Spinal Cord Stimulation Is an Effective Treatment for the Chronic Intractable Visceral Pelvic Pain

Authors

  • Leonardo Kapural MD, PhD,

    Corresponding author
    1. Pain Management Department, The Cleveland Clinic Foundation, Cleveland, Ohio;
      Leonardo Kapural, MD, PhD, Pain Management Center, The Cleveland Clinic Foundation, 9500 Euclid Ave Desk C25, Cleveland, OH 44195, USA. Tel: 216-444-6325; Fax: 216-444-8980; E-mail: Kapural@ccf.org
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  • Samer N. Narouze MD,

    1. Pain Management Department, The Cleveland Clinic Foundation, Cleveland, Ohio;
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  • Thomas I. Janicki MD,

    1. Department of Obstetrics and Gynecology, Case Western Reserve University, University Hospital of Cleveland, Cleveland, Ohio, USA
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  • Nagy Mekhail MD, PhD*

    1. Pain Management Department, The Cleveland Clinic Foundation, Cleveland, Ohio;
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Leonardo Kapural, MD, PhD, Pain Management Center, The Cleveland Clinic Foundation, 9500 Euclid Ave Desk C25, Cleveland, OH 44195, USA. Tel: 216-444-6325; Fax: 216-444-8980; E-mail: Kapural@ccf.org

ABSTRACT

Objective.  Recent studies have demonstrated significant involvement of dorsal column pathways in transmission of visceral pelvic pain. Spinal cord stimulation (SCS) suppresses visceral response to colon distension in an animal model and therefore may be an effective therapy for chronic pelvic pain of visceral origin. We are reporting on the value of neurostimulation for chronic visceral pelvic pain in six female patients with the diagnosis of long-standing pelvic pain (history of endometriosis, multiple surgical explorations, and dyspareunia).

Design and Settings.  Case-series report. All patients received repeated hypogastric blocks (in an average of 5.3 blocks) with a significant pain relief for a period ranging from 1 to 6 weeks. Three received neurolytic hypogastric block with the pain relief of 3, 8, and 12 months, respectively. Following psychological evaluation and clearance by our Multidisciplinary Committee on Implantable Devices, they all underwent SCS trial for 7–14 days. All patients received SCS systems with dual leads (Compact or Quad leads, Medtronic Inc., Minneapolis, MN, USA).

Results.  The average follow-up was 30.6 months. Median visual analog scale pain score decreased from 8 to 3. All patients had more than 50% of the pain relief. Pain Disability Index changed from an average of 57.7 ± 12 to 19.5 ± 7. Opiate use decreased from an average 22.5 mg to 6.6 mg of morphine sulfate milligram equivalents per day.

Conclusion.  It appears that SCS may have a significant therapeutic potential for treatment of visceral pelvic pain.

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