Аннотация:Emil D. Isagulyan (1)
- Andrey A. Polushkin (1)
- Alexey A. Tomskiy (1)
- Dmitry A. Lysachev (1)
- Dmitry Yu. Pushkar (2)
N. N. Burdenko National Medical Research Center of Neurosurgery, Functional Neurosurgery, Moscow, Russian Federation (1)
- A.I. Evdokimov
Moscow State University of Medicine and Dentistry, Moscow, Russia, Department of Urology, Moscow, Russian Federation (2)
INTRODUCTION
Among pain syndromes, approximately 25% of the patients have refractory pelvic pain syndromes, which consider one
of the most difficult diseases to be diagnosed and cured. The methods of neuromodulation can be used in refractory pain,
but a frequency of occurrence of these methods is very low. We would like to share our experience of using different
neuromodulation methods in patients with refractory pelvic pain.
PATIENTS AND METHODS
In our case series were included 36 patients with refractory pelvic pain. In 16 patients were implanted sacral lead on one
side of the sacral root, in 7 patients were implanted sacral lead on both side of the sacral root, in 5 patients were implanted
spinal cord stimulation lead, in 3 patients were implanted spinal cord stimulation lead and sacral lead and in 5 patients
were implanted sacral and pudendal nerve leads. We evaluate pain intensively with visual analog scale (VAS) and Brief
Pain Inventory before test period, after the test period, after implantation of the pulse generator and in follow-up. All
patients in our case series had a high point of the standard scale of the neuropathic pain: Pain Detect, DN4 and Leeds
Assessment of Neuropathic Symptoms and Signs (LANSS).
RESULTS
Test stimulation was successful in 28 patients. Of the 28 patients with the implant 26 had a decrease in the severity of the
worst pain compared to baseline. Median VAS before the operation was 9 points and 3,5 points in follow-up (p<0,005).
Average mean of physical activity scale before the operation was 14.03 points and 3,125 points in a follow-up (p <0,05).
In our case series not found a significant difference between pain duration and efficacy of neuromodulation therapy, but
at the same time, we noted a clear correlation with catastrophizing and passive and coping strategies. The more
pronounced they were, the worse the results were. Moreover, all cases of explantation were observed only in patients with
an extremely pronounced degree of catstarophization and the absence of active strategies. Neuromodulation therapy
therefore is an effective and safe method to manage pelvic pain.