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.

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Human subjects: Consent was obtained or waived by all participants in this study. Johns Hopkins Medicine IRB issued approval NA. The JHM IRB determined that this case did not constitute human subject research under the DHHS or FDA regulations. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.