Interventional treatments for chronic pelvic pain caused by myometrial cysts.

•Diagnosing these patients is rather difficult, majority of the patients in the case series shared chronic pelvic pain as a common symptom.•Nerve blocks with image guided fluoroscopy can potentially eliminate the patient's chronic pelvic pain.•Examples include pudendal nerve block, superior and inferior hypogastric plexus block, and ganglion impar block.

Dear Editor,

We read the recent article by Green et al., Myometrial Cysts: A case series [1], with great interest. Although diagnosing these patients is rather difficult, whether from MRI or histopathological assessment, the majority of the patients in the case series shared chronic pelvic pain as a common symptom. Although resection of the cyst with hysterectomy or other means will likely treat the chronic pelvic pain, there are certain situations in which a hysterectomy is not desired by the patient or access to the cyst is simply not possible. In these cases, there are alternatives to pharmacologic management of chronic pelvic pain, which anyway is usually insufficient.

As Interventional Pain Medicine physicians, the best intervention is the performance of diagnostic and therapeutic nerve blocks with image-guided fluoroscopy to eliminate the source of the patient's chronic pelvic pain.

Pudendal nerve blockade or ablation may relieve chronic perineal pain via interruption of pudendal innervation within the penis, clitoris, bulbospongiosus muscle, ischiocavernosus muscles, perineum, and anus [2]. Pain physicians may block the superior hypogastric for sympathetically mediated pain pathways associated with cancer-related pelvic pain [3]. Inferior hypogastric plexus block can treat pain in the lower pelvic viscera as well as pelvic cancer pain [4,5]. The ganglion impar, a collection of nerves adjacent to the coccyx, can be blocked to treat chronic pelvic and perineal pain.

Myometrial cysts can cause chronic pelvic pain, and in certain cases image-guided nerve blocks can provide substantial relief.

Conflict of Interest

The author declares that he has no conflict of interest in relation to this letter.

Funding

No funding was received in relation to this letter.