Abstract
Objective
To evaluate the long-term effects of percutaneous tibial nerve stimulation (PTNS) on quality of life in women with chronic pelvic pain.
Materials and methods
Thirty-three women with chronic pelvic pain were randomized into PTNS (n = 16) or control (n = 17) groups. In PTNS group, weekly PTNS in 30-min sessions for 12 weeks was performed whereas the control group received no stimulation. Present pain intensity-visual analog scale (PPI-VAS), short-form McGill pain questionnaire (SF-MPQ), and SF-36 were used at baseline, 12-week, and 6-month follow-up for the evaluation of pain intensity and quality of life.
Results
Two women (12.5 %) were cured, 7 (43.8 %) were much improved, 6 (37.5 %) were the same and 1 (6.3 %) was worse after PTNS. Two women (11.8 %) were improved, 10 (58.8 %) were the same, and 5 (29.4 %) were worse in the control group. Mean PPI-VAS of PTNS group at baseline, 12 weeks, and 6 months was 8.4 ± 1.1, 3.8 ± 3.5 and 4.5 ± 3.7, respectively. There was a significant improvement in PPI-VAS scores of PTNS group whereas no change was observed in the control group. There was a slight increase in the PPI-VAS scores of the PTNS group at 6-month, but the difference was not statistically significant. There was significant improvement in all domains of SF-MPQ and SF-36 in PTNS group with continuing effects at 6 months whereas no significant change was observed in the control group.
Conclusion
PTNS is a minimally invasive treatment method that leads to decrease in pain severity and improvement in quality of life in women with chronic pelvic pain with effects continuing at 6 months.
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References
ACOG Committee on Practice Bulletins–Gynecology (2004) ACOG Practice Bulletin No: 51. Chronic pelvic pain. Obstet Gynecol 103(3):589–605
Howard FM (2003) The role of laparoscopy in the chronic pelvic pain patient. Clin Obstet Gynecol 46(4):749–766
Walker EA, Katon WJ, Jemelka R (1991) The prevalence of chronic pelvic pain and irritable bowel syndrome in two university clinics. J Psychosom Obstet Gynecol 12:65–75
Jamieson DJ, Steege JF (1996) The prevalence of dysmenorrhea, dyspareunia, pelvic pain and irritable bowel syndrome in primary care practices. Obstet Gynecol 87(1):55–58
Hulka JF, Peterson HB, Phillips JM (1993) Operative laparoscopy. American Association of Gynecologic Laparoscopists 1991 membership survey. J Reprod Med 38:569–571
Walter M, Sammer U, Kessler TM (2012) Chronisches Schmerzsyndrom des Beckens. Neurostimulation, Neuromodulation und Akupunktur. Urologe 51:1683–1691
Gambone JC, Mittman BS, Munro MG (2002) Consensus statement for the management of chronic pelvic pain and endometriosis: proceeding of an expert-panel consensus project. Fertil Steril 78:96
Zermann DH, Ishiooka M, Doggweiler R, Schubert J, Schmidt RA (2001) The male chronic pelvic pain syndrome. World J Urol 19:173–179
Evaraert K, Devulder J, De Muynck M (2001) The pain cycle: implications for the diagnosis and treatment of pelvic pain syndromes. Int Urogynecol J Pelvic Floor Dysfunct 12(1):9–14
Klingler HC, Pycha A, Schmidbauer J, Marberger M (2000) Use of peripheral neuromodulation of the S3 region for treatment of detrusor overactivity: a urodynamic-based study. Urology 56(5):766–771
Govier FE, Litwiller S, Nitti V, Kreder KJ Jr, Rosenblatt P (2001) Percutaneous afferent neuromodulation for the refractory overactive bladder: results of a multicenter study. J Urol 165(3):1193–1198
Van Balken MR, Vandoninck V, Gisolf KWH et al (2001) Posterior tibial nerve stimulation as neuromodulative treatment of lower urinary tract dysfunction. J Urol 166:914–918
Onal M, Ugurlucan FG, Yalcin O (2012) The effects of posterior tibial nerve stimulation on refractory overactive bladder syndrome and bladder circulation. Arch Gynecol Obstet 286(6):1453–1457
