Sacral nerve modulation in the treatment of chronic pelvic pain

Martellucci, Jacopo; Naldini, Gabriele; Carriero, A.

doi:10.1007/s00384-011-1394-2

Cited by 45 publications

(40 citation statements)

References 30 publications

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“…Finally, neuropathic pain associated with the incisional scar, as well as visceral pain traits reflected by presence of deep abdominal and pelvic pain (often related to uterine contractions), have been suggested to develop and even coexist in patients undergoing obstetric interventions (Landau et al 2013; Lavand’homme 2013). Interestingly, afferent transmission modulation by epidural analgesia (Bouman et al 2014) or sacral nerve stimulation (Martellucci et al 2012) efficiently reduces the incidence of chronic postsurgical pain, including deep pain. However, it remains to be established what is the relative effect of epidural analgesia or sacral nerve stimulation over visceral vs. non-visceral afferents.…”

Section: Discussionmentioning

confidence: 99%

Axotomy of tributaries of the pelvic and pudendal nerves induces changes in the neurochemistry of mouse dorsal root ganglion neurons and the spinal cord

et al. 2015

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Using immunohistochemical techniques, we characterized changes in the expression of several neurochemical markers in lumbar 4-sacral 2 (L4-S2) dorsal root ganglion (DRG) neuron profiles (NPs) and the spinal cord of BALB/c mice after axotomy of the L6 and S1 spinal nerves, major tributaries of the pelvic (targeting pelvic visceral organs) and pudendal (targeting perineum and genitalia) nerves. Sham animals were included. Expression of cyclic AMP-dependent transcription factor 3 (ATF3), calcitonin gene-related peptide (CGRP), transient receptor potential cation channel subfamily V, member 1 (TRPV1), tyrosine hydroxylase (TH) and vesicular glutamate transporters (VGLUT) types 1 and −2 was analysed seven days after injury. L6-S1 axotomy induced dramatic de novo expression of ATF3 in many L6-S1 DRG NPs, and parallel significant downregulations in the percentage of CGRP-, TRPV1-, TH- and VGLUT2-immunoreactive (IR) DRG NPs, as compared to their expression in uninjured DRGs (contralateral L6-S1-AXO; sham mice); VGLUT1 expression remained unaltered. Sham L6-S1 DRGs only showed a small ipsilateral increase in ATF3-IR NPs (other markers were unchanged). L6-S1-AXO induced de novo expression of ATF3 in several lumbosacral spinal cord motoneurons and parasympathetic preganglionic neurons; in sham mice the effect was limited to a few motoneurons. Finally, a moderate decrease in CGRP- and TRPV1-like-immunoreactivities was observed in the ipsilateral superficial dorsal horn neuropil. In conclusion, injury of a mixed visceral/non-visceral nerve leads to considerable neurochemical alterations in DRGs matched, to some extent, in the spinal cord. Changes in these and potentially other nociception-related molecules could contribute to pain due to injury of nerves in the abdominopelvic cavity.

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Section: Discussionmentioning

confidence: 99%

Axotomy of tributaries of the pelvic and pudendal nerves induces changes in the neurochemistry of mouse dorsal root ganglion neurons and the spinal cord

et al. 2015

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“…However a number of publications stated the ability of such stimulation to relieve pain, as well as relieving voiding symptoms in pelvic pain patients treated for coinciding pelvic dysfunction [18][19][20][21]. This is the first study demonstrating the effectiveness of CSRN in the management of CPPS in patients refractory to conventional treatment or only partially responding to continuous sacral nerve stimulation, with more than 85% improvement in naïve patients and up to 77% in patients already implanted.…”

Section: Discussionmentioning

confidence: 87%

“…VAS scale, McGill and SF-36 questionnaires improved consistently in all domains and patients reported an overall satisfaction rate of 95% when asked if they could recommend this therapy to a friend or a relative [18][19][20][21]. Tables 2 and 3 Table 3: Implanted patients, Pain and QoL evaluation in 7 previously implanted patients.…”

