Chronic pelvic pain is a burdensome condition that involves multiple medical sub-specialties and is often difficult to treat. Sacral stimulation for functional bladder disease has been well established, but little large-scale evidence exists regarding utilization of other neuromodulation techniques to treat chronic pelvic pain. Emerging evidence does suggest that neuromodulation is a promising treatment, and we aim to characterize the use and efficacy of such techniques for treating chronic pelvic pain syndromes.
A systematic review of the literature demonstrating the treatment of chronic pelvic pain syndromes with neuromodulation. Abstracts were reviewed and selected for inclusion, including case series, prospective studies, and randomized controlled trials (RCTs). Case studies and publications in abstract only were not included. The reporting for this systematic review follows Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The literature search was performed using MEDLINE, Embase, Cochrane Library, PubMed, CINAHL, and Scopus.
A total of 50 studies were included in this review, three of which were randomized controlled trials, and the remaining were prospective and retrospective case series. The range of pelvic pain conditions treated included interstitial cystitis, peripheral neuralgia, pudendal neuralgia, gastrointestinal pain, urogenital pain, sacroiliac joint pain, and visceral chronic pelvic pain. We reported on outcomes involving pain, functionality, psychosocial improvement, and medication reduction.
Neuromodulation is a growing treatment for various chronic pain syndromes. Peripheral nerve stimulation was the least studied form of stimulation. Posterior tibial nerve stimulation appears to offer short-term benefit, but long-term results are challenging. Sacral nerve stimulation is established for use in functional bladder syndromes and appears to offer pain improvement in these patients as well. Dorsal root ganglion stimulation and spinal cord stimulation have been used for a variety of conditions with promising results. Further studies of homogeneous patient populations are necessary before strong recommendations can be made at this time, although pooled analysis may also be impactful.
Pain practice : the official journal of World Institute of Pain. 2023 Sep 19 [Epub ahead of print]
Brandon Gish, Brendan Langford, Christopher Sobey, Chahait Singh, Newaj Abdullah, Jeremy Walker, Hannah Gray, Jon Hagedorn, Priyanka Ghosh, Kiran Patel, Timothy Deer
Lexington Clinic Interventional Pain, Lexington, Kentucky, USA., Division of Pain Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Empire Minimally Invasive Spine and Pain, New York, New York, USA., Division of Pain Medicine, Department of Anesthesiology, University of Utah, Salt Lake City, Utah, USA., Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Mayo Clinic, Rochester, Minnesota, USA., ReMeDy Medical Group, San Francisco, California, USA., Lennox Hill Hospital, New York, New York, USA., The Spine and Nerve Center of the Virginias, Charleston, West Virginia, USA.