Neuromodulatory approaches to chronic pelvic pain and coccygodynia
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Intractable chronic pelvic pain (CPP) despite a multidisciplinary approach is challenging to treat. Every structure in the abdomen and/or pelvis could have a role in the etiology of CPP. Management of chronic pelvic pain may require a combination of interventions, including pharmacological, physical and psychological therapy. Interventions suggested to date include nerve blocks (ilioinguinal, iliohypogastric, genitofemoral, hypogastric, presacral) and trigger point injections, radiofrequency treatments, spinal cord stimulation (SCS), sacral root stimulation, sacral magnetic stimulation and sacral stimulation via tibial nerve. Peripheral nerve stimulation (PNS) has been particularly successful in the treatment of mononeuropathies. Indications for targeted stimulation include localised pain in non dermatomal distribution. Herein, the epicenter of the site of pain (target) is stimulated either transcutaneously or percutaneously or via permanent neuromodulating implant. Targeted and PNS probably are underused treatment modalities given the simplicity of the technique. The introduction of a stimulating electrode directly to the center of peripherally affected, painful areas, thereby bypassing the spinal cord and peripheral nerves is a novel simple procedure with effectiveness in the control of intractable neuropathic pain. Development of newer devices and miniaturization of electrodes will play a role in refinement and further simplification of subcutaneous neuromodulation.
KeywordsNeuromodulation chronic pelvic pain coccygodynia peripheral nerve stimulation
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- 1.Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A (2002) The standardisation of terminology of lower urinary tract function: report from the Standardisation Subcommittee of the International Continence Society. M J Obstet Gynecol 187: 116–126CrossRefGoogle Scholar
- 2.Bennett DS, Brookoff D (2003) Sacral nerve root stimulation for interstitial cystitis. In: Simpson B (ed) Electrical stimulation and relief of pain in pain research and clinical management. Elsevier Science BV, Amsterdam pp 57–67Google Scholar
- 6.Derasari MD (2000) Taxonomy of pain syndromes: classification of chronic pain syndromes. In: Raj PP, Abrams BM, Benson HT et al (eds) Practical management of pain 3rd edn. Mosby Inc., St. Louis, pp 10–16Google Scholar
- 10.Goroszeniuk T, Gorszeniuk K (2003) Short neuromodulation trial in neuropathic pain produces varying duration but reproducible pain relief. Pain in Europe IV. 4th Congress of EFIC, Prague, Sept. 2003. Abstract book p. 326, No. 494 TGoogle Scholar
- 12.Kothari S (2005) Short term neuromodulation trial in the treatment of coccygodynia. 7th Meeting of the International Neutomodualtion Society, Rome, June 2005Google Scholar
- 13.Kothari Sb (2005) Ilioinguinal/iliohypogastric nerve percutaneous stimulation for pelvic pain. 7th Meeting of the International Neutomodualtion Society, Rome, June 2005Google Scholar
- 15.Krames E (2000) Using a pain treatment continuum: a logical and cost-effective approach. In: Raj PP, Abrams BM, Benson HT et al (eds) Practical management of pain, 3rd edn. Mosby Inc., St. Louis, pp 441–444Google Scholar
- 19.Merskey H, Bogduk N (1994) Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms, 2nd edn. IASP PressGoogle Scholar
- 21.Randic M, Jiang MC, Cerne R (1993) Long-term potientiation and long-term depression of primary afferent neurotransmission in rat spinal cord. Neurosci 13(12): 5228–5241Google Scholar
- 22.Raj PP (2000) Visceral pain. In: Raj PP, Abrams BM, Benson HT et al (eds) Practical management of pain 3rd edn. Mosby Inc., St. Louis, pp 223–239Google Scholar
- 24.Stanton-Hicks M (2003) Transcutaneous and peripheral nerve stimulation. In: Simpson BA (ed) Electrical stimulation and relief of pain, pain research and clinical management, vol. 15. Elsevier, Amsterdam, pp 37–55Google Scholar