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Percutaneous Sacral Nerve Stimulation

  • Corey W. HunterEmail author
  • Dipan Patel
Chapter

Abstract

Pelvic pain is a poorly understood phenomenon that is notoriously difficult to treat. Conservative treatment modalities like medication and nerve blocks are largely ineffective in this particular patient population rendering most of these patients debilitated and suffering. Spinal cord stimulation would seem to be the logical treatment option for these recalcitrant cases, and given the predominance of sacral innervation in the pelvic viscera, targeting the sacral nerve themselves for direct stimulation is obvious choice. Percutaneous sacral nerve stimulation (SNS) is a therapeutic option pelvic pain with demonstrated efficacy. In this chapter we present an overview of the implementation and the supporting evidence.

Keywords

Neuromodulation Sacral nerve stimulation Chronic pelvic pain Perineal pain Percutaneous sacral nerve stimulation Vulvodynia Rectal pain Anal pain Neuropathic pain Scrotal pain 

Recommended Reading

  1. 1.
    Alo K, Yland M, Redko V, Feler C, Naumann C. Lumbar and sacral nerve root stimulation (NRS) in the treatment of chronic pain: a novel anatomic approach and neuro stimulation technique. Neuromodulation. 1999;2(1):23–31.CrossRefGoogle Scholar
  2. 2.
    Alo` KM, McKay E. Selective nerve root stimulation (SNRS) for the treatment of intractable pelvic pain and motor dysfunction: a case report. Neuromodulation. 2001;4(1):19–23.CrossRefGoogle Scholar
  3. 3.
    Alo` KM, Yland MJ, Redko V, Feler C, Naumann C. Lumbar and sacral nerve root stimulation (NRS) in the treatment of chronic pain: a novel anatomic approach and neurostimulation technique. Neuromodulation. 1999;2:23–31.CrossRefGoogle Scholar
  4. 4.
    Brookoff D, Bennett D. Neuromodulation in intractable interstitial cystitis and related pelvic pain syndromes. Pain Med. 2006;7(suppl 1):S166–84.CrossRefGoogle Scholar
  5. 5.
    Deer T, Lamer T, Pope J, Falowski S, Provenzano D, Slavin K, Golovac S, Arle J, Rosenow J, Williams K, McRoberts P, Narouze S, Eldabe S, Lad S, De Andrés J, Buchser E, Rigoard P, Levy R, Simpson B, Mekhail N. The neurostimulation appropriateness consensus committee (NACC) safety guidelines for the reduction of severe neurological injury. Neuromodulation Technol Neural Interface. 2017;20(1):15–30.CrossRefGoogle Scholar
  6. 6.
    Deer T, et al. The neurostimulation appropriateness consensus committee (NACC) recommendations for infection prevention and management. Neuromodulation Technol Neural Interface. 2017;20(5):516.CrossRefGoogle Scholar
  7. 7.
    Deer T, et al. The neurostimulation appropriateness consensus committee (NACC): recommendations on bleeding and coagulation management in neurostimulation devices. Neuromodulation Technol Neural Interface. 2017;20(4):407.CrossRefGoogle Scholar
  8. 8.
    Ebraheim N, Lu J. Morphometric evaluation of the sacral dorsal root ganglia: A cadaveric study. Surg Radiol Anat. 1998;20(2):105–8.PubMedGoogle Scholar
  9. 9.
    Feler C, Whitworth L, Brookoff D, Powell R. Recent advances: sacral nerve root stimulation using a retrograde method of lead insertion for the treatment of pelvic pain due to interstitial cystitis. Neuromodulation. 1999;2(3):211–6.CrossRefGoogle Scholar
  10. 10.
    Gajewski J, Al-Zahrani A. The long-term efficacy of sacral neuromodulation in the management of intractable cases of bladder pain syndrome: 14 years of experience in one centre. BJU Int. 2010;107(8):1258–64.CrossRefGoogle Scholar
  11. 11.
