Spinal cord stimulation is an effective treatment for the chronic intractable visceral pelvic pain.
OBJECTIVE
Recent studies have demonstrated significant involvement of dorsal column pathways in transmission of visceral pelvic pain. Spinal cord stimulation (SCS) suppresses visceral response to colon distension in an animal model and therefore may be an effective therapy for chronic pelvic pain of visceral origin. We are reporting on the value of neurostimulation for chronic visceral pelvic pain in six female patients with the diagnosis of long-standing pelvic pain (history of endometriosis, multiple surgical explorations, and dyspareunia).


METHODS
Case-series report. All patients received repeated hypogastric blocks (in an average of 5.3 blocks) with a significant pain relief for a period ranging from 1 to 6 weeks. Three received neurolytic hypogastric block with the pain relief of 3, 8, and 12 months, respectively. Following psychological evaluation and clearance by our Multidisciplinary Committee on Implantable Devices, they all underwent SCS trial for 7-14 days. All patients received SCS systems with dual leads (Compact or Quad leads, Medtronic Inc., Minneapolis, MN, USA).


RESULTS
The average follow-up was 30.6 months. Median visual analog scale pain score decreased from 8 to 3. All patients had more than 50% of the pain relief. Pain Disability Index changed from an average of 57.7 +/- 12 to 19.5 +/- 7. Opiate use decreased from an average 22.5 mg to 6.6 mg of morphine sulfate milligram equivalents per day.


CONCLUSIONS
It appears that SCS may have a significant therapeutic potential for treatment of visceral pelvic pain.
Kapural
Leonardo
L
Pain Management Department, The Cleveland Clinic Foundation, Cleveland, Ohio, USA. Kapural@ccf.org
Narouze
Samer N
SN
Janicki
Thomas I
TI
Mekhail
Nagy
N
D000328:Adult; D000344:Afferent Pathways / Q000503:physiopathology / Q000601:surgery; D000698:Analgesia / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D004566:Electrodes / Q000592:standards; D004715:Endometriosis / Q000150:complications; D005260:Female; D005831:Genital Diseases, Female / Q000150:complications; D005836:Genitalia, Female / Q000294:innervation / Q000503:physiopathology; D006801:Humans; D007001:Hypogastric Plexus / Q000187:drug effects / Q000503:physiopathology; D008875:Middle Aged; D010148:Intractable Pain / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D010149:Postoperative Pain / Q000503:physiopathology / Q000628:therapy; D017699:Pelvic Pain / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D013116:Spinal Cord / Q000503:physiopathology / Q000601:surgery*; D013995:Time; D000267:Tissue Adhesions / Q000150:complications / Q000209:etiology; D016896:Treatment Outcome; D014781:Viscera / Q000293:injuries / Q000294:innervation / Q000503:physiopathology; D017833:Visceral Afferents / Q000503:physiopathology / Q000601:surgery*
D000701:Analgesics, Opioid; D000779:Anesthetics, Local