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Prasad B, Sharma A, Garg A, Dokouhaki P, Lanktree MB. Decoding Loin Pain Hematuria Syndrome: In-Depth Review of Clinical Characteristics and Family History. Kidney Int Rep 2023; 8:2826-2829. [PMID: 38106595 PMCID: PMC10719562 DOI: 10.1016/j.ekir.2023.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 12/19/2023] Open
Affiliation(s)
- Bhanu Prasad
- Section of Nephrology, Department of Medicine, Regina General Hospital, Regina, Saskatchewan, Canada
- College of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Aditi Sharma
- Institute for Microbial Systems and Society, University of Regina, Regina, Saskatchewan, Canada
| | - Aarti Garg
- Institute for Microbial Systems and Society, University of Regina, Regina, Saskatchewan, Canada
| | - Pouneh Dokouhaki
- Department of Pathology and Lab Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mathew B. Lanktree
- Division of Nephrology, St Joseph’s Health Care Hamilton, Departments of Medicine and Health Research Methodology, Evidence and Impact, McMaster’s University, Hamilton, Ontario, Canada
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Sharma A, Lanktree MB, Liskowich S, Dokouhaki P, Prasad B. Basic Research Protocol: Exome Sequencing in Adults With Loin Pain Hematuria Syndrome: A Pilot Study. Can J Kidney Health Dis 2023; 10:20543581231183856. [PMID: 37426491 PMCID: PMC10328052 DOI: 10.1177/20543581231183856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/18/2023] [Indexed: 07/11/2023] Open
Abstract
Background Loin pain hematuria syndrome (LPHS) is a poorly understood clinical syndrome characterized by hematuria and either unilateral or bilateral severe kidney pain in the absence of identifiable urological disease. Loin pain hematuria syndrome imposes a significant health and economic impact with a loss of productivity and quality of life in a young population. Owing to an incomplete understanding of its pathophysiology, treatment has been limited to nonspecific pain management. Nearly 60 years after its initial description, we are no further ahead in understanding the molecular pathways involved in LPHS. Objective To outline the study design for exome sequencing in adults with LPHS and their families. Methods In this single-center case series, 24 patients with LPHS and 2 additional first-degree family members per participant will be recruited. DNA extracted from venous blood samples will undergo exome sequencing on the Illumina NovaSeq 6000 System at 100× depth and will be assessed for pathogenic variants in genes associated with hematuria (number of genes in: glomerular endothelium [n = 10] and basement membrane [n = 8]), and pain pathways (number of genes in: pain transduction [n = 17], conduction [n = 8], synaptic transmission [n = 37], and modulation [n = 27]). We will further examine identified potentially pathogenic variants that co-segregate with LPHS features among affected families. Conclusions This pilot study may identify new directions for an investigation into the molecular mechanisms underlying LPHS.
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Affiliation(s)
- Aditi Sharma
- Dr. T. Bhanu Prasad Med Prof Corp, Regina, SK, Canada
| | - Matthew B. Lanktree
- Departments of Medicine and Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Division of Nephrology, St Joseph’s Healthcare Hamilton, ON, Canada
| | - Sarah Liskowich
- Department of Academic Family Medicine, College of Medicine, University of Saskatchewan, Regina, Canada
| | - Pouneh Dokouhaki
- Department of Pathology and Lab Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Bhanu Prasad
- Section of Nephrology, Department of Medicine, Regina General Hospital, SK, Canada
- College of Medicine, University of Saskatchewan, Regina, Canada
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Urits I, Li N, Berger AA, Walker P, Wesp B, Zamarripa AM, An D, Cornett EM, Abd-Elsayed A, Kaye AD. Treatment and Management of Loin Pain Hematuria Syndrome. Curr Pain Headache Rep 2021; 25:6. [PMID: 33495883 DOI: 10.1007/s11916-020-00925-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW Loin pain hematuria syndrome (LPHS) is rare and seldom diagnosed, yet it has a particularly significant impact on those affected. This is a review of the latest and seminal evidence of the pathophysiology and diagnosis of LPHS and presents the typical clinical presentation and treatment options available. RECENT FINDINGS LPHS is typically found in young women with characteristic symptoms, including severe recurrent flank pain and gross or microscopic hematuria. The majority of patients will experience crippling pain for many years without effective therapy, often requiring frequent use of narcotic medication. However, the lack of conclusive pathophysiology, in conjunction with the rarity of LPHS, has prohibited the development and trial of definitive treatment options. Nevertheless, in order to combat this rare but severe disease, management strategies have continued to evolve, ranging from conservative measures to invasive procedures. This review presents an overview of the current hypotheses on the pathophysiology of LPHS in addition to summarizing the management strategies that have been utilized. Only 30% of LPHS patients will experience spontaneous resolution, whereas the majority will continue to face chronic, crippling pain. Several methods of treatment, including invasive and non-invasive, may provide an improved outcome to these patients. Treatment should be individually tailored and multi-disciplinary in nature. Further research is required to further elucidate the pathophysiology and develop new, specific, treatment options.
