Sacral neuromodulation treating chronic pelvic pain: a meta-analysis and systematic review of the literature.

Abstract

INTRODUCTION AND HYPOTHESIS:

Sacral neuromodulation (SNM) is gaining popularity as a treatment option for chronic pelvic pain (CPP). Our hypothesis is that SNM is effective in improving CPP.

METHODS:

A systematic search was conducted through September 2018. Peer-reviewed studies using pre- and postpain intensity scores were selected. The primary outcome was pain improvement on a 10-point visual analog scale (VAS) (adjusted or de novo) in patients with CPP. Secondary outcomes included comparing SNM approaches and etiologies and evaluating lower urinary tract symptoms (LUTS).

RESULTS:

Fourteen of 2175 studies, evaluating 210 patients, were eligible for further analysis. The overall VAS pain score improvement was significant [weighted mean difference (WMD) -4.34, 95% confidence interval (CI) = -5.22, to-3.64, p < 0.0001)]. Regarding SNM approach, both standard and caudal approaches had significant reduction in pain scores: WMD -4.32, CI 95% = -5.32, to -3.31 (p < 0.001) for the standard approach, compared with WMD -4.63, 95% CI = -6.57 to -2.69 (P < 0.001), for the caudal approach (p = 0.75). While significant improvement in pain was observed both in patients with and without interstitial cystitis/bladder pain syndrome (IC/BPS), the observed improvement was lower in patients with (WMD -4.13, CI 95% -5.36 to -2.90 versus without (WMD -5.72, CI 95% = -6.18, to-5.27) IC/BPS (p = 0.02). SNM was effective in treating voiding symptoms (frequency, urgency, nocturia) associated with IC/BPS (all p < 0.01).

CONCLUSIONS:

SNM is an effective therapy for CPP in both IC/BSP and non-IC/BSP patients, with better results in non-IC/BSP patients. Outcomes of the antegrade caudal approach were comparable with the standard retrograde approach.

• Authors: Amr Mahran, Gina Baaklini, Daisy Hassani, Hassan A Abolella, Ahmed S Safwat, Mandy Neudecker, Adonis K Hijaz, Sangeeta T Mahajan, Steven W Siegel, Sherif A El-Nashar
• Journal: International urogynecology journal (Int Urogynecol J) Vol. 30 Issue 7 Pg. 1023-1035 (07 2019) ISSN: 1433-3023 [Electronic] England
• PMID: 30874835 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)

Topics

• Animals
• Chronic Pain (therapy)
• Cystitis, Interstitial (therapy)
• Electrodes, Implanted
• Female
• Humans
• Lumbosacral Plexus
• Pain Measurement
• Pelvic Pain (therapy)
• Prospective Studies
• Retrospective Studies
• Transcutaneous Electric Nerve Stimulation (methods)
• Treatment Outcome