David Hao1, Alp Yurter2, Robert Chu3, Mariam Salisu-Orhurhu4,5, Henry Onyeaka6, Jon Hagedorn7, Kiran Patel8,9, Ryan D'Souza10, Susan Moeschler10, Alan David Kaye11,12,13, Vwaire Orhurhu14,15. 1. Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 2. Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA. 3. Department of Anesthesiology, Duke University, Durham, NC, USA. 4. University of Pittsburgh Medical Center, Susquehanna, Williamsport, PA, USA. 5. MVM Health, East Stroudsburg, PA, USA. 6. Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 7. iSpine Pain Physicians, Maple Grove, MN, USA. 8. Department of Anesthesiology, New York University Langone Medical Center, New York City, NY, USA. 9. Department of Anesthesiology and Pain Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, USA. 10. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA. 11. Anesthesiology and Pharmacology, Toxicology, and Neurosciences, LSU School of Medicine, Shreveport, LA, USA. 12. Anesthesiology and Pharmacology, LSU School of Medicine, New Orleans, LA, USA. 13. Anesthesiology and Pharmacology, Tulane School of Medicine, New Orleans, LA, USA. 14. University of Pittsburgh Medical Center, Susquehanna, Williamsport, PA, USA. vwo569@mail.harvard.edu. 15. MVM Health, East Stroudsburg, PA, USA. vwo569@mail.harvard.edu.
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.
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.
Authors: Daniel S Engeler; Andrew P Baranowski; Paulo Dinis-Oliveira; Suzy Elneil; John Hughes; Embert J Messelink; Arndt van Ophoven; Amanda C Williams Journal: Eur Urol Date: 2013-04-28 Impact factor: 20.096