Benefits and Harms of Electrical Neuromodulation for Chronic Pelvic Pain: A Systematic Review

Cottrell, Angela M.; Schneider, Marc P.; Goonewardene, Sanchia S.; Yuan, Yuhong; Baranowski, A.; Engeler, Daniel E.; Borovicka, Jan; Dinis-Oliveira, Paulo; Elneil, Sohier; Hughes, John; Messelink, Bert; Williams, Amanda C de C

doi:10.1016/j.euf.2019.09.011

Cited by 34 publications

(30 citation statements)

References 48 publications

(52 reference statements)

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“…The most robust systematic review for chronic pelvic pain was published by Cottrell et al [ 71 ] in 2020 and concluded that TENS was beneficial for women with chronic pelvic pain secondary to dysmenorrhea. Cottrell et al [ 71 ] reported the overall effect size for data extracted for various neuromodulation treatments including percutaneous tibial nerve stimulation and transcutaneous interferential electrical stimulation that included 2 RCTs on TENS (87 participants), but did not report the effect size for TENS per se. Cottrell et al, conducted a separate analysis that pooled data from various neuromodulation techniques that included 4 non-RCTs on TENS (131 participants), but did not report the effect estimate for TENS per se.…”

Section: Resultsmentioning

confidence: 99%

Does TENS Reduce the Intensity of Acute and Chronic Pain? A Comprehensive Appraisal of the Characteristics and Outcomes of 169 Reviews and 49 Meta-Analyses

et al. 2021

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Background and Objectives: Uncertainty about the clinical efficacy of transcutaneous electric nerve stimulation (TENS) to alleviate pain spans half a century. There has been no attempt to synthesise the entire body of systematic review evidence. The aim of this comprehensive review was to critically appraise the characteristics and outcomes of systematic reviews evaluating the clinical efficacy of TENS for any type of acute and chronic pain in adults. Materials and Methods: We searched electronic databases for full reports of systematic reviews of studies, overviews of systematic reviews, and hybrid reviews that evaluated the efficacy of TENS for any type of clinical pain in adults. We screened reports against eligibility criteria and extracted data related to the characteristics and outcomes of the review, including effect size estimates. We conducted a descriptive analysis of extracted data. Results: We included 169 reviews consisting of eight overviews, seven hybrid reviews and 154 systematic reviews with 49 meta-analyses. A tally of authors’ conclusions found a tendency toward benefits from TENS in 69/169 reviews, no benefits in 13/169 reviews, and inconclusive evidence in 87/169 reviews. Only three meta-analyses pooled sufficient data to have confidence in the effect size estimate (i.e., pooled analysis of >500 events). Lower pain intensity was found during TENS compared with control for chronic musculoskeletal pain and labour pain, and lower analgesic consumption was found post-surgery during TENS. The appraisal revealed repeated shortcomings in RCTs that have hindered confident judgements about efficacy, resulting in stagnation of evidence. Conclusions: Our appraisal reveals examples of meta-analyses with ‘sufficient data’ demonstrating benefit. There were no examples of meta-analyses with ‘sufficient data’ demonstrating no benefit. Therefore, we recommend that TENS should be considered as a treatment option. The considerable quantity of reviews with ‘insufficient data’ and meaningless findings have clouded the issue of efficacy. We offer solutions to these issues going forward.

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Section: Resultsmentioning

confidence: 99%

Does TENS Reduce the Intensity of Acute and Chronic Pain? A Comprehensive Appraisal of the Characteristics and Outcomes of 169 Reviews and 49 Meta-Analyses

et al. 2021

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“…They are the most effective treatments for CPP despite possible complications also being reported. [ 1 3 4 ]…”

Section: Discussionmentioning

confidence: 99%

“…Engineering advances focus on increasing SCS efficacy[ 1 2 3 4 ] by stimulating the correct target (with anatomically guided 3D neural targeting), [5] and the surge of new devices.…”

Section: Introductionmentioning

confidence: 99%

Spinal cord stimulation in the approach to chronic pelvic pain

Romero-Serrano¹,

Esparza-Miñana²

2021

Medicine

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Rationale: Chronic pelvic pain (CPP) is a pain related to pelvic structures that arise from posttraumatic pain, postsurgical pain, or somatic or visceral pain syndromes. Despite the available treatment options, CPP remains mostly untreated, due to difficulties in covering such a large area. Patient concerns: A 46-year-old woman presented chronic low back pain and CPP for more than 1 year and 6 months respectively after multiple pelvic fractures. Diagnosis: Pelvic fractures and a severe lumbar facet arthrosis were revealed through computed tomography and lumbosacral nuclear magnetic resonance imaging. Evidence of a reduced amplitude in the left femoral nerve and a demyelinating neuropathy in the left pudendal nerve were also detected. Intervention: A pharmacologic treatment was prescribed, consisting of celecoxib, fluoxetine, gabapentin, and morphine. Since no pain relief was achieved, spinal cord stimulation was performed using spectra WaveWriter system, placing 2 octopolar linear leads over the bilateral T8 and T9 vertebras with the help of a 3-dimensional neural targeting program. Outcomes: Two weeks after the intervention a reduction of 80% of the pain was achieved, which led to the removal of the pharmacologic treatment. Additionally, both EuroQOL-5D and visual analogue scale scores improved after the intervention. Lesson: Through the combination of spinal cord stimulation Spectra Wavewriter and 3D programming technology, both lumbar and leg pain and CPP were successfully relieved, along with an improvement in the quality of life of the patient.

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“…PNS for pelvic pain has been the subject of systematic reviews in the gynecologic literature [ 41 , 42 ] and is included here, as interventional pain physicians regularly treat pelvic pain. Shah et al also described the numerous techniques of PNS for chronic pelvic pain, particularly pudendal neuralgia [ 43 ].…”

Section: Methodsmentioning

confidence: 99%

Peripheral Nerve Stimulation for Chronic Pain: A Systematic Review of Effectiveness and Safety

et al. 2021

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Benefits and Harms of Electrical Neuromodulation for Chronic Pelvic Pain: A Systematic Review

Cited by 34 publications

References 48 publications

Does TENS Reduce the Intensity of Acute and Chronic Pain? A Comprehensive Appraisal of the Characteristics and Outcomes of 169 Reviews and 49 Meta-Analyses

Does TENS Reduce the Intensity of Acute and Chronic Pain? A Comprehensive Appraisal of the Characteristics and Outcomes of 169 Reviews and 49 Meta-Analyses

Spinal cord stimulation in the approach to chronic pelvic pain

Peripheral Nerve Stimulation for Chronic Pain: A Systematic Review of Effectiveness and Safety

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