Neuromodulation for Chronic Pelvic Pain: A Single-Institution Experience With a Collaborative Team

Abstract

BACKGROUND Secondary to the complex care, involved specialty providers, and various etiologies, chronic pelvic pain patients do not receive holistic care. OBJECTIVE To compare our general and neuromodulation cohorts based on referrals, diagnosis, and therapy and describe our neuromodulation patients. METHODS A multidisciplinary team was established at our center. The intake coordinator assessed demographics and facilitated care of enrolled patients. Outcomes were compared using minimal clinical important difference of current Numerical Rating Scale (NRS) between patients with neuropathic pain who received neuromodulation and those who did not. The neuromodulation cohort completed outcome metrics at baseline and recent follow-up, including NRS score (best, worst, and current), Oswestry Disability Index (ODI), Beck Depression Inventory, and Pain Catastrophizing Scale. RESULTS Over 7 yr, 233 patients were referred to our consortium and 153 were enrolled. A total of 55 patients had neuropathic pain and 44 of those were managed medically. Eleven underwent neuromodulation. A total of 45.5% patients of the neuromodulation cohort were classified as responders by minimal clinically important difference compared to 26.6% responders in the control cohort at most recent follow-up (median 25 and 33 mo, respectively). Outcome measures revealed improvement in NRS at worst (P = .007) and best (P = .025), ODI (P = .014), and Pain Catastrophizing Scale Rumination (P = .043). CONCLUSION Eleven percent of patients were offered neuromodulation. There were more responders in the neuromodulation cohort than the conservatively managed neuropathic pain cohort. Neuromodulation patients showed significant improvement at 29 mo in NRS best and worst pain, disability, and rumination. We share our algorithm for patient management.

Current Challenges in the Management of Chronic Pelvic Pain in Women: From Bench to Bedside

“… Levine et al, 2016 121 Canada Prospective 15 Chronic groin, pelvic and abdominal pain SCS Reduction in pain intensity from 7.3±1.3 to 3.1±2.8, 3.8±2.4 and 4.2±3.2 at 3, 6 and 12 months, respectively. Bridger et al, 2021 122 USA Prospective 55 Neuropathic pelvic pain DRGS and SCS Satisfactory response in 45.5% of 11 patients in the neuromodulation group versus 26.6% of 44 patients in the clinical treatment group after 25 and 33 months, respectively. Deer et al, 2017 123 USA Randomized clinical trial 152 Complex regional pain syndrome and causalgia DRGS and SCS Reduction of ≥50% in pain in 81.2% of the DRGS a group versus 55.7% of the SCS b group after 3 months (p<0.001).…”

Multidisciplinary Firms and the Treatment of Chronic Pain: A Case Study of Low Back Pain

“…The multidisciplinary firm we discuss in this article focuses on back pain, but it is important to note that the entry point should be altered depending on the disease process and the external market. For example, all patients with pelvic pain that come into care with any of our providers can be entered into the system because there are so few resources available to these patients that they often have been suffering for more than a decade before they seek care (64). Patients with cancer pain also would need to enter into the system much more quickly (65).…”

“…However, in order for a multidisciplinary clinic to be successful, thoughtful deliberation between all clinicians involved is necessary to develop a protocol/ pathway for pain patients. We have done this for our pelvic pain patients ( 64 ). Similar could be done with different types of pain leading to low back pain, including SI joint dysfunction, mechanical pain, and neuropathic pain.…”

“…In establishing our multidisciplinary pelvic pain health consortium at our institution-Albany Medical Center, we have found that providing a single contact with an email and phone number works well for providers ( 64 ). Intake is then performed by that one patient navigator, using a form that was developed by the group as a whole and appropriate consultations are embarked upon.…”

Scrambler Therapy for Chronic Pain after Burns and Its Effect on the Cerebral Pain Network: A Prospective, Double-Blinded, Randomized Controlled Trial

“…Chronic pain in burn patients can be treated using pharmacological strategies (e.g., NSAIDS, opioids, tramadol, and anticonvulsants) and non-pharmacological modalities (e.g., compression garments, physical therapy, and occupational therapy) [ 4 , 5 ]. Many reports have described the clinical effects of peripheral nerve electrostimulation for chronic pain [ 6 , 7 ]. Scrambler therapy (ST) is a non-invasive electrostimulation treatment that blocks pain, and recently it has been proven effective for treating chronic pain syndromes [ 8 ].…”