Neuromodulation for the Treatment of Endometriosis-Related Symptoms

Lemos, Nucelio; Lemos, Nereusa M.B.M.

doi:10.5301/je.5000243

Cited by 4 publications

(4 citation statements)

References 86 publications

(114 reference statements)

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“…The prevalence of muscle spasms and hypertonicity is three times higher in women with endometriosis than in controls [18]. Four mechanisms of actions of neuromodulation have been demonstrated in vitro: afferent modulation, synaptic facilitation, direct stimulation and increased neuroplasticity, the first one possibly explaining the modulation of abnormal fibres in neuropathic pain or the reduction of pelvic floor hyperactivity in myofascial pain, thus explaining why SNM was more efficient in the treatment of endometriosis-related CPP [19].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of sacral neuromodulation for chronic pelvic pain: a Finnish national multicenter study

et al. 2020

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Background The aim of this study was to report the outcomes of sacral neuromodulation (SNM) in chronic pelvic pain (CPP) patients in the Finnish national cohort. Methods This was a register-based retrospective study, involving all the centers that provide SNM treatment in Finland. The data of all patients treated with SNM for CPP were gathered from Oulu-, Turku-, Tampere-and Helsinki University Hospitals, as well as Jyväskylä and Seinäjoki Central Hospitals. All patients who had been tested for SNM implantation prior to April 2017 were included in the study. Results A total of 51 patients were selected for SNM treatment due to CPP from 2004 until 2017. The mean follow-up time was 13.8 months (SD 22.9 months). A total of 28 patients (57%) advanced from testing to permanent stimulator implantation. There were 21 patients (41%) who had a working modulator implanted at the end of follow-up. Patients with endometriosisrelated pain had a significantly higher permanent implantation rate than the overall implantation rate (88% vs. 57%; p = 0.01). The endometriosis patients also had a higher overall success rate by the end of the follow-up (75% vs. 41%; p = 0.026) Conclusions SNM may be a viable treatment option for patients with CPP due to endometriosis. Further research on SNM treatment for endometriosis patients with refractory CPP is needed.

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Section: Discussionmentioning

confidence: 99%

Outcomes of sacral neuromodulation for chronic pelvic pain: a Finnish national multicenter study

et al. 2020

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“…Neuromodulation mechanisms are not completely understood, but four basic mechanisms of action have been proposed and demonstrated in vitro: afferent modulation, synaptic facilitation, direct stimulation and increased neuroplasticity. 23 The FDA approved SNM as a treatment option for patients with urge incontinence in 1997 and for urgency/frequency and nonobstructive urinary retention in 1999. Currently SNM does not have FDA approval for the treatment of chronic pelvic pain.…”

Section: Discussionmentioning

confidence: 99%

“…This is where neuromodulation may help. Neuromodulation mechanisms are not completely understood, but four basic mechanisms of action have been proposed and demonstrated in vitro: afferent modulation, synaptic facilitation, direct stimulation and increased neuroplasticity 23 …”

Section: Discussionmentioning

confidence: 99%

Sacral neuromodulation in endometriosis – A promising treatment option for chronic pelvic pain

Zegrea,

Ojala,

Suvitie

et al. 2023

Acta Obstet Gynecol Scand

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IntroductionChronic pelvic pain (CPP) affects over one fifth of women worldwide, and endometriosis is one of the most common causes. In the present study, we examined whether sacral neuromodulation (SNM) is effective in the treatment of refractory chronic pelvic pain in women with endometriosis.Material and methodsThis multicenter prospective pilot study was started in 2017 and includes patients with chronic pelvic pain with no other obvious pathology than endometriosis. Other treatment options have been tried or they are unsuitable. Patients underwent SNM implantation. The main outcome was postoperative pain reduction and secondary outcome was quality of life. The following questionnaires were used to assess the outcomes: Brief pain inventory (BPI), clinical global impression ‐ improvement (CGI‐I), 15D‐measure of health‐related quality of life, and Biberoglu and Behrman (B&B) score.ResultsA total of 35 patients underwent the SNM procedure and, at the time of analysis, 15 patients had returned one‐year questionnaires. The patients had a history of endometriosis for a median of 5.5 (interquartile range 2–9) years, with no correlation between the severity of symptoms and the duration of the disease (p = 0.158). A total of 31 patients (89%) were implanted with the internal pulse generator. There were statistically significant changes in BPI pain‐related items. Worst experienced daily pain decreased among those who returned 12‐month questionnaires from median 9 to 5 (p = 0.006), average daily pain from 6 to 3.5 (p = 0.004), and least daily pain from 3 to 1 (p = 0.004). Based on the CGI questionnaire (n = 14), at 12 months nine patients (60%) experienced great improvement in their symptoms, three patients (20%) much improvement and two patients (13%) minimal improvement. None of the patients experienced worsening of their symptoms. There was a statistically significant change in overall 15D score at 1 month (p < 0.001), 6 months (p = 0.001) and 12 months (p = 0.018), when the results were compared to baseline values. Median B&B score also improved significantly and decreased from a baseline value of 8 (4–12) to 4.5 (0–6), p = 0.002.ConclusionsBased on the preliminary findings of our study, SNM might be a promising treatment of CPP in endometriosis patients.

