Spinal cord stimulation is a safe and significant treatment to tame chronic pelvic pain and prevent its devastating effects on patients’ lives. The technique helps achieve neuromodulation more readily and effectively and minimize the inconvenience to the patient. It keeps unwanted sensation at bay, improves blood flow, and assures significant relief from chronic pelvic pain.
What is chronic pelvic pain?
Urologic chronic pelvic pain syndrome refers to any type of pain feeling in the pelvic area for more than six weeks. Such type of pain affects pelvis, pelvic floor, genitalia, and even lower urinary tract.
How common is chronic pelvic pain?
One in every 7 women suffers from chronic pelvic pain. Among women within their reproductive age, the incidence of chronic pelvic pain can be as high as 39%. It may have its roots in an interplay of musculoskeletal, neurologic, and psychiatric factors that impacts the pelvic system. Complex etiology, uncertain history, and poor response to treatment make the problem a major health care challenge.
It may lead to prolonged suffering, bowel, bladder, and sexual dysfunction, depression, and life-long need for treatment.
What are symptoms of chronic pelvic pain?
- 1. Severe, sharp, or steady pain in the pelvic area
- 2. Intermittent, dulling pelvic pain
- 3. Feeling of heaviness in the pelvis
- 4. Cramping in the pelvic area
- 5. Pain during sex, urination, bowel movement, or while sitting or standing for long
What causes chronic pelvic pain?
- 1. Endometriosis or outgrowth of uterus lining tissue
- 2. Painful cysts and scar tissue in pelvic area
- 3. Pelvic floor muscle tension
- 4. Chronic pelvic inflammatory disease
- 5. Scarring of pelvic organs
- 6. Ovarian remnant after uterus surgery
- 7. Growth of fibroids
- 8. Chronic irritable bowel syndrome
- 9. Painful bladder syndrome
- 10. Pelvic congestion syndrome linked
- 11. Chronic stress, depression
- 12. Pudendal neuralgia or compression of pudendal nerve feeding genitals, anal area and the urethra
How effective is spinal cord stimulation for managing chronic pelvic pain?
Spinal cord stimulation enables significant relief from chronic pelvic pain and improves blood flow to the pelvic area significantly. A Cleveland Clinic study indicate at least 50 percent pain reduction and more than 3/5 times less opioid use following the therapy over 30 months.
A 2011 study attests the efficacy of SCS therapy for “chronic renal pain secondary to uretero-pelvic junction obstruction.” According to a 2014 research report, spinal cord stimulation plays a crucial role in neutralizing dorsal column pathways responsible for pelvic pain transmission and thus useful for treating “chronic pelvic pain resistant to medical management.”
Spinal cord stimulation is also effective to manage intractable visceral pain associated with chronic pancreatitis, claims a Korean study. Researchers also found SCS helpful in treating coccygodynia, vulvovaginal burning pain, and deep pelvic pain.
How does spinal cord stimulation relieve chronic pelvic pain?
The spinal cord stimulator sends electrical signals to the dorsal column and prevents pain sensation transmission through it. This inhibits pain perception in the brain and provides relief from chronic pelvic pain.
Who is a suitable candidate for spinal cord stimulator implant?
Spinal cord stimulation is for those who
- 1. have chronic pelvic pain
- 2. have persistent pain not responsive to other treatment modalities
- 3. have no painkiller addiction
How is spinal cord stimulation therapy performed?
Patients with chronic pelvic pain have to undergo spinal cord stimulator implant for the SCS therapy. This involves two stages – screening and actual implant.
Is screening test mandatory?
Yes, the trial is essential to see if your chronic pelvic pain is responsive to SCS therapy without any side effects.
What is done during the SCS trial?
Patients carry a spinal cord stimulator device around their waist. A catheter inserted into the lumbar spine using local anesthesia delivers electrical impulses generated by the stimulator to the dorsal column of the spine.
How long does the spinal cord stimulator trial take?
The trial implant takes about an hour. Patients remain in the trial mode for 5 to 7 days. If spinal cord stimulation is found to reduce chronic pelvic pain by 50 percent, doctors consider a permanent implant.
How is a spinal cord stimulator implanted?
Performed under general anesthesia, doctors create place for spinal cord stimulator implant just above the buttocks using surgical techniques. Another incision is made to place electrode leads close to the spine. A wire passing through soft tissues connects both. Once the functional parameters are checked, incisons are closed.
