Abstract
Purpose of Review
Chronic pelvic pain (CPP) is a complex condition that can be multifactorial, disabling, and difficult to treat. It is important to understand the various diagnoses and pathways that can be involved and have an understanding of the available treatment options.
Recent Findings
There is a complex innervation of the pelvic region which makes its treatment very challenging. There are pathophysiological similarities of CPP to disease states like complex regional pain syndrome and sympathetically driven pain.
Summary
CPP is poorly understood and includes psychological, psychosocial, cultural, and economic influences. Treatment options vary, but neuromodulation does remain a centerpiece and can include sacral stimulation, SCS, DRG stimulation, and PNS.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance
Kothari S. Neuromodulation approaches to chronic pelvic pain and coccydynia. Acta Neurochir Suppl. 2007;97:365–71.
Hunter C, Dave 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. 2013;13(1):3–17.
De Leon Casasola OA, Kent E, Lema MJ. Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Pain. 1993;54:145–51.
Lee RB, Stone K, Magelssen D, Belts RP, Benson WL. Presacral neurectomy for chronic pelvic pain. Obstet Gynecol. 1986;68(4):517–21.
Ploteau S, Labat JJ, Riant T, Levesque A, Robert R, Nizard J. New concepts on functional chronic pelvic and perineal pain: pathophysiology and multidisciplinary management. Discov Med. 2015;19(104):185–92.
Ingber MS, Peters KM, Killinger KA, Carrico DJ, Ibrahim IA, Diokno AC. Dilemmas in diagnosing pelvic pain: multiple pelvic surgeries common in women with interstitial cystitis. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(3):341–5.
• Hunter C, Stovall B, Chen G, et al. Anatomy, pathophysiology and interventional therapies for chronic pelvic pain: a review. Pain Physician. 2018;21(2):147–67 Discusses the difficulty in diagnosis and use of imaging in patients with CPP.
Janicki TI. Chronic pelvic pain as a form of complex regional pain syndrome. Clin Obstet Gynecol. 2003;46:797–803.
Hayek SM, Veizi E, Hanes M. Treatment-limiting complications of percutaneous spinal cord stimulator implants: a review of eight years of experience from an academic center database. Neuromodulation. 2015;18(7):603–8 discussion 608-609.
• Falowski S, Sharan A, McInerney J, Jacobs D, Venkatesan L, Agnesi F. NAPS – nonawake versus awake placement of spinal cord stimulators: a prospective, multicenter study comparing safety and efficacy. Neurosurgery. 2019;84(1):198–205. https://doi.org/10.1093/neuros/nyy062Landmark study for changing the approach for the implantation of neuromodulation devices in an asleep patient.
Falowski S, Dianna A. A prospective analysis of neuromonitoring for confirmation of lead placement in dorsal root ganglion stimulation. Oper Neurosurg (Hagerstown). 2018;14(6):654–60. https://doi.org/10.1093/ons/opx172.
Falowski S. A prospective analysis of the use of intra- operative neuromonitoring for mapping the S1 DRG location to determine ideal lead positioning and predict post- operative programming. Neuromodulation. 2020. https://doi.org/10.1111/ner.13156 Online ahead of print.
Falowski S, Conti K, Mogilner A. Analysis of S1 DRG programming to determine location of the DRG and ideal anatomic positioning of the electrode. Neuromodulation. 2019;23:252–7. https://doi.org/10.1111/ner.13039.
• Hunter C, Yang A. Dorsal root ganglion stimulation for chronic pelvic pain: a case series and technical report on a novel lead configuration. Neuromodulation. 2019;22(1):87–95 Great description of ideal lead locations for DRG stimulation.
Patel K. Dorsal root ganglion stimulation for chronic pelvic Pain. Obstet Gynecol. 2019;13:223S.
Bock S, Folie P, Wolff K, Marti L, Engeler DS, Hetzer FH. First experiences with pudendal nerve stimulation in fecal incontinence: a technical report. Tech Coloproctol. 2010;14(1):41–4.
Heinze K, Hoermann R, Fritsch H, Dermietzel R, van Ophoven A. Comparative pilot study of implantation techniques for pudendal neuromodulation: technical and clinical outcome in first 20 patients with chronic pelvic pain. World J Urol. 2015;33(2):289–94.
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Corey Hunter and Steven Falowski performed the design, study, data collection, analysis, and writing of the paper.
Steven Falowski consults for Abbott, Medtronic, Boston Scientific, Vertoss, and Saluda. Research is performed with Abbott, Medtronic, Biotronik, Saluda, and Vertiflex. Equity positions held in Saluda, CornerLoc, SPR Therapeutics, Thermaquil, Stimgenics, SpineThera, Neural Integrative Solutions, and AGR.
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Hunter, C.W., Falowski, S. Neuromodulation in Treating Pelvic Pain. Curr Pain Headache Rep 25, 9 (2021). https://doi.org/10.1007/s11916-020-00927-y
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DOI: https://doi.org/10.1007/s11916-020-00927-y