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“…Neuromodulation (NM) is defined as the alteration of neural pathways through the delivery of electrical stimulation or chemical agents to targeted sites of the body and can be used to improve functions and alleviate symptoms related to the relief of pain, restoration of function or normal bowel, bladder control and many more (Haylen et al., 2010). Several neuromodulation routes have been shown to treat chronic and/or refractory pelvic pain, including: transcutaneous pelvic stimulation (Iglesia & Smithling, 2017; Isaza et al., 2021), transvaginal and trans rectal electrical stimulation (Istek et al., 2014), percutaneous tibial nerve stimulation (Juliana et al., 2020; Kelly et al., 2016), sacral nerve electrical stimulation (SNS) (Lauretti et al., 2015; Lemos & Lemos, 2016; Zimmerman et al., 2018), pudendal nerve electrical stimulation (Logsdon et al., 2006; Malaguti, 2009), and conus medularis stimulation (Martellucci et al., 2012). NM has been shown to be effective at improving all these aspects of pelvic floor function, pelvic pain, bowel, bladder and sexual function which potentially makes it particularly useful in the adjuvant treatment of vaginal laxity (Miller et al., 1998), by improving in pelvic floor strength which is responsible for them.…”

Section: Introductionmentioning

confidence: 99%

Effect of knack technique on vaginal laxity in multiparous women: A randomized controlled trial

Hady,

Kassem,

Abdalla

2023

Physiotherapy Res Intl

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BackgroundVaginal laxity defined according to the International Urogynecological Association/International Continence society is excessive vaginal looseness; it is one of the most common symptoms of pelvic floor dysfunction, which refers to medical/functional disorders that can have a significant impact on a woman's sexual self‐esteem and sexual life.AimThis study aimed to determine the impact of the Knack Technique on Pelvic floor muscle (PFM) and sexual function in women with vaginal laxity.MethodsThirty females complaining of vaginal laxity were randomly chosen from the outpatient clinic at Deraya University. Their ages varied from 35 to 45 years, their body mass index was 25–30 kg/m2, and a number of parities ≤ three normal vaginal deliveries and at least two years from the last delivery complaining about vaginal laxity, water entrapment, and loss of friction during sexual intercourse. They were randomized into two equal groups at random (A, B). Group A (15 females) received (PSTES) and group B (15 females) received (PSTES) and Knack Technique. Both the groups received three sessions per week for 2 months.EvaluationThe outcome measures were evaluated through pre‐ and post‐interventions by using ultrasonography imaging to assess PFM function, Sexual Satisfaction Index, and Vaginal Laxity Questionnaires (VLQ) to assess sexual function.ResultsAnalysis indicated a significant improvement in vaginal laxity in the two groups. Comparison between groups pre‐ and posttreatment showed that there was no statistically significant difference between the groups B and A in SSI and VLQ, while there were significant differences between the groups A and B in PFM force.ConclusionCombining Parasacral transcutaneous electrical stimulation (PSTES) and Knack Technique is more effective than PSTES alone in reducing vaginal laxity as well as improving PFM and sexual function in women with vaginal laxity.

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Neuromodulation for the Treatment of Endometriosis-Related Symptoms

Cited by 4 publications

References 86 publications

Outcomes of sacral neuromodulation for chronic pelvic pain: a Finnish national multicenter study

Outcomes of sacral neuromodulation for chronic pelvic pain: a Finnish national multicenter study

Sacral neuromodulation in endometriosis – A promising treatment option for chronic pelvic pain

Effect of knack technique on vaginal laxity in multiparous women: A randomized controlled trial

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