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Neuromodulation for Chronic Pelvic Pain

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Adult and Pediatric Neuromodulation

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Abstract

Chronic pelvic pain, a complex condition defined by non-malignant pain of the pelvic musculature or viscera often with associated hyperalgesia, is difficult to treat. The pathophysiology can be hard to delineate, as pelvic innervation involves the sympathetic, parasympathetic, and somatic nervous systems. However, dysregulated central nervous system responses to non-noxious stimuli are likely the major underlying factor.

Given this proposed etiology, some clinicians offer sacral neuromodulation as part of a multimodal approach to this condition, believing that neuromodulation can restore the balance between excitatory and inhibitory impulses to and from the pelvic organs at the levels of the sacral and suprasacral spinal cord. Studies have demonstrated improvement in pain in some patients, though these are mostly small and non-randomized, making generalization difficult. Controversy remains regarding the best approach, including which pelvic nerves to target and whether bilateral stimulation offers better results than unilateral stimulation. Large-scale randomized trials with long term follow up and clearly stated, strict inclusion criteria are needed in order to more thoroughly evaluate SNS as a treatment for chronic pelvic pain.

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Authors and Affiliations

  1. Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, USA

    Jessica C. Lloyd & Courtenay K. Moore

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  1. Jessica C. Lloyd
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Correspondence to Courtenay K. Moore .

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Editors and Affiliations

  1. Department of Urology, Oakland University William, Beaumont School of Medicine, Royal Oak, Michigan, USA

    Jason P. Gilleran

  2. Section of Urology, Nationwide Children’s Hospital and The Ohio State Wexner Medical Center, Columbus, Ohio, USA

    Seth A. Alpert

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Lloyd, J.C., Moore, C.K. (2018). Neuromodulation for Chronic Pelvic Pain. In: Gilleran, J., Alpert, S. (eds) Adult and Pediatric Neuromodulation . Springer, Cham. https://doi.org/10.1007/978-3-319-73266-4_8

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  • DOI: https://doi.org/10.1007/978-3-319-73266-4_8

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