Gungor Ugurlucan F, Karamustafaoglu B, Yalcin O (2012) Posterior tibial nerve stimulation for the treatment of voiding dysfunction 8 years after radical hysterectomy. Arch Gynecol Obstet 286(2):545–547
McGuire EJ, Zhang SC, Horwinski ER, Lytton B (1983) Treatment of motor and sensory detrusor instability by electric stimulation. J Urol 129:78–79
Van Balken MR, Vandoninck V, Messelink BJ, Vergunst H, Heesakkers JPFA, Debruyne FMJ, Bemelmans BLH (2003) Percutaneous tibial nerve stimulation as neuromodulative treatment of chronic pelvic pain. Eur Urol 43:158–163
Gokyildiz S, Kizilkaya Beji N, Yalcin O, Istek A (2012) Effects of percutaneous tibial nerve stimulation therapy on chronic pelvic pain. Gynecol Obstet Invest 73(2):99–105
Cooperberg MR, Stoller ML (2005) Percutaneous neuromodulation. Urol Clin N Am 32:71–78
Stoller M (1999) Afferent nerve stimulation for pelvic floor dysfunction. Eur Urol 35:16
Pinar R (1995) Quality of life of patients with diabetes mellitus and examination of the factors affecting the quality of life (in Turkish). In: Thesis, Istanbul University Health Sciences Institute thesis of doctorate, Istanbul
Melzack R (1987) The Short-form McGill pain questionnaire. Pain 30(2):191–197
Mayer RD, Howard FM (2008) Sacral nerve stimulation: neuromodulation for voiding dysfunction and pain. Neurotherapeutics 5(1):107–113
Sikiru L, Shmaila H, Muhammed SA (2008) Transcutaneous electrical nerve stimulation (TENS) in the symptomatic management of chronic prostatitis/chronic pelvic pain syndrome: a placebo-control randomized trial. Int Braz J Urol 34(6):708–713
Dionisi B, Anglana F, Inghirami P, Lippa P, Senatori R (2008) Use of transcutaneous electrical stimulation and biofeedback for the treatment of vulvodynia (vulvar vestibular syndrome): result of 3 years of experience. Minerva Ginecol 60(6):485–491
Biemans JMAE, van Balken MR (2013) Efficacy and effectiveness of percutaneous tibial nerve stimulation in the treatment of pelvic organ disorders: a systematic review. Neuromodulation 16:25–34
Vandoninck V, Van Balken MR, Agro EF (2002) Posterior tibial nerve stimulation in the treatment of urge incontinence. Neurourol Urodyn 22:17
Amarenco G, Ismael SS, Even-Schneider A, Raibaut P, Demaille-Wlodyka S, Parratte B, Kerdraon J (2003) Urodynamic effect of acute transcutaneous posterior tibial nerve stimulation in overactive bladder. J Urol 169(6):2210–2215
Bemelmans BLH, Mundy AR, Craggs MD (1999) Neuromodulation by implant for treating lower urinary tract symptoms and dysfunction. Eur Urol 36(2):81–91
Melzack R, Wall PD (1965) Pain mechanisms: a new theory. Science 150(699):971–979
Oosterwijk RFA, Meyler WJ, Henley EJ, Scheer SS, Tannenbaum J (1994) Pain control with TENS and team nerve stimulators: a review. Crit Rev Phys Rehabil Med 6(3):219–258
Chang CJ, Huang ST, Hsu K, Lin A, Stoller ML, Lue TF (1998) Electroacupuncture decreases c-fos expression in the spinal cord induced by noxious stimulation of the rat bladder. J Urol 160(6 Pt 1):2274–2279
Hrobjartsson A, Gotzsche PC (2001) Is the placebo powerless? An analysis of clinical trials comparing placebo with no treatment. N Engl J Med 344:1594–1602
Acknowledgments
This work was supported by Scientific Research Projects Coordination Unit of Istanbul University. Authors convey sincere gratitude for the support.
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Istek, A., Gungor Ugurlucan, F., Yasa, C. et al. Randomized trial of long-term effects of percutaneous tibial nerve stimulation on chronic pelvic pain. Arch Gynecol Obstet 290, 291–298 (2014). https://doi.org/10.1007/s00404-014-3190-z
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DOI: https://doi.org/10.1007/s00404-014-3190-z