    Hayek SM, Veizi E, Hanes M. Treatment-limiting complications of percutaneous spinal cord stimulator implants: a review of eight years of experience from an academic center database. Neuromodulation Technol Neural Interface. 2015;18(7):603–9.CrossRefGoogle Scholar
  12. 12.
    Hunter C, Davé N, Diwan S, Deer T. Neuromodulation of pelvic visceral pain: review of the literature and case series of potential novel targets for treatment. Pain Pract. 2012;13(1):3–17.CrossRefGoogle Scholar
  13. 13.
    Kapural L, Narouze S, Janicki T, Mekhail N. Spinal cord stimulation is an effective treatment for the chronic intractable visceral pelvic pain. Pain Med. 2006;7(5):440–3.CrossRefGoogle Scholar
  14. 14.
    Lavano A, Volpentesta G, Piragine G, Iofrida G, De Rose M, Abbate F, et al. Sacral nerve stimulation with percutaneous dorsal transforamenal approach in treatment of isolated pelvic pain syndromes. Neuromodulation Technol Neural Interface. 2006;9(3):229–33.CrossRefGoogle Scholar
  15. 15.
    Martellucci J, Naldini G, Carriero A. Sacral nerve modulation in the treatment of chronic pelvic pain. Int J Color Dis. 2011;27(7):921–6.CrossRefGoogle Scholar
  16. 16.
    McDonald JS, Alo KM. Bonica’s Management of Pain, 3rd Edition. In: Loeser J, editor. Section E: Pain in Pelvis, Perineum, and Genitalia: Chapter 73, Pain of Urogenital Origin. Philadelphia, PA: Lippinncott, Williams & Wilkins; 2001. p. 1448–61.Google Scholar
  17. 17.
    Nair A, Klapper A, Kushnerik V, Margulis I, Del Priore G. Spinal cord stimulator for the treatment of a woman with vulvovaginal burning and deep pelvic pain. Obstet Gynecol. 2008;111(2, Part 2):545–7.CrossRefGoogle Scholar
  18. 18.
    Paleček J. The role of dorsal columns pathway in visceral pain. Physiol Res. 2004;53(Supp. 1):S125–30.PubMedGoogle Scholar
  19. 19.
    Role of lumbosacral retrograde neuromodulation in the treatment of painful disorders. Pain Physician. 2013;16(2):145–53.Google Scholar
  20. 20.
    Sakas D, Krames E, Simpson B. Operative neuromodulation. Vienna: Springer; 2007.CrossRefGoogle Scholar
  21. 21.
    Sator-Katzenschlager S, Scharbert G, Kress H, Frickey N, Ellend A, Gleiss A, et al. Chronic pelvic pain treated with gabapentin and amitriptyline: a randomized controlled pilot study. Wien Klin Wochenschr. 2005;117(21–22):761–8.CrossRefGoogle Scholar
  22. 22.
    Stones R, Selfe S, Fransman S, Horn S. Psychosocial and economic impact of chronic pelvic pain. Best Pract Res Clin Obstet Gynaecol. 2000;14(3):415–31.CrossRefGoogle Scholar
  23. 23.
    Stratton P, Khachikyan I, Sinaii N, Ortiz R, Shah J. Association of chronic pelvic pain and endometriosis with signs of sensitization and myofascial pain. Obstet Gynecol. 2015;125(3):719–28.CrossRefGoogle Scholar
  24. 24.
    Woolf CJ. Central sensitization: Implications for the diagnosis and treatmentof pain. Pain. 2011;152:S2–15.CrossRefGoogle Scholar
  25. 25.
    Yang C. Neuromodulation in male chronic pelvic pain syndrome: rationale and practice. World J Urol. 2013;31(4):767–72.CrossRefGoogle Scholar
  26. 26.
    Zuidema X, Breel J, Wille F. S3 dorsal root ganglion/nerve root stimulation for refractory postsurgical perineal pain: technical aspects of anchorless sacral transforaminal lead placement. Case Rep Neurol Med. 2016;2016:1–3.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Ainsworth Institute of Pain ManagementNew YorkUSA
  2. 2.Garden State Pain Control CenterCliftonUSA
  3. 3.Residents & Fellows SocietyNorth American Neuromodulation Society (NANS)Jersey CityUSA

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