You’re acting as though the medical route means opioids. Masking the pain is exactly what is needed so your central nervous system can heal from the damage of long term pain signals. As far as the strength and psychoactive properties I feel no sluggishness or any other side effect on my low dose nerve pain meds. These are not opiates. Hard drugs are ineffective for this kind of pain. I literally race crits at 26-28mph on these.
Enjoy your needless suffering. You have every right to it.
I wasn’t suggesting that opioids are the meds of choice here. I was offered amitriptyline which made me sleepy and then pregabalin which i didn’t like the sound of at all, so i only took 2 of them and gave them back to the Doc. These are anti-depression type drugs which have a side effect of masking nerve pain. Bonus, i’m sure, but the list of side effects seemed to include possible suicide. Hmm, no thanks. Also, i didn’t like the thought of being reliant on the long term use of something that you can’t just stop taking without possibly serious problems… (I’ve just Googled the drugs and their side effects and it’s a sobering list).
PN sucks and it’s one of those things that is just “not fair”. If you have found a way to get on with your life then i’m happy for you. I’ll take the more risk-averse and pharma-adverse approach as that is more my way of doing things.
I’ve made the decision to at least “postpone” the nerve block I had scheduled for August 1st. My doctor upped my dosage of gabapentin from 100mg (way too low) to 300mg 3x/day. I also had my first session with my physiotherapist on Monday. Hopefully between physiotherapy and the increase in dosage I can get some relief. I just would like this occasional electric zapping at the top of my favorite body part to stop! 
Fair. There are no one side fits all easy answers it seems. I’m fortunate gabapentin works so well for me without any of the potential side effects. Honestly, my morning coffee is more psychoactive. Mine is an anti-convulsant rather than an anti-depressant so I don’t know if that makes a difference but it is fair to point out that in a minority of people all of these can carry side effects that outweigh the benefit.
Sorry you didn’t find a med that works for you and I’m glad you’re seeing improvement nevertheless. Being risk averse is unferstandable but it did feel like you’re casting those of us for whom have seen little downside to the medical route as… druggies.
I mean, I was worried about being on meds long term too but my doc assured me that neuroplasticity will do it’s work it just takes a long time. Im already skipping a dose almost every single day and am expected to come off these damn things eventually.
Combined with my special saddle Im able to do anything with bikes without restriction and that changed my life for the better! Crits. mountains. Group rides with my friends. I’m very fortunate. I want people to see both sides here so they don’t write off the medical route without giving it a shot (and you gave it a shot).
Sounds like the exact same titration I went through with my doc. We also ended up with a 600mg evening dose to make it longer through the night for 1200mg total daily which I’m told is on the low side. I’m back to 600-900mg now.
Perhaps you are right and I know this is slightly off topic, but some diagnoses are incurable. I have ulcerative colitis, which is unfortunately one of those. Taking medication every day to “treat” it is a fact of life for me. I know it’s a bit apples to oranges, and while I used to think the idea of being on medication of any sort for life was for the elderly and a sign of the coming end of my life. Being in my mid-thirties when I diagnosed with this came to terms pretty quickly that I’m much better off treating my illness than not.
Druggies? For sure not. I am a child of the raving generation - i have a lot of stories i’d never be able to tell my kids 
Part of my worry was thinking that the pudendal nerve does a lot of useful things. I’m in my fifties with 3 kids so really sexual activity is a lower priority for me. But the thought of masking the pain and continuing to damage a nerve that controls urinary and rectal incontinence was a risk too far for me. 
I’m still able to ride again now, probably not centuries but 4 hour XC rides are no problem.
@RCC didn’t do this at all, and I think everyone agrees that taking medication sucks and if you can avoid it, awesome. It’s down to personal choice and measurement of quality of life. I luckily don’t have to take anything at the moment. I’m 43.