Section: Resultsmentioning

confidence: 96%

Cycling Sacral Root Neuromodulation: Pilot Study to Assess the Effectiveness of This Mode in Neuromodulator Programming for the Treatment of Chronic Pelvic Pain Syndrome

Cappellano¹,

Ciotti²,

Tafuri³

et al. 2017

Med Surg Urol

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Aim: There is lack of evidence of the role of sacral root neuromodulation (SNM) in the management of chronic pelvic pain syndrome (CPPS). We evaluated the effectiveness of cycling sacral root neuromodulation (CSNM) in the management of CPPS in patients non responders to conservative treatment. Methods:A prospective, single center, cohort study was carried out on all patients with CPPS refractory to conventional treatment, who underwent test stimulation using the tined lead between February 2012 and March 2016. During test stimulation the tine lead was positioned along the third sacral nerve, on the side where they reported more pain. Success was defined as >50% improvement of pain and concurrent urinary symptoms. After a successful SNM test period of 4 weeks, patients received a permanent implant. We also included 9 more patients already with a permanent implant and partial responders to continuous mode in neuromodulator programming. To assess pain and quality of life, all patients filled-in a VAS scale and SF-36 and McGill questionnaires, at baseline, after the 4-week test period ad after the permanent implant.Results: Overall 22 consecutive adult patients were suitable to undergo a cycling test stimulation; 19 out of them (86.3%) underwent a permanent implant after a satisfactory test phase, using a codified cycling mode of programming. Eighteen naive patients out of nineteen (94.7%) maintained the benefits of the test stimulation at a mean follow up of 21.3 months. VAS scale, McGill and SF-36 questionnaires scores improved significantly in all domains with a 95% satisfaction rate; 7 out of the 9 already implanted patients (77.7%) significantly improved their pain control.Conclusion: CSRN appears to be effectiveness in treating CPPS in both naïve and previous implanted partial responder patients.

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“…In some studies, sacral stimulation application is observed to provide sufficient pain control in patients with anorectal pain (18,19). Martellucci et al (20) argued that sacral stimulation is effective in patients with various chronic pelvic pains, and that an effective response to pregabalin and gabapentin can be a predictive factor for successful treatment; in addition, the use of surgical staples may negatively impact the result. In a systematic research, neurostimulation applications are recommended to be effective, safe, and, in the long term, profitable treatments in chronic pelvic pain and bladder pain (21).…”

Section: Painmentioning

confidence: 99%

A Different Option for Neuromodulation Procedures: Sacral Nerve Stimulation

Ozyalcin¹

2015

Turk J Phys Med Rehab

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The aim of this article is to determine the effectiveness and the safety of sacral nerve stimulation on the several indications. Sacral nerve stimulation as a neuromodulation technique, is an effective and increasingly used therapeutic option. As a minimally invasive technique, many advances in the techniques for sacral neuromodulation have been described. The well-known indication of sacral nerve stimulation is the urinary voiding dysfunction. Although the mechanism of neuromodulation is still unclear, multipl new indications have been identified, include faecal incontinence, constipation, pain sydromes, interstitial cystitis, mixt urinary and bowel disoders, spinal injury and neurodegenerative disease, and sexual dysfunction. Since there is lack of high quality evidence of the procedure at present, good quality prospective, cross-over and randomize controlled studies are required to determine the true benefits of sacral nerve stimulation.

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Sacral nerve modulation in the treatment of chronic pelvic pain

Cited by 45 publications

References 30 publications

Axotomy of tributaries of the pelvic and pudendal nerves induces changes in the neurochemistry of mouse dorsal root ganglion neurons and the spinal cord

Axotomy of tributaries of the pelvic and pudendal nerves induces changes in the neurochemistry of mouse dorsal root ganglion neurons and the spinal cord

Cycling Sacral Root Neuromodulation: Pilot Study to Assess the Effectiveness of This Mode in Neuromodulator Programming for the Treatment of Chronic Pelvic Pain Syndrome

A Different Option for Neuromodulation Procedures: Sacral Nerve Stimulation

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