Combined site-specific sacral neuromodulation and pudendal nerve release surgery in a patient with interstitial cystitis and persistent arousal

Armstrong, G; Vancaillie, Thierry G.

doi:10.1136/bcr-2015-213513

Cited by 11 publications

(13 citation statements)

References 7 publications

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“…In addition to these local effects on the pelvic floor, pain attenuation following MPT may be attributed to processes that occur at the systemic pain level, i.e., in the spinal and supraspinal structures. e latter include changes in the activity of the sympathetic nervous system and induction of pain inhibitory effects via supraspinal pathways [46,47]. We have recently reported that MPT results in attenuation of vulvar pain and pain evoked at trigger points [48].…”

Section: Introductionmentioning

confidence: 99%

How Does Myofascial Physical Therapy Attenuate Pain in Chronic Pelvic Pain Syndrome?

Grinberg

Weissman-Fogel

Löwenstein³

et al. 2019

Pain Research and Management

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Background. Chronic pelvic pain syndrome (CPPS) is a multifactorial disorder comprising structural and functional muscular abnormalities, a dysfunctional pain system, and psychological distress. Myofascial physical Therapy (MPT) that is targeted at improving pelvic muscle functioning is considered a first line nonpharmacological treatment for CPPS, although the precise mechanisms that lead to symptoms alleviation have not yet been elucidated. Purpose. This longitudinal study aimed to examine the local and systemic effects of MPT intervention, including biopsychophysiological processes, among CPPS patients. Methods. The study included 50 CPPS women. Morphologic assessment of the levator ani and quantitative sensory testing of the pain system were applied alongside with evaluation of pain-related psychological factors using designated questionnaires. All measures were evaluated both before and after MPT in 39 patients. The long-term effects of MPT were evaluated by clinical pain reports obtained at 3 and 9 months following MPT that were compared with a nontreated group of 11 untreated CPPS women. Results. Along with an improvement in the clinical pain intensity (p=0.001) and sensitivity to experimental pain tests (p=0.001) following MPT, the results also indicate that MPT has anatomical, psychological, and social therapeutic effects (p=0.04; p=0.001; p=0.01, respectively). Furthermore, clinical pain evaluation at 3 and 9 months after MPT revealed a significant improvement in women who received treatment (p=0.001). Conclusions. The findings of this pilot study suggest multisystemic (direct and indirect anatomical, neurophysiological, and psychological) effects of MPT on the multifactorial pain disorder of CPPS and therefore place MPT as a mechanism-based intervention.

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Section: Introductionmentioning

confidence: 99%

How Does Myofascial Physical Therapy Attenuate Pain in Chronic Pelvic Pain Syndrome?

Grinberg

Weissman-Fogel

Löwenstein³

et al. 2019

Pain Research and Management

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“…Patients were followed longitudinally from 6 months to 6 years with evaluation of mixed pain outcomes. Three studies reported promising results with greater than 80% pain relief and overall high patient satisfaction [ 74 – 76 ]. The largest study, however, comprising an 84-patient case series, did not identify a statistically significant change in self-reported pain scores at the 12-month follow-up, though more than half of the patients reported improvement in pain [ 74 ].…”

