115 Exploring Pain-related Anxiety in Pudendal Neuralgia

Abstract

Pudendal neuralgia (PN), a chronic form of vulvar and pelvic pain, is defined as pain in the distribution of the pudendal nerve. The pudendal nerve Results in 3 terminal branches: the perineal nerve, the dorsal clitoral nerve, and the inferior rectal nerves. Of these branches, injury to the dorsal clitoral nerve (DCN) has been associated with longer duration of pain. Pain-related anxiety, an independent variable in models of chronic pain, has been postulated to exacerbate and extend chronic pain. Additionally, posttraumatic stress symptoms (PTSS), which are highly prevalent in chronic pain patients, have been shown to also have significant impact on psychosocial components of pain. This study was conducted to explore pain-related anxiety in pudendal neuralgia patients via analysis of patient scoring on pain anxiety symptoms scale (PASS20) questionnaire. The effect of dorsal clitoral nerve (DCN) involvement and/or posttraumatic stress on scoring was also investigated. Patient anxiety symptom scale questionnaire (PASS20) was collected from new patients who visited two vulvovaginal specialty clinics in DC and NY between January 1, 2017 and December 31, 2017 (n=352). Data from patients clinically diagnosed with pudendal neuralgia was analyzed further (n=26). Pudendal neuralgia diagnosis was confirmed by diagnostic pudendal nerve block. DCN involvement was assessed by testing allodynia of the glans clitoris during physical exam. Patient subjective PTSS was recorded. Cut off score for anxiety was PASS 20 score greater than 30. Pairwise Mann-Whitney U test was performed between DCN, PTSS, and PASS 20 total and subscale (cognitive, escape/avoidance, fear, and physiological anxiety) scores.