Sacral nerve stimulation: an effective treatment for chronic functional anal pain?

Dudding, T. C.; Thomas, G. P.; Hollingshead, James; George, Anil Thomas; Stern, Julian; Vaizey, C. J.

doi:10.1111/codi.12277

Cited by 23 publications

(20 citation statements)

References 28 publications

(34 reference statements)

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“…Three small noncontrolled case series with fewer than 30 patients total suggested that sacral nerve stimulation (SNS) may benefit some patients. 34-36 In our opinion, SNS should not be used to manage levator ani syndrome outside of clinical trials.…”

Section: Methodsmentioning

confidence: 99%

Anorectal and Pelvic Pain

Bharucha

Lee

2016

Mayo Clinic Proceedings

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Although pelvic pain is a symptom of several structural anorectal and pelvic disorders (eg, anal fissure, endometriosis, and pelvic inflammatory disease), this comprehensive review will focus on the three most common nonstructural, or functional, disorders associated with pelvic pain: functional anorectal pain (ie, levator ani syndrome, unspecified anorectal pain, and proctalgia fugax), interstitial cystitis/bladder pain syndrome, and chronic prostatitis/chronic pelvic pain syndrome. The first two conditions occur in both sexes, while the latter occurs only in men. They are defined by symptoms, supplemented with levator tenderness (levator ani syndrome) and bladder mucosal inflammation (interstitial cystitis). Although distinct, these conditions share several similarities, including associations with dysfunctional voiding or defecation, comorbid conditions (eg, fibromyalgia, depression), impaired quality of life, and increased health care utilization. Several factors, including pelvic floor muscle tension, peripheral inflammation, peripheral and central sensitization, and psychosocial factors, have been implicated in the pathogenesis. The management is tailored to symptoms, is partly supported by clinical trials, and includes multidisciplinary approaches such as lifestyle modifications and pharmacologic, behavioral, and physical therapy. Opioids should not be avoided, and surgery has a limited role, primarily in refractory interstitial cystitis.

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Section: Methodsmentioning

confidence: 99%

Anorectal and Pelvic Pain

Bharucha

Lee

2016

Mayo Clinic Proceedings

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“…[5][6][7][8][9][10] SNS was reported to be effective in treating pelvic pain after abdominal surgery 11 and anal pain with controversial results. [12][13][14] There are few research works of SNS on IBS or visceral hypersensitivity. Fassov et al 15 applied SNS to patients with IBS and reported some improvement in symptoms and the quality of life.…”

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confidence: 99%

Sacral nerve stimulation with optimized parameters improves visceral hypersensitivity in rats mediated via the autonomic pathway

Jiang

Zhang

et al. 2019

Mol Pain

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The purpose of this study was to determine effects and mechanisms of sacral nerve stimulation (SNS) on visceral hypersensitivity in rodent models of colonic hypersensitivity. SNS was performed with different sets of parameters for 30 min in six regular rats. Visceral sensitivity was assessed by the measurement of electromyogram and abdominal withdrawal reflex before and after SNS. Real/sham SNS with optimized parameters was performed in 8 restraint stress-induced visceral hypersensitivity rats and 10 neonatal acetic acid-treated colonic hypersensitivity rats; acute effect of SNS was assessed by comparing electromyogram and heart rate variability. Neonatal acetic acid-treated rats were treated by SNS (n = 10) or sham-SNS (n = 10) daily for seven days for the assessment of the chronic effect of SNS. (1) When the stimulation amplitude was reduced from 90% of motor threshold to 65% or 40% motor threshold, SNS with certain parameters showed an inhibitory effect on abdominal withdrawal reflex. The best stimulation parameters for SNS were “14 Hz, 330 µs, and 40% motor threshold.” (2) SNS significantly reduced visceral hypersensitivity and improved autonomic function in restraint stress-induced rats. The inhibitory effect was blocked by naloxone. (3)Acute and chronic SNS significantly reduced visceral hypersensitivity and improved autonomic function in acetic acid-treated rats. SNS with reduced stimulation strength may be used to treat colonic hypersensitivity and the best stimulation parameters seem to be “14 Hz, 330 µs and 40% motor threshold”. SNS with optimized parameters improved visceral hypersensitivity in rodent models of colonic hypersensitivity mediated via the autonomic and opioid mechanisms.

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“…Similar findings have been shown by Govaert et al., who described successful SNS treatment for anorectal pain in 4 patients with improved VAS pain scores and quality of life scores. But Dudding et al . believed that SNS was ineffective in the treatment of anorectal pain in 10 patients.…”

Section: Discussionmentioning

confidence: 99%

“…One factor may relate to the sample size. In our study, the parameters of stimulation that we used differed from those of other researchers . In the test mode, we selected 1 Hz, 10 mA, and 0.50 milliseconds.…”

Section: Discussionmentioning

confidence: 99%

Treatment Outcome of Acute Sacral Nerve Stimulation in Functional Anorectal Pain

Gao

Wang

et al. 2019

Pain Practice

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Background Sacral nerve stimulation (SNS) has revolutionized the management of certain intractable cases of fecal and urinary incontinence; however, the management of functional anorectal pain (FAP) has been addressed in only a few studies. Objective The aim of this study was to evaluate the treatment effect of SNS in improving FAP symptoms. Methods A total of 120 patients with FAP who had undergone temporary SNS probe placement were investigated at Qianfoshan Hospital between January 2014 and December 2016. Pre‐ and post‐SNS treatment outcomes were assessed using the VAS, anorectal manometry, and the 36‐item short‐form health survey (SF‐36) medical outcomes study instrument. Results A total of 120 patients proceeded to insertion of an SNS probe at the S3 nerve root (2 Hz, 1.50 mA, 0.10 milliseconds). Of these, 75 patients were cured, 41 improved, and 4 had an ineffective outcome. The total effectiveness rate was 96.7% 1 year after treatment. There was a significant reduction in the median VAS score pre‐SNS and post‐SNS, from 8 to 3, respectively. Patients post‐SNS had lower anal maximum contraction pressure and anal rest pressure than did patients pre‐SNS. Compared with the pretreatment group, there were no substantial differences between anal longest contraction time and rectal rest pressure. In addition to general health, there was a substantial improvement in the remaining dimension scores of the SF‐36. Conclusion The effect of SNS in treating FAP was positive, and the improvement of symptoms was substantial and worthy of clinical promotion.

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Sacral nerve stimulation: an effective treatment for chronic functional anal pain?

Abstract: This study would suggest that SNS is not an effective treatment for chronic anal pain in the majority of patients. PNE is not an effective means of identifying which of these patients are likely to respond to permanent SNS.

Cited by 23 publications

References 28 publications

Anorectal and Pelvic Pain

Anorectal and Pelvic Pain

Sacral nerve stimulation with optimized parameters improves visceral hypersensitivity in rats mediated via the autonomic pathway

Treatment Outcome of Acute Sacral Nerve Stimulation in Functional Anorectal Pain

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