I have had pain in the medial area of the right ischial tuberosity since 2009. It sometimes radiates up into my scrotum, It is worse with sitting, especially on soft surfaces, and is only lessened by standing. Over the years I had minimally invasive surgery to the proximal adductor and hamstring tendons/muscles (tenjet, tenex, prp injections, dry needling). I have tried pelvic floor physical therapy multiple times. I have had diagnostic nerve blocks using fluoroscopic imaging with mixed results, and thus they did not want to pursue that path. I had a SI joint ablation which did not help. I have tried all the various pharmaceutical options and am currently taking 125mg topiramate and 30-60mg baclofen daily with little or no effect. I started ketamine infusion therapy at 2-3 week intervals and have had 8 treatments which offer some relief for anywhere from 4-7 days before symptoms start coming back. The relief seems to be lengthening as the treatments continue but I don't know how long I think we will go down this path. At the beginning of the year I started with a psychatrist that uses hypnosis and teaches self-hypnosis and this has been maybe the most useful tool of all. Yesterday I met with a new doctor that suggested trying pudendal nerve blocks with a rectal approach as opposed to the gluteal blocks I have had before. She suggested the gluteal approach is hit and miss and that is why my previous blocks were inconsistent and they would not continue with them. She also offers neuromodulation, but it is not FDA approved for the pudendal nerve so it would be self pay. She also can refer me to other Drs. in the system to explore PN surgery if compression or restriction is the actual problem. She also told me she can repeat the block every 4-6 weeks as needed and has had success in calming the problem through that approach. A pillow I found personally helpful for this is the Kabooti. I made the hole in the center larger to fit my personal anatomy and it takes the pressure off the inside and places it all on the outside.