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Hao D, Yurter A, Chu R, Salisu-Orhurhu M, Onyeaka H, Hagedorn J, Patel K, D'Souza R, Moeschler S, Kaye AD, Orhurhu V. Neuromodulation for Management of Chronic Pelvic Pain: A Comprehensive Review. Pain Ther 2022; 11:1137-1177. [PMID: 36109459 PMCID: PMC9633896 DOI: 10.1007/s40122-022-00430-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/26/2022] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Chronic pelvic pain (CPP) is a symptom that derives from a complex group of heterogeneous pathologies of the pelvic organs. The aim of this study was to review the available evidence on efficacy of neuromodulatory modalities including sacral neuromodulation, dorsal root ganglion stimulation, dorsal column neuromodulation, and pudendal nerve stimulation. METHODS This narrative review focuses on updated information on neuromodulation for management of chronic pelvic pain. In 2022, we searched English-language studies on neuromodulation, pelvic pain, and chronic pain in a comprehensive search. We searched the following databases: PubMed, Medline, SciHub, Cochrane Database of Systematic Reviews, and Google Scholar. We used the following combinations of keywords: neuromodulation, pelvic pain, chronic pain, chronic pelvic pain, pelvic pain treatment. We tried to include as many recent manuscripts as possible (within the last 3 years) but also included papers older than 3 years if they were particularly relevant to our topic. We also attempted to search for, use, and cite primary manuscripts whenever possible. RESULTS CPP is a challenging entity to treat because of diagnostic inconsistencies and limited evidence for therapeutic modalities. Our review found evidence suggestive of benefit for all modalities reviewed but the data was of overall low quality with numerous limitations. The literature highlights a lack of randomized controlled trials for neuromodulatory therapies but suggests a growing role for such techniques in treating refractory chronic pelvic pain syndrome (CPPS). CONCLUSIONS This review explores the available evidence on efficacy of neuromodulatory modalities for CPPS and contextualizes the results with information about the type of neuromodulation, lead location and waveform, pain outcomes and assessment timepoints, and reported adverse effects.
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Affiliation(s)
- David Hao
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alp Yurter
- Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert Chu
- Department of Anesthesiology, Duke University, Durham, NC, USA
| | - Mariam Salisu-Orhurhu
- University of Pittsburgh Medical Center, Susquehanna, Williamsport, PA, USA
- MVM Health, East Stroudsburg, PA, USA
| | - Henry Onyeaka
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Kiran Patel
- Department of Anesthesiology, New York University Langone Medical Center, New York City, NY, USA
- Department of Anesthesiology and Pain Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, USA
| | - Ryan D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Susan Moeschler
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alan David Kaye
- Anesthesiology and Pharmacology, Toxicology, and Neurosciences, LSU School of Medicine, Shreveport, LA, USA
- Anesthesiology and Pharmacology, LSU School of Medicine, New Orleans, LA, USA
- Anesthesiology and Pharmacology, Tulane School of Medicine, New Orleans, LA, USA
| | - Vwaire Orhurhu
- University of Pittsburgh Medical Center, Susquehanna, Williamsport, PA, USA.
- MVM Health, East Stroudsburg, PA, USA.
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Rongqing G, Yafei W, Zhimin W, Feng L, Yuantao L, Xinhua C, Lu C, Hui Z, Kailun L. Treatment Outcome of Acute Sacral Nerve Stimulation in Functional Anorectal Pain. Pain Pract 2018; 19:390-396. [PMID: 30472789 DOI: 10.1111/papr.12751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/27/2018] [Accepted: 11/15/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Sacral nerve stimulation (SNS) has revolutionized the management of certain intractable cases of fecal and urinary incontinence; however, the management of functional anorectal pain (FAP) has been addressed in only a few studies. OBJECTIVE The aim of this study was to evaluate the treatment effect of SNS in improving FAP symptoms. METHODS A total of 120 patients with FAP who had undergone temporary SNS probe placement were investigated at Qianfoshan Hospital between January 2014 and December 2016. Pre- and post-SNS treatment outcomes were assessed using the VAS, anorectal manometry, and the 36-item short-form health survey (SF-36) medical outcomes study instrument. RESULTS A total of 120 patients proceeded to insertion of an SNS probe at the S3 nerve root (2 Hz, 1.50 mA, 0.10 milliseconds). Of these, 75 patients were cured, 41 improved, and 4 had an ineffective outcome. The total effectiveness rate was 96.7% 1 year after treatment. There was a significant reduction in the median VAS score pre-SNS and post-SNS, from 8 to 3, respectively. Patients post-SNS had lower anal maximum contraction pressure and anal rest pressure than did patients pre-SNS. Compared with the pretreatment group, there were no substantial differences between anal longest contraction time and rectal rest pressure. In addition to general health, there was a substantial improvement in the remaining dimension scores of the SF-36. CONCLUSION The effect of SNS in treating FAP was positive, and the improvement of symptoms was substantial and worthy of clinical promotion.