How long does the SCS implant surgery take?
The spinal cord stimulator implant surgery takes about 2 to 3 hours.
How do I feel after the spinal cord stimulator implant?
Chronic pelvic pain patients experience pain relief immediately after. However, the impact varies. It takes about 72 hours to stabilize and offer permanent pain relief.
Patients are discharged within hours of the surgery. Medications are prescribed to overcome soreness and discomfort.
How are the electrical current impulses regulated?
A hand-held remote control is used to regulate and manage the spinal cord stimulator. You can set timing, program, regulate intensity of impulse, and switch on or off suing this small device.
How do I know if the stimulator works?
Every time you use the spinal cord stimulator, there will be a faint sensation felt in your body. Apart from that, gradual reduction of chronic pelvic pain intensity is also an indication of its successful functioning.
Is there any post-surgical care to follow?
- Ensure incisions remain dry and clean
- It is essential to take rest for 7 days
- Avoid playing, rigorous movements, intense activities, bending, twisting for 6 weeks
- No driving for 4 weeks
How long is the post-SCS implant recovery?
You can perform all normal activities after a week. However, avoid driving for 4 weeks and rigorous movements, intense activities, running, swimming, aerobic exercises, bending, twisting for 6 weeks.
Do I need to stay in the hospital?
No, most patients are discharged within hours. However, a hospital stay is suggested for those with potential risk of surgical complications.
How big are the incisions made during the implant?
A spinal cord stimulator is not bigger than a stopwatch. Two incisions are made – one equal to the device size to create a pocket to place it and another around 2 to 3 inches long for placing electrode leads.
Is spinal cord damage a possible side effect?
No, the spinal cord stimulator implant to manage chronic pelvic pain does not damage the spine. However, surgical placement of the lead may cause injury unless performed by an expert surgeon.
Where is the lead placed?
Depending on your body construction and pain area and intensity, the lead position is determined. It connects with any of the spinal joint.
Does the spinal cord stimulator make any noise?
No, it does not make any sound.
Is the process covered by insurance?
Many insurance providers cover implant of spinal cord stimulator for chronic pelvic pain management subject to individual plan. Check with your insurer.
Medicare covers up to 80% of the cost subject to the certification that the SCS therapy is necessary to manage pain.
Do I need to replace spinal cord stimulator?
No, spinal cord stimulator is a life-long process. However, you have to change batteries in 5 to 10 years depending on the usage.
What are complications associated with spinal cord stimulation therapy?
Spinal cord stimulation is a safe procedure to treat chronic pelvic pain. However, there may be surgical complications, scar tissue formation, or spinal headache due to fluid leakage in rare cases. Patients may also have bladder disorder initially.
Kapural L, Narouze SN, Janicki TI, et al. Spinal cord stimulation is an effective treatment for the chronic intractable visceral pelvic pain. Pain Med, 2006; 7(5), 440-443.
Abdel-Aziz, S. and Ghaleb, A. Combined Sacral Nerve Roots Stimulation and Low Thoracic Spinal Cord Stimulation for the Treatment of Chronic Pelvic Pain. Pain Studies and Treatment, 2014; 2, 86-90.
Kim CH, Issa M. Spinal cord stimulation for the treatment of chronic renal pain secondary to uretero-pelvic junction obstruction. Pain Physician. 2011 Jan-Feb;14(1):55-9.
Hunter C, Dave N, Deer T, et al. Neuromodulation of Pelvic Visceral Pain: Review of the Literature and Case Series of Potential Novel Targets for treatment. Pain Practice, Volume 13, Issue 1, 2013 3–17
Kim JK, Hong SH, Kim M-H, Lee J-K.Spinal Cord Stimulation for Intractable Visceral Pain due to Chronic Pancreatitis.Journal of Korean Neurosurgical Society. 2009;46(2):165-167.
Kapural L, Rakic M. Spinal cord stimulation for chronic visceral pain secondary to chronic non-alcoholic pancreatitis. J ClinGastroenterol. 2008 Jul;42(6):750-1.
Nair AR, Klapper A, Kushnerik V, et al. Spinal cord stimulator for the treatment of a woman with vulvovaginal burning and deep pelvic pain. Obstet Gynecol. 2008 Feb;111(2 Pt 2):545-7.
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