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Affiliation(s)
- Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.,Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Nathan Li
- Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Amnon A Berger
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - Paul Walker
- Weill Cornell Medical College, New York, NY, USA
| | - Brendan Wesp
- Georgetown University School of Medicine, Washington, DC, USA
| | - Alec M Zamarripa
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Daniel An
- Georgetown University School of Medicine, Washington, DC, USA
| | - Elyse M Cornett
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
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Lugo-Gavidia LM, Nolde JM, Kiuchi MG, Shetty S, Azzam O, Carnagarin R, Schlaich MP. Interventional Approaches for Loin Pain Hematuria Syndrome and Kidney-Related Pain Syndromes. Curr Hypertens Rep 2020; 22:103. [PMID: 33128173 DOI: 10.1007/s11906-020-01110-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Loin pain hematuria syndrome (LPHS) frequently presents with severe chronic pain that poses a clinical challenge. Current treatment approaches are mostly empirical and include a wide range of therapeutic strategies such as physical therapy, local and systemic analgesia, interventional and surgical approaches usually flanked by psycho-behavioral therapy, and other strategies. LPHS often impacts negatively on quality of life particularly in patients who are refractory to treatment. RECENT FINDINGS With recent advances in catheter-based treatment approaches and better understanding of the pathophysiology of LPHS, intraluminal renal denervation (RDN) has been proposed as a valuable treatment option for kidney-related pain syndromes. The present review provides a brief overview of the clinical challenges associated with LPHS, highlights recent insights into its underlying mechanisms, and summarizes currently available data on the use of RDN in the context of LPHS and kidney-related pain syndromes. Renal denervation via various approaches including surgical and catheter-based techniques has shown promise in alleviating kidney-related pain syndromes. Randomized controlled trials are now required to better define its role in the management of these conditions.
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Affiliation(s)
- Leslie Marisol Lugo-Gavidia
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, 6000, Australia
| | - Janis M Nolde
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, 6000, Australia
| | - Márcio Galindo Kiuchi
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, 6000, Australia
| | - Sharad Shetty
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
- Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, Australia
| | - Omar Azzam
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, 6000, Australia
- Departments of Internal Medicine, Royal Perth Hospital, Perth, Australia
| | - Revathy Carnagarin
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, 6000, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, 6000, Australia.
- Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, Australia.
- Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia.
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Richter B, Bergman J, Pierre J, Tomycz ND. Spinal Cord Stimulation for Loin Pain Hematuria Syndrome: Clinical Report. Pain Pract 2018; 19:440-442. [PMID: 30554461 DOI: 10.1111/papr.12755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/06/2018] [Accepted: 12/09/2018] [Indexed: 11/30/2022]
Abstract
Loin pain hematuria syndrome (LPHS) is a rare condition characterized by cryptogenic debilitating flank pain and microscopic or macroscopic hematuria. The pathophysiology of LPHS remains poorly understood, and diagnosis is made largely by exclusion of alternate pathology. Management strategies can vary widely and include chronic opioid medication and a variety of invasive procedures, including regional nerve blocks, transcutaneous electrical nerve stimulation, local capsaicin infusion, and surgical renal denervation. Neuromodulation may provide a new paradigm of treatment for LPHS, potentially sparing patients from long-term complications of opiate therapy and invasive surgery. This report demonstrates the first case of successful symptomatic management of LPHS using spinal cord stimulation.
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Affiliation(s)
- Bertram Richter
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, U.S.A
| | - Jeff Bergman
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, U.S.A
| | - James Pierre
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, U.S.A
| | - Nestor D Tomycz
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, U.S.A
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Grech AK. Loin Pain Haematuria Syndrome - A Narrative Review of Pain Management Strategies. Korean J Pain 2016; 29:78-85. [PMID: 27103962 PMCID: PMC4837123 DOI: 10.3344/kjp.2016.29.2.78] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/29/2016] [Accepted: 03/02/2016] [Indexed: 11/26/2022] Open
Abstract
Loin pain haematuria syndrome (LPHS) is an uncommon clinical entity that has divided renal physicians, pain practitioners, and even psychiatrists since its initial description. A relative paucity of data exists regarding the condition, with best practice guidelines lacking amid the existing threads of anecdotal experiences and variable follow-up observations. The aim of this article was to review the cumulative published experience of pain relief strategies for LPHS.