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Affiliation(s)
| | - Wang Yafei
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wang Zhimin
- Qianfoshan Hospital Affiliated to Shandong University, Jinan, China
| | - Liu Feng
- Qianfoshan Hospital Affiliated to Shandong University, Jinan, China
| | - Li Yuantao
- Qianfoshan Hospital Affiliated to Shandong University, Jinan, China
| | - Chen Xinhua
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chen Lu
- Weifang Medical University, Weifang, China
| | - Zhang Hui
- Weifang Medical University, Weifang, China
| | - Liu Kailun
- Weifang Medical University, Weifang, China
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Maeda Y, O'Connell PR, Lehur PA, Matzel KE, Laurberg S. Sacral nerve stimulation for faecal incontinence and constipation: a European consensus statement. Colorectal Dis 2015; 17:O74-87. [PMID: 25603960 DOI: 10.1111/codi.12905] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 10/29/2014] [Indexed: 12/14/2022]
Abstract
AIM In Europe during the last decade sacral nerve stimulation (SNS) or sacral neuromodulation (SNM) has been used to treat faecal incontinence (FI) and constipation. Despite this, there is little consensus on baseline investigations, patient selection and operative technique. A modified Delphi process was conducted to seek consensus on the current practice of SNS/SNM for FI and constipation. METHOD A systematic literature search of SNS for FI and constipation was conducted using PubMed. A set of questions derived from the search and expert opinion were answered on-line on two occasions by an international panel of specialists from Europe. A 1-day face-to-face meeting of the experts finalized the discussion. RESULTS Three hundred and ninety-three articles were identified from the literature search, of which 147 fulfilled the inclusion criteria. Twenty-two specialists in FI and constipation from Europe participated. Agreement was achieved on 43 (86%) of 50 domains including the set-up of service, patient selection, baseline investigations, operative technique and programming of the device. The median of agreement was 95% (35-100%). CONCLUSION Consensus was achieved on the majority of domains of SNS/SNM for FI and constipation. This should serve as a benchmark for safe and quality practice of SNS/SNM in Europe.
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Affiliation(s)
- Y Maeda
- Sir Alan Parks Physiology Unit, St Mark's Hospital, Harrow, UK
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Borycka-Kiciak K, Wawiernia K, Namysł J, Garstka-Namysł K, Tarnowski W. Role of electromyography and functional electrical stimulation in the treatment of anorectal diseases. POLISH JOURNAL OF SURGERY 2015; 87:194-202. [DOI: 10.1515/pjs-2015-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Indexed: 11/15/2022]
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Chronic idiopathic anal pain. Results of a diagnostic-therapeutic protocol in a colorectal referral unit. Cir Esp 2014; 93:34-8. [PMID: 24411560 DOI: 10.1016/j.ciresp.2013.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 09/06/2013] [Accepted: 09/23/2013] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Chronic idiopathic anal pain (CIAP) remains a diagnosis of exclusion. Its study and management still lack a standardized protocol. The aim of this study is to evaluate the results obtained with the diagnostic-therapeutic protocol established in our service. MATERIAL AND METHODS We performed a retrospective study of patients diagnosed with CIAP at the Colorectal Unit of the General University Hospital of Elche, between 2005 and 2011. RESULTS We evaluated 57 patients with a diagnosis of chronic anal pain for functional anorectal disease (FAD). After the application of our diagnostic protocol, final diagnosis of chronic anal pain (CAP) was achieved in 43 cases (75%), including 22 cases of descending perineum syndrome, 12 of proctalgia fugax, 2 of pudendal neuritis and 7 of coccydynia. In 14 patients exclusion diagnosis of CIAP was established. Among the therapies used on patients with CIAP, biofeedback combined with conservative measures improved symptoms in 43% of the cases. Sacral nerve stimulation was assessed in patients who did not respond to other treatments. CONCLUSION Through proper anamnesis, physical examination and complementary tests, a specific diagnosis of the cause of CAP by FAD can be achieved, reducing exclusion diagnosis of CIAP to 25% of cases. Conservative measures combined with biofeedback achieved an improvement in pain in more than 40% of the cases of CIAP in our study. Sacral nerve stimulation can be considered as a treatment option in refractory cases.
