname: Pérez-Medina
authors.forename: Ana
authors.initials: A
authors.lastname: Rodríguez-Tapia
authors.forename: Steffi
authors.initials: S
authors.lastname: Rutherford
authors.forename: Isabel
authors.initials: I
authors.lastname: Millan
authors.forename: Enrique
authors.initials: E
authors.lastname: Iglesias
authors.forename: Luis
authors.initials: L
authors.lastname: Ortiz-Quintana
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000175:diagnosis; D005260:Female; D006801:Humans; D008875:Middle Aged; D010147:Pain Measurement; D011379:Prognosis; D060545:Pudendal Neuralgia / Q000175:diagnosis* / Q000503:physiopathology*; D012044:Regression Analysis; D055815:Young Adult