Neuromodulatory approaches to chronic pelvic pain and coccygodynia

Part of the Acta Neurochirurgica Supplements book series (NEUROCHIRURGICA, volume 97/1)


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.


Neuromodulation chronic pelvic pain coccygodynia peripheral nerve stimulation 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 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. 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
  3. 3.
    Berkley KJ (1997) Sex differences in pain. Behav Brain Sci 20: 371–380PubMedCrossRefGoogle Scholar
  4. 4.
    Bjorling DE, Wang Z (2001) Estrogen and neuroinflammation. Urology 57Suppl 6A: 40–46PubMedCrossRefGoogle Scholar
  5. 5.
    Campbell JN, Long DM (1976) Peripheral nerve stimulation in the treatment of intractable pain. J Neurosurg 45: 692–699PubMedCrossRefGoogle Scholar
  6. 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
  7. 7.
    Fall M, Baranowski AP, Fowler CJ, Lepinard V, Malone Lee JG, Messelink EJ, Oberpenning F, Osborne JL, Schumacher S (2004) European Association of Urology. Guidelines on chronic pelvic pain. Eur Urol 46: 681–689PubMedCrossRefGoogle Scholar
  8. 8.
    Giamberardino MA, Berkley KJ, Affaitati G, Lerza R, Centurione L, Lapenna D, Vecchiet L (2002) Influence of endometriosis on pain behaviours and muscle hyperalgesia induced by a ureteral calculosis in female rats. Pain 95: 247–257PubMedCrossRefGoogle Scholar
  9. 9.
    Goroszeniuk T, Kothari S (2004) Targeted external area stimulation. Reg Anesth Pain Med 29Suppl 4: 98CrossRefGoogle Scholar
  10. 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
  11. 11.
    Goroszeniuk T (2003) Short term peripheral neuromodulation trial via stimulating catheter in neuropathic pain. Reg Anesth Pain Med 28Suppl 1: 64CrossRefGoogle Scholar
  12. 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. 13.
    Kothari Sb (2005) Ilioinguinal/iliohypogastric nerve percutaneous stimulation for pelvic pain. 7th Meeting of the International Neutomodualtion Society, Rome, June 2005Google Scholar
  14. 14.
    Klingler HC, Pycha A, Schmidbauer J, Marberger M (2000) Use of peripheral neuromodulation of the S3 region for treatment of detrusor overactivity. Urology 56: 766–771PubMedCrossRefGoogle Scholar
  15. 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
  16. 16.
    Leippold T, Strebel R, Huwyler M, Mirjam J, John H, Hauri D, Schmid D (2005) Sacral magnetic stimulation in non-inflammatory chronic pelvic pain syndrome. BJU Int 95: 838–841PubMedCrossRefGoogle Scholar
  17. 17.
    Mathias SD, Kupperman M, Liberman RF Lipschutz RC, Steege JF (1996) Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol 87: 321–327PubMedCrossRefGoogle Scholar
  18. 18.
    Mehik A, Leskinen Mj, Hellstrom P (2003) Mechanisms of pain in chronic pelvic pain syndrome: influence of prostatic inflammation. World J Urol 21: 90–94PubMedCrossRefGoogle Scholar
  19. 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
  20. 20.
    Pinter E, Szolcanyi J (1995) Plasma extravasation in the skin and pelvic organs evoked by antidromic stimulation of lumbosacral dorsal roots in the rat. Neuroscience 68: 603–614PubMedCrossRefGoogle Scholar
  21. 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. 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
  23. 23.
    Rowe E, Smith C, Laverick L, Elkabir J, Witherow R, Patel A (2005) A prospective, randomized, placebo controlled, double-blind study of pelvic electromagnetic therapy for the treatment of chronic pelvic pain syndrome with 1 year of follow up. J Urol 173: 2044–2047PubMedCrossRefGoogle Scholar
  24. 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
  25. 25.
    Stinson LW, Roderer GT, Cross NE, Davis BE (2001) Peripheral subcutaneous electrostimulation for control of intractable post-operative inguinal pain: a case repot series. Neuromodulation 4: 99–104CrossRefGoogle Scholar
  26. 26.
    Sun Y, Chai TC (2004) Up-regulation of P2X3 receptor during stretch of bladder urothelial cells from patients with interstitial cystitis. J Urol 171: 448–452PubMedCrossRefGoogle Scholar
  27. 27.
    Unruh AM (1996) Gender variations in clinical pain experience. Pain 65: 123–176PubMedCrossRefGoogle Scholar
  28. 28.
    Zondervan KT, Yudkin PL, Vessey MP, Jenkinson CP, Dawes MG, Barlow DH, Kennedy SH (2001) The community prevalence of chronic pelvic pain in women and associated illness behaviour. Br J Gen Pract 51: 541–547PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  1. 1.Pain Management CentreSt. Thomas’ HospitalLondonUK

Personalised recommendations