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Sacral nerve modulation in the treatment of chronic pelvic pain

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Chronic pelvic pain is a common condition that significantly compromises the quality of life of affected patients. Unfortunately, despite treatment procedures, the results are often ineffective and symptoms persist for years. For these reasons, the search for less aggressive treatment options with fewer negative consequences leading to minimally invasive techniques was conducted.

Objective

The aim of the present study was to evaluate the efficacy of sacral nerve modulation in the treatment of chronic pelvic pain. Moreover, we aimed to identify potential predictors of positive results of sacral neuromodulation through the comparison between failed and successful patients.

Patients

From January 2004 to December 2009, all consecutive patients suffering from chronic pelvic pain and tested for sacral nerve modulation in three pelvic floor dedicated centers were evaluated. Severity of symptoms were analyzed by a visual analog scale (VAS)

Results

Twenty-seven patients (2 males; mean age, 53 years) were tested for sacral nerve modulation in the screening period and were included in the present study. The mean duration of pain was 51 months (range, 10–132 months). The mean preoperative VAS was 7.8 (range, 5–10). Previous pelvic surgery was reported in 18 patients (66.5%). Sixteen patients (59%) fulfil the successful criteria and were definitively implanted. The mean follow-up was 37 months (range, 12–71 months). The mean preoperative VAS was 8.1 (range, 6–8) and decreased to 2.1 ± 1.2 at 6-month follow-up (p < 0.0001), to 2.1 ± 1.1 at 12 months (16 patients), to 2.0 ± 1.2 at 24 months (13 patients), to 2.3 ± 1.4 at 36 months (9 patients), to 2.1 ± 1.5 at 48 months (5 patients), and to 1.9 ± 1.3 at 60 months (3 patients).

Conclusions

Sacral neuromodulation proved to be effective in the treatment of some patients affected by chronic pelvic pain, and the effect persists over time. A positive screening phase and a positive response to gabapentin or pregabalin showed to be predictors of a successful response. Multiple localizations of pelvic pain and pain occurred after stapler surgery seem to be negative factors for the success of the treatment.

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Conflicts of interest

The authors have no conflict of interest to be disclosed.

Author information

Authors and Affiliations

  1. General Surgery I, University of Siena, Ospedale Le Scotte viale Bracci, 1, 53100, Siena, Italy

    J. Martellucci

  2. General Surgery IV, University Hospital of Pisa, Pisa, Italy

    G. Naldini

  3. Pelvic Floor Center, Montecchio Emilia, Italy

    A. Carriero

Authors
  1. J. Martellucci
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  2. G. Naldini
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  3. A. Carriero
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Corresponding author

Correspondence to J. Martellucci.

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Authors contribution

Jacopo Martellucci had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. J.M. was involved in the study concept and design, acquisition, analysis and interpretation of data, and statistical analysis and performed the procedure. N.G. was the main performer of the procedure and was responsible for supervising the patients in Pisa Department. C.A. was the main performer of the procedure and was responsible for supervising the patients in Montecchio Emilia Department.

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Martellucci, J., Naldini, G. & Carriero, A. Sacral nerve modulation in the treatment of chronic pelvic pain. Int J Colorectal Dis 27, 921–926 (2012). https://doi.org/10.1007/s00384-011-1394-2

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