Electrical stimulation for pelvic pain

Abstract

Electrical stimulation of peripheral nerves for the therapy of intractable pain has been used over the past 30 years. In most of cases neuropathic pain is the cause of a CPPS: it is caused as believed in the past by entrapment or more recently by neurogenic inflammation of the pudendal nerve and alteration of pain receptors and central pain pathways. Neuropathic pain and CPPS are currently treated with spinal cord and peripheral nerve stimulation by pain clinicians. Peripheral nerve stimulation is likely to recruit a larger number of nerve fibers for the purpose of activating inhibitory interneurons than spinal cord stimulation. Since many patients with CPP experience an insufficient effect of conservative treatment, minimally invasive alternatives such as SNM and PTNS have been advocated to prevent major surgery. Currently, electrical stimulation should only be considered as a treatment for patients with refractory pelvic pain when all other treatment options have failed. The currently published results might suggest that SNM and PTNS could be used as a valuable alternative treatment option in patients with refractory chronic pelvic pain.