But on the topic of drugs, perhaps the absolute worst is begging for pain meds and being treated like a druggie. I’ve been there. Stupid PA called my problem “piriformis syndrome “, and when I explained I knew exactly what that is and that isn’t the problem, and muscle relaxers won’t help, he said too bad, that’s all he’d do. I explained that I’ve already had surgery twice for herniated discs, and I knew the pain and sciatica. He wouldn’t budge. I had an MRI at a different hospital, showed a HUGE herniation, and a week later I was having a fusion.
I filed a complaint against that PA and the hospital administrator called me personally to apologize.
I get that opiate abuse is rampant, but what is the point of having it if you don’t show some mercy on someone? I was in absolute agony and could barely walk.
I have a saddle that prevents further damage and so far it has worked. My gabapentin dose has gone down in 2.5 years of riding. Maybe this is too personal but you know what else I did in that time while riding with pudendal neuralgia? Got my wife pregnant twice. Nothing I’m doing , treating my pain and living my life is hurting my pudendal nerve.
The thing that you have to understand is that sometimes when the underlying cause is healed, pain persists because long term pain alters your nervous system.
True, my urologist said that sometimes nerves take a couple of years to fix themselves after damage during surgery or an accident.
Yes I have read that you almost have to retrain your brain to relax enough to forget the pain.
Hi @RCC,
Last time we spoke you were trying Airplan. Would you still recommend them? Also, which Selle SMP saddle worked for you?
Cheers,
Abhi
Hi @cosgroveb,
Are you still on the infinity saddle? I tried the E2 but didn’t have much relief from it…maybe I didn’t set it up properly…I agree with what you are saying…the central sensitisation of the nervous system has to be avoided …the recurrent pain signals in my case although I stopped cycling have been continuing for almost 18 months despite the small dose of meds and this keeps most hip and back muscles in spasm leading to discs getting worse if they are already bad (for most cyclists).
Getting over the pain in hindsight for me would have kept my back in better condition not to mention the mental effects of not being able to cycle and being stuck in the house…
I had to give up cycling for 6 months, but i managed to keep running which was a lifesaver. Have you looked at that, or given it a go?
Aidplan had some value. It didn’t fix it for me but it’s probably worth a look.
In terms of saddles i used the Selle SMP VT 20 Sport. I seem to have quite narrow sit bones so this was their recommended option. I’ve since also got a MTB with a Bontrager P3 Verse Elite which is even more comfortable.
I tried running but that made me worse…so I am now swimming and walking…even with swimming, I use a pull buoy between my thighs…front crawl is ok for a bit but breast stroke is an absolute no-no…
When I first got injured in Jan 2021, I should have stopped everything but I kept riding till March and made everything worse and then NHS physio told me to do core exercises which was probably the last straw…
Can I just say a massive thank you for every one who posts on this forum - I often view it when in pain and it gives me some hope
I have been trying duloxetene and that has made things a little better
Jumped on my old mountain bike and went for a short ride with my young daughter yesterday and now back in pain . Overall I’m 15 months on and not that much better
My pain doc has said try and epidural type spine injection
My urologist says go for trigger point injection
Not really sure what to do but don’t want to live like this
Hi @Anchorman,
Glad you are doing slightly better to even try a MTB for a bit…my tuppence worth is as follows; if your spine has been imaged by MRI previously and they haven’t found anything wrong with facets,discs etc, the epidural will not help …I got no relief from it and the physio exercises everyone prescribes once they are led to believe you have a bad back lead to pelvic pain getting worse…most if not all core exercises put strain on the pelvic floor muscles and the area around the alcock’s canal leading to PN getting worse if that is the root cause. Atleast, this is what happened to me…
Have you thought about using one of these saddles that are recommended on this forum to see whether it keeps the pain away?
Best wishes,
Abhi
I’m sorry to hear that. Yes, I’m still on the E2. It’s the only thing that works for me but I had to try a few others first… SQLab, ISM. I think that like with meds there’s no one size fits all solution for saddles either. Lots of individual variation 
I swam a LOT but like you it wasn’t perfect. Running was a no go. Swimming was okay if I didn’t kick off the wall too much when I was not doing as well. Some days just touch turns… But I mostly didn’t modify my swimming very much. Probably should have but I needed an outlet.