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Sacral neuromodulation may alleviate chronic pelvic pain.

NEW YORK -- Sacral neuromodulation appears effective in modulating pelvic pain in patients who have both refractory chronic pelvic pain and irritable voiding symptoms, Jackie S. Shriver, a nurse-practitioner, said at an international congress of the Society of Laparoendoscopic Surgeons.

The finding suggests that there may be a bladder component in many cases of chronic gynecologic pelvic pain, particularly that which is not alleviated by hormonal or surgical therapy. "It's important to think outside the box and think of other organs when you're dealing with chronic pelvic pain," said Ms. Shriver of the Midwest Regional Center for Chronic Pelvic Pain and Bladder Control, Lima, Ohio.

Medtronic's InterStim Therapy for Urinary Control was approved in the United States in 1997 for the treatment of urinary retention, urge incontinence, and/or urinary urgency-frequency in patients who do not respond to other therapies or are unable to tolerate them.

In a prospective analysis, 18 women (aged 18-70 years) who had both gynecologic pelvic pain and irritable voiding symptoms for more than 5 years were initially assessed with the Pelvic Pain and Urinary Urgency/Frequency (PUF) scale, the O'Leary-Sant Interstitial Cystitis Symptom Index (ICSI), and the American Urological Association (AUA) questionnaire on irritable voiding symptoms. They also kept a 3-day voiding diary and underwent a preoperative potassium sensitivity test, the results of which are highly correlated with interstitial cystitis. The test was positive in 16 of the 18 women, strongly suggesting that bladder pain was contributing to the chronic pelvic pain, Ms. Shriver said.

All patients underwent sacral neuromodulation, in which an electrode is inserted with a needle into the S3 sacral nerve and then hooked up to an external box the patient carries for 2-3 weeks. If her symptoms diminish, the device is then implanted permanently. Average postoperative follow-up was 3-14 months, during which the patients filled out the three questionnaires every 3 months.

Before surgery, mean scores were 18.4 on the PUF Scale, 10.9 on the ICSI, and 19.8 on the AUA questionnaire. During follow-up, scores dropped to 7.7 for the PUF, 4.2 for the ICSI, and 8.8 for the AUA, with significant improvements in pain. In all, there was at least a 60% improvement in symptoms, she said. The women had received many interventions for their pelvic pain before undergoing sacral neuromodulation.


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Title Annotation:Women's Health
Author:Tucker, Miriam E.
Publication:Internal Medicine News
Geographic Code:1USA
Date:Dec 1, 2004
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