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Spinal Cord Stimulation for Chronic Neuropathic Pelvic Pain

High frequency intervention shown beneficial; offers new treatment possibilities

A PPM Brief

Chronic neuropathic pain in the pelvis presents a challenge for many doctors, as treatment is limited and requires multiple tests and procedures to relieve pain symptoms. A number of comorbidities and other complexities common with this condition make treatment consistency another uphill battle. High frequency (10-kHz) spinal cord stimulation (SCS) has shown promise in reducing lower back and leg pain,1 and a recent report by Simopoulos et al,2 looked to apply this same intervention to patients with chronic neuropathic pelvic pain.

The case series evaluated three patients who presented with SCS treatment, underwent a standard anterograde approach, and were carefully selected for mediation via dysfunction of sacral nerves (S2–S5) and coccygeal nerves.2

Patient 1 was a 65-year-old man with a four-year history of refractory left-sided coccydynia status postcoccygectomy, presenting with severe pain on the left side that was greater than on right side of the base of the sacrum. He rated his average pain intensity over the week preceding the procedure on the visual analog scale (VAS) as 8.2. Following full implantation of the Senza SCS system (Nevro Corp, Redwood City, CA) at 9 months, the patient reported an average pain intensity score on the VAS of 4.0, and noted improved sitting tolerance.2

Patient 2 was a 72-year-old man presenting with a five-year history of pain in the perineal region, including the rectum, scrotum, and penis, who had an average pain intensity score of 8.3 on the VAS. At 12-month follow-up after full implantation of the SCS system, the patient reported an average VAS score over a week of 3.3, and marked a 75% reduction in opioid usage.2

Patient 3 was a 72-year-old woman presenting with a 10-year history of pudendal neuralgia manifesting as pain in the vagina, rectum, and coccyx. Her average VAS score was 7.5. Following full implantation of the SCS system at 11 months, the patient achieved a significant reduction of pain, rating her pain intensity VAS score at 4.1, as well as improved sitting tolerance.2

The researchers noted the importance of distinguishing between traditional and 10-kHz stimulation in future neuropathic pelvic pain research and application. “A grasp of intricacies of each method is important in offering this therapy and achieving optimum outcomes for the patient,” they wrote. Despite the noted observational bias, lack of controls, and short-term follow-up of the case series, the authors hope that their preliminary review may “establish the basis for a more rigorous study designed to define and quantify the response seen.”2

Last updated on: April 5, 2018
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Chronic Pelvic Pain Resolved Best With Interdisciplinary Approach
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