Section: Neuromodulationmentioning

confidence: 99%

Neuromodulation for Management of Chronic Pelvic Pain: A Comprehensive Review

et al. 2022

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Introduction Chronic pelvic pain (CPP) is a symptom that derives from a complex group of heterogeneous pathologies of the pelvic organs. The aim of this study was to review the available evidence on efficacy of neuromodulatory modalities including sacral neuromodulation, dorsal root ganglion stimulation, dorsal column neuromodulation, and pudendal nerve stimulation. Methods This narrative review focuses on updated information on neuromodulation for management of chronic pelvic pain. In 2022, we searched English-language studies on neuromodulation, pelvic pain, and chronic pain in a comprehensive search. We searched the following databases: PubMed, Medline, SciHub, Cochrane Database of Systematic Reviews, and Google Scholar. We used the following combinations of keywords: neuromodulation, pelvic pain, chronic pain, chronic pelvic pain, pelvic pain treatment. We tried to include as many recent manuscripts as possible (within the last 3 years) but also included papers older than 3 years if they were particularly relevant to our topic. We also attempted to search for, use, and cite primary manuscripts whenever possible. Results CPP is a challenging entity to treat because of diagnostic inconsistencies and limited evidence for therapeutic modalities. Our review found evidence suggestive of benefit for all modalities reviewed but the data was of overall low quality with numerous limitations. The literature highlights a lack of randomized controlled trials for neuromodulatory therapies but suggests a growing role for such techniques in treating refractory chronic pelvic pain syndrome (CPPS). Conclusions This review explores the available evidence on efficacy of neuromodulatory modalities for CPPS and contextualizes the results with information about the type of neuromodulation, lead location and waveform, pain outcomes and assessment timepoints, and reported adverse effects.

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“…After surgery, 7 patients reported complete elimination, three reported significant remission, and 1 reported no changes in their PGAD symptoms. Armstrong, 2016 37 1 Case studylongitudinal 35 6 Sacral neuromodulation Surgery in the form of bilateral pudendal nerve released with neuromodulator insertion (4 lead neurostimulator-2 leads at the sacral hiatus and 2 adjacent to the pudendal nerves). After 6 months, almost total remission of PGAD symptoms occurred, except for emergency urinary sensations.…”

Section: Physical Therapiesmentioning

confidence: 99%

“…43 In the same line, applying the neuromodulation of the sacral nerve (SNM) has proven effective. 37,40 TENS. The TENS technique consists of the application of electrical stimuli to reduce overstimulation in a specific area.…”

Section: Chronic Pudendal Neuromodulationmentioning

confidence: 99%

Treatments for Persistent Genital Arousal Disorder in Women: A Scoping Review

Martin-Vivar

Villena-Moya

Mestre‐Bach

et al. 2022

The Journal of Sexual Medicine

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Background Persistent genital arousal disorder (PGAD) is characterized by elevated discomfort associated with persistent genital arousal in the absence of sexual desire. Aim To perform a scoping review of the proposed treatments for PGAD and their efficacy. Methods A scoping review was carried out (PRISMA-Scr) that included articles on PGAD as the main disorder, only in women, which explained, in detail, the treatment and its efficacy, was empirical, was written in English and Spanish. No prior filtering by years was performed. Outcomes Three different effective treatments were found (physical therapies, pharmacological therapies, and psychotherapeutics in combination with other therapies). Results Thirty-eight articles were selected. From physical therapies, treatments using neuromodulation, transcutaneous electrical stimulation, Botox, surgery, electroconvulsive therapy, manual therapy, pelvic floor therapy, dietary changes, and transcranial magnetic stimulation showed effectiveness. Using the pharmacological approach, paroxetine, duloxetine, pramipexole, ropinirole, and clonazepam treatments were effective. Psychotherapy treatments showed effectiveness only in combination with other types of treatments, specifically a combination of cognitive–behavioral strategies with pharmacological treatment. Clinical implications Pharmacological treatment, specifically SSRIs, have proven to be the therapy of choice for different subtypes of patients. Strengths and limitations This study analyzed treatment effectiveness with different approaches and took into consideration those articles where psychotherapy was used as a combination treatment with pharmacological and physical therapy. The main limitation is that it was focused exclusively on women, and the results cannot be generalized to include men. Conclusions To date, a combination of pharmacological interventions with physical therapy and, in some occasions, with psychological therapy is main strategy followed to accomplish effective treatment of PGAD.

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Combined site-specific sacral neuromodulation and pudendal nerve release surgery in a patient with interstitial cystitis and persistent arousal

Cited by 11 publications

References 7 publications

How Does Myofascial Physical Therapy Attenuate Pain in Chronic Pelvic Pain Syndrome?

How Does Myofascial Physical Therapy Attenuate Pain in Chronic Pelvic Pain Syndrome?

Neuromodulation for Management of Chronic Pelvic Pain: A Comprehensive Review

Treatments for Persistent Genital Arousal Disorder in Women: A Scoping Review

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