Diagnostic Pain: A Case of Pudendal Neuralgia

Pudendal neuralgia remains a challenging diagnosis given the absence of sensitive biomarkers or imaging findings. The following case describes a patient with rectal pain complicated by prolonged hospitalization who was eventually diagnosed with pudendal neuralgia per the Nantes criteria. It furthermore underscores several confounders that prevented timely diagnosis, including misattribution of her symptoms to prior resolved conditions, anchoring bias in the absence of confirmatory evidence, and misattribution of her pain to opiate-induced allodynia. It also draws attention to the toll exacted by delays in diagnosis, including patient discomfort, deconditioning, exposure to high-dose opioids, susceptibility to potential nosocomial infections, strain on patient-provider relationships, and the need for post-discharge inpatient rehabilitation, in addition to significant financial costs.