Chronic pelvic pain is a debilitating condition that has a major impact on quality of life, health care resource utilization, and work productivity. It is the single most common reason for referral to women's health services and costs ~1 billion $ per year on its outpatient management. The etiology of chronic pelvic pain includes chronic pelvic pain syndrome [in women and men (formerly known as abacterial prostatitis)], pudendal neuralgia, nerve entrapment, post-surgical pain, cancer-related pain, and perineal/pelvic pain of unknown etiology. Chronic pelvic pain syndrome is often associated with irritable bowel syndrome, interstitial cystitis/painful bladder syndrome, endometriosis, or pelvic/adhesions. Treatment of chronic pelvic pain is multidimensional, including pelvic physical therapy, cognitive behavioral therapy, and various pharmacologic agent. However, pain often remains refractory despite this approach, and neuromodulation with Peripheral Nerve Stimulation can offer substantial pain relief in these cases. In addition to neural targets within the pelvis, there's growing evidence to suggest successful pain relief with neural targets outside of the pelvis.
Upon completion of this educational activity, participants should be able to:
- Discuss overall pelvic pain burden and traditional management options (conservative therapy, first-line pharmacologic therapy, and injection therapy); various Peripheral Nerve Stimulation (PNS) choices available currently and helpful decision-making tools; review general considerations for PNS including technical and patient factors.
- Explain posterior neural targets within the pelvis for refractory pelvic pain, including pudendal, superior, and middle cluneal nerves (relevant pain epidemiology and burden, evidence, approach, technical tips, and examples).
- Identify anterior neural targets within the pelvis for refractory pelvic pain, including ilioinguinal, iliohypogastric, and genitofemoral nerves (relevant pain epidemiology and burden, evidence, approach, technical tips, and examples).
- Review neural targets outside the pelvis for pelvic pain such as the tibial nerve (the potential mechanism of action, evidence, approach, technical tips, and examples). Briefly review additional neuromodulation options for pelvic pain beyond PNS such as Transcutaneous Electric Nerve Stimulation (TENS) and Dorsal Root Ganglion (DRG) Stimulation.
Pelvic Pain: PNS Choices at Your Disposal
Vinita Singh, MD
Pelvic Pain: Neural Targets Within the Pelvis
Matthew Pingree, MD
Pelvic Pain: Additional Neuromodulation Options and Targets
Jennifer Hah, MD
Faculty subject to change.