Pudendal neuromodulation for pelvic pain
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RECONSTRUCTED BLADDER FUNCTION & DYSFUNCTION (M KAUFMAN, SECTION EDITOR)
Pudendal neuromodulation for pelvic pain Alyssa Gracely 1 & Priyanka Gupta 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Current literature regarding the role of neuromodulation for the treatment of pelvic pain will be addressed with a focus on pudendal neuromodulation. The mechanism of action for pudendal nerve stimulation and technique for pudendal neuromodulation will be reviewed. Literature regarding the efficacy of neuromodulation for the treatment of pelvic pain will be summarized. Recent Findings Multiple studies have demonstrated efficacy of various modalities of neuromodulation in the treatment of chronic pelvic pain. Summary Neuromodulation may be an effective treatment option for the treatment of chronic pelvic pain, with studies showing a reduction of pain and an improvement in quality of life with various neuromodulation modalities. However, the quality of these studies is generally poor and further large-scale, randomized controlled trials are required. Keywords Neuromodulation . Pelvic pain . Sacral neuromodulation . Percutaneous tibial nerve stimulation . Pudendal neuromodulation
Introduction Chronic pelvic pain (CPP) affects many men and women globally and is characterized by a plurality of symptoms, creating particular treatment challenges. A variety of definitions for chronic pelvic pain have been proposed with one wellaccepted description as “pain symptoms perceived to originate from the pelvic organs/structures typically lasting more than 6 months. It is often associated with negative cognitive, behavioral, sexual and emotional consequences as well as with symptoms suggestive of lower urinary tract, sexual, bowel, pelvic floor, myofascial, or gynecological dysfunction” [1]. Lack of a universal consensus on a CPP definition further complicates management and an understanding of the true prevalence of the disease in order to report the success of various treatments [2]. This article is part of the Topical Collection on Reconstructed Bladder Function & Dysfunction * Priyanka Gupta [email protected]
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Despite the lack of a universally accepted definition, the global prevalence of CPP is estimated to range from 5.7 to 26.6% of women [3] and 2.2 to 13.8% of men [4]. The multitude of presenting symptoms, in addition to pain, lends itself to an interdisciplinary care approach where multi-modal treatment is often required. Treatment options include physical therapy, psychological therapy, oral pharmacotherapy, intravesical pharmacotherapy, trigger point injections, and surgical management—including neuromodulation. Although neuromodulation is not yet approved by the Food and Drug Administration (FDA) for the treatment of pelvic pain syndromes, it is approved for the treatment of urinary urgency and frequency, which are common concomitant symptoms in CPP syndromes. Furthermore, studies suggest that when neuromodulation is employed for urgency and frequency, pain symptoms
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