[Neurostimulation techniques in the therapeutic management of chronic pelvic and perineal pain]

S3 Dorsal Root Ganglion/Nerve Root Stimulation for Refractory Postsurgical Perineal Pain: Technical Aspects of Anchorless Sacral Transforaminal Lead Placement

Chronic perineal pain limits patients in physical and sexual activities, leading to social and psychological distress. In most cases, this pain develops after surgery in the urogenital area or as a consequence of trauma. Neuromodulation is one of the options in chronic postsurgical perineal pain treatment. We present a case of refractory perineal pain after right sided surgical resection of a Bartholin's cyst which was treated with third sacral nerve root/dorsal root ganglion stimulation using the transforaminal approach. We describe a new anchorless lead placement technique using a unique curved lead delivery sheath. We postulate that this new posterior foraminal technique of lead placement is simple, safe, and reversible and may lower the occurrence of lead related complications.

Pelvic pain: a pathway for care developed for both men and women by the British Pain Society

This paper aims to explain the key points and highlight some of the controversies in the development of the British Pain Society's pelvic pain patient pathway map. Many clinicians lack experience and confidence with this group of patients, and this issue is highlighted. Additionally, the difficulties of classification and definitions in this area are discussed in detail. These are historical causes of disagreement among specialists which can lead to confused clinical care. This group of patients have multiple issues that cross many professional boundaries; they are best managed by the co-ordinated involvement of multiple teams. Patients suffer from significant distress and disability that often needs specialist assessment and intervention (interdisciplinary). This suggests that an integrated approach is required across the historic boundaries of primary and secondary care. A variety of interventions, including opioids and neuromodulation are recommended in the pathway and the controversies surrounding these inclusions are aired in detail.

[Treatment algorithms for the management of chronic pelvic and perineal pain: from syndrome to treatment]

INTRODUCTION

The treatment of patients with chronic pelvic and perineal pain is often complex and involves a number of different parameters. The purpose of this article is to propose a series of treatment algorithms to facilitate the therapeutic management of patients with chronic pelvic and perineal pain.

MATERIAL AND METHODS

A review of the literature was performed by searching Pubmed for articles on treatment of chronic pelvic and perineal pain. Treatment algorithms were established for each type of pain syndrome.

RESULTS

Treatment algorithms were defined for the various types of chronic pain syndrome: pudendal nerve entrapment syndrome, chronic pelvic pain syndrome, painful bladder syndrome, vulvar pain syndrome, epididymotesticular pain syndrome, complex pelvic pain syndrome. Therapeutic management is proposed for each algorithm.

CONCLUSION

The proposed algorithms are designed to be a clinical aid and do not constitute a comprehensive approach to the management of patients with chronic pelvic and perineal pain.