[Neurostimulation techniques in the therapeutic management of chronic pelvic and perineal pain].
BACKGROUND
Neuromodulation is a nonspecific analgesic treatment whose mechanism of action has not yet been elucidated. The purpose of this article is to review the techniques and results of neuromodulation in the management of chronic pelvic and perineal pain.


METHODS
A comprehensive review of the literature was performed by searching PUBMED for articles on the various neuromodulation techniques used in the management of chronic pelvic and perineal pain.


RESULTS
Several levels of neuromodulation of the somatic nervous system have been evaluated in the management of pelvic pain: transcutaneous electrical nerve stimulation (TENS), percutaneous nerve stimulation (PNS), nerve root or nerve trunk stimulation, spinal cord stimulation. An improvement was obtained in an average of two thirds of cases, but with declining efficacy over time. The various studies were difficult to compare due to the heterogeneous study populations and very diverse endpoints. Interesting studies on the value of autonomic nervous system intervention have been described, but with no specific trials of neuromodulation.


CONCLUSIONS
The place of neuromodulation in the management of patients with chronic pelvic and perineal pain has yet to be defined, as it is too frequently used as a last resort. It appears important to develop and analyse this treatment modality in large-scale, randomized, prospective studies.
Clinique urologique, centre fédératif de pelvipérinéologie, hôpital Hôtel Dieu, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France. jrigaud@chu-nantes.fr
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J
Rigaud
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Delavierre
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L
Sibert
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JJ
Labat
D002908:Chronic Disease; D006801:Humans; D017699:Pelvic Pain / Q000628:therapy*; D010502:Perineum; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*