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Chronic Visceral Pelvic Pain Responds to Neurostimulation in Small Study


 

PALM SPRINGS, CALIF. — Pain scores declined by half and opioid use significantly declined in a small number of patients treated with spinal cord stimulation for chronic visceral pelvic pain at the Cleveland Clinic Foundation.

Nagy Mekhail, M.D., chairman of pain management, and his associate Leonardo Kapural, M.D., conducted a small clinical study of spinal cord stimulation for pelvic pain based on recent studies implicating dorsal column pathways in the transmission of visceral pelvic pain.

Six patients were enrolled in the study Dr. Mekhail presented at the annual meeting of the American Academy of Pain Medicine.

All had long-standing histories of chronic pelvic pain of a mean duration of nearly 15 years. All had pelvic adhesions and had undergone multiple surgical explorations for endometriosis and other diagnoses. Their clinical diagnoses included chronic pelvic inflammatory disease, adenomyosis, urinary retention, dyspareunia, vaginal prolapse and vulvodynia, and vulvar vestibulitis. Multiple surgical and medical therapies, including antidepressants and opioids, failed to relieve their pain for long.

After psychological evaluation and approval by an implantable devices committee, each patient underwent a spinal cord stimulation trial of 7-14 days and was implanted with two dual compact or dual quad leads connected to a generator. The lead tip was at the T11 or T12 level.

After an average follow-up of more than 30 months, the patients' mean visual analog score declined from 8 to 3, with all patients reporting a 50% or greater decrease in pain. Mean Pain Disability Index scores declined from 57.7 to 19.5, and mean opioid use was reduced from 22.5 mg morphine equivalent per day to 6.6 mg per day.

Dr. Mekhail acknowledged that the study was very small and the results were preliminary. However, he said these encouraging results suggest that spinal cord stimulation may offer “significant therapeutic potential” for difficult to treat patients with severe, long-standing visceral pelvic pain.

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