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Park CH, Kim BI. Sacral nerve stimulation through the sacral hiatus. Korean J Pain 2012; 25:195-7. [PMID: 22787552 PMCID: PMC3389326 DOI: 10.3344/kjp.2012.25.3.195] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 06/07/2012] [Indexed: 11/05/2022] Open
Abstract
Sacral nerve stimulation through the retrograde approach has been used for peroneal or irritable bowel syndrome through the retrograde approach. However, several reasons, lead could not be advanced down ward. In this case, anterograde sacral nerve stimulation through the sacral hiatus could be used. The aim of this report is to present of technique of sacral nerve root stimulation through the sacral hiatus approach.
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Affiliation(s)
- Chan Hong Park
- Department Anesthesiology and Pain Medicine, Daegu Wooridul Spine Hospital, Daegu, Korea
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Hunter C, Davé N, Diwan S, Deer T. Neuromodulation of pelvic visceral pain: review of the literature and case series of potential novel targets for treatment. Pain Pract 2012; 13:3-17. [PMID: 22521096 DOI: 10.1111/j.1533-2500.2012.00558.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Chronic pelvic pain (CPP) is complex and often resistant to treatment. While the exact pathophysiology is unknown, the pain states resultant from conditions such as interstitial cystitis and the like yield patients with a presentation that bears a striking similarity to neuropathic syndromes that are known to respond to neuromodulation. While there has been past success using the sacral region as a target for spinal cord stimulation (SCS) to treat these patients, there remains to be a consensus on the optimal location for lead placement. In this article, the authors discuss the potential etiology of CPP, examine the current literature on lead placement for SCS as a method of treatment, as well as present several cases where novel lead placement was successfully employed.
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Affiliation(s)
- Corey Hunter
- Department of Anesthesiology, Division of Pain Medicine, Weill Cornell Medical College, New York, New York 10010, USA.
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Abstract
AIM The aim of this article was to determine the effect of sacral nerve stimulation (SNS) on the treatment of faecal incontinence, constipation, irritable bowel syndrome, mixed urinary and bowel disorders, spinal injury and neurodegenerative disease, pain syndromes, and sexual dysfunction. METHOD A Medline search was performed including the keywords and/or MeSH headings of 'sacral nerve stimulation', 'neuromodulation', 'artificial pacemaker', 'faecal incontinence', 'constipation' and 'anal pain'. Further studies were identified by cross-referencing from relevant articles and by appraisal of recent peer-reviewed conference abstracts and proceedings. RESULTS SNS has been used for the treatment of urinary, bowel and sexual dysfunction, as well as pain resulting from such disorders, and dysfunction arising from nerve injury and degenerative disease. There is a paucity of high quality evidence to support the use of SNS for the majority of novel indications at present. CONCLUSION Good quality prospective, cross-over studies are required to determine the true benefits of SNS. Further research into patient selection, operative technique and stimulation parameters for existing indications will ensure a place for SNS in the future treatment algorithm of functional pelvic floor disorders.
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Affiliation(s)
- T C Dudding
- Basingstoke and North Hampshire Hospital, Basingstoke, UK.
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