Neuromodulation in Chronic Pelvic Pain: A Narrative Review

Abstract

Chronic primary pelvic pain syndrome (CPPPS) is a heterogeneous disease with unknown pathogenesis and a lack of distinct pathological features, which complicates diagnosis and therapy and has a significant impact on patients' daily life. Because pharmacological management is ineffective and long-term use may result in additional system damage, developing a more effective treatment is critical. Neuromodulation has advanced rapidly over the last few decades, and various types of neuromodulations have demonstrated efficacy in the treatment of CPPPS. In this article we discuss the evolution of neuromodulation technology in the treatment of chronic pelvic pain, its application to various subtypes of chronic pelvic pain, and the comparison of relevant efficacy and parameter differences, as well as assess the relative advantages and disadvantages of sacral neuromodulation, percutaneous tibial nerve stimulation , transcutaneous electrical nerve stimulation, electroacupuncture, and pudendal neuromodulation. Furthermore, it was noted that chronic pelvic pain should be evaluated in terms of pain, associated symptoms, psychological problems, and quality of life. Although neuromodulation approaches have been shown to be effective in treating chronic pelvic pain, more extensive multicenter trials are required to confirm this. Supplementary Information The online version contains supplementary material available at 10.1007/s40122-022-00405-w.

Chronic Overlapping Pain Conditions and Nociplastic Pain

“…Tarsal tunnel syndrome, a nerve entrapment syndrome analogous to carpal tunnel syndrome in the wrist, was also found to be more common in fibromyalgia patients 94 – while causes of tarsal tunnel syndrome are likely multifactorial, enlarged tibial nerve diameter may contribute to this nerve entrapment. Neuromodulation involving the tibial nerve (e.g., through percutaneous tibial nerve stimulation) has also been investigated in the treatment of a range of pelvic pain disorders, including IBS, dysmenorrhea, and bladder pain syndrome 95 . One caveat is that tibial nerve is the only peripheral nerve tissue sampled in GTEx – other peripheral nerve tissues, potentially also representing therapeutic targets in neuromodulation for chronic pain, could potentially be enriched for nociplastic pain gene expression.…”

Chronic pelvic pain: An underrecognised perioperative consideration

“…Neuromodulation techniques, including transcutaneous electrical nerve stimulation, sacral neuromodulation, percutaneous tibial nerve stimulation and pudendal neuromodulation have shown promise in rewiring pain signalling and providing long-term relief. 68 However, more extensive multi-centre trials are required to confirm their efficacy in treating CPP.…”

Updates in pelvic neuromodulation: the role of pelvic neuromodulation in pelvic disorders

“…The most commonly utilized neuromodulation techniques are SNM (Figure 1), PTNS (Figure 2), and PNM (Figure 3) (6)(7)(8). The use of SNM has been approved by the U.S. Food and Drug Administration (FDA) for the treatment of fecal incontinence, chronic non-obstructive urinary retention, and medication refractory overactive bladder (OAB), whereas PTNS is solely approved for the treatment of OAB (9,10).…”