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Affiliation(s)
- Andrew Kristian Grech
- Department of Anaesthesia, Intensive Care & Pain Medicine, Mater Dei Hospital, Msida MSD, Malta
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Zubair AS, Salameh H, Erickson SB, Prieto M. Loin pain hematuria syndrome. Clin Kidney J 2015; 9:128-34. [PMID: 26798473 PMCID: PMC4720203 DOI: 10.1093/ckj/sfv125] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 10/29/2015] [Indexed: 12/13/2022] Open
Abstract
Loin pain hematuria syndrome (LPHS), first described in 1967, is a rare pain syndrome, which is not well understood. The syndrome is characterized by severe intermittent or persistent flank pain, either unilateral or bilateral, associated with gross or microscopic hematuria. LPHS is a diagnosis of exclusion as there still is not a consensus of validated diagnostic criteria, though several criteria have been proposed. The wide differential diagnosis would suggest a meticulous yet specific diagnostic work-up depending on the individual clinical features and natural history. Several mechanisms regarding the pathophysiology of LPHS have been proposed but without pinpointing the actual causative etiology, the treatment remains symptomatic. Treatment modalities for LPHS are diverse including simple analgesia, opioid analgesic and kidney autotransplantation. This review article summarizes the current understanding regarding the pathophysiology of LPHS along with the steps required for proper diagnosis and a discussion of the different therapeutic approaches for LPHS.
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Affiliation(s)
- Adeel S Zubair
- Division of Transplantation Surgery, Department of Medicine , Mayo Clinic , Rochester, MN , USA
| | - Hassan Salameh
- Division of Nephrology and Hypertension, Department of Medicine , Mayo Clinic College of Medicine , Rochester, MN , USA
| | - Stephen B Erickson
- Division of Nephrology and Hypertension, Department of Medicine , Mayo Clinic College of Medicine , Rochester, MN , USA
| | - Mikel Prieto
- Division of Transplantation Surgery, Department of Medicine , Mayo Clinic , Rochester, MN , USA
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Abstract
Peripheral nerve stimulation (PNS) is likely the most diverse and rapidly expanding area of neuromodulation. Its expansion has become possible due to both technological and clinical advances in pain medicine. The first implantable systems were surgically placed. However, it is currently commonplace to use percutaneous leads, as this approach has become instrumental in its expansion. The first percutaneous peripheral nerve stimulators were reported in 1999. Cylindrical leads were implanted to stimulate the greater occipital nerve to manage intractable headache. It has been expanded into other individual nerves or nerve plexuses to treat neuropathic, visceral, cardiac, abdominal, low back and facial pain. The use of PNS in modulating organ function in treatment of syndromes such as epilepsy, incontinence and obesity with vagal, tibial and gastric stimulation is under extensive investigation. New technologies that allow easier and safer electrode placement are expected to further expand the uses of PNS. A noninvasive stimulation will open this treatment modality to more clinicians of varying backgrounds.
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Affiliation(s)
- Teodor Goroszeniuk
- Interventional Pain Management and Neuromodulation Practice, 18 Wimpole Street, London, W1G 8GD, UK,
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Goroszeniuk T, Shetty A. To Test or Not to Test in Peripheral Nerve Stimulation? Neuromodulation 2014; 17:705-6. [DOI: 10.1111/ner.12240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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A Patient With Loin Hematuria Syndrome and Chronic Flank Pain Treated With Pulsed Radiofrequency of the Splanchnic Nerves. Clin J Pain 2013; 29:e26-9. [DOI: 10.1097/ajp.0b013e31828c8922] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Goroszeniuk T, Pang D, Shetty A, Eldabe S, O'Keeffe D, Racz G. Percutaneous peripheral neuromodulation lead insertion using a novel stimulating Coudé needle. Neuromodulation 2013; 17:506-9. [PMID: 24180632 DOI: 10.1111/ner.12126] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 07/11/2013] [Accepted: 08/28/2013] [Indexed: 11/30/2022]
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de Beus E, Blankestijn PJ, Fox JG, Zoccali C. Catheter-based renal denervation as a novel treatment for loin pain haematuria syndrome. Nephrol Dial Transplant 2013; 28:2197-9. [DOI: 10.1093/ndt/gft225] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Almaiman H, Serre J, Abid N, Fouque D, Martin X. Approche mini-invasive de l’autotransplantation rénale dans la prise en charge du loin pain hematuria syndrome. Prog Urol 2013; 23:389-93. [PMID: 23628096 DOI: 10.1016/j.purol.2012.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 11/29/2012] [Accepted: 11/29/2012] [Indexed: 10/27/2022]
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Goroszeniuk T, Khan R. Permanent percutaneous splanchnic nerve neuromodulation for management of pain due to chronic pancreatitis: a case report. Neuromodulation 2011; 14:253-7; discussion 257. [PMID: 21992249 DOI: 10.1111/j.1525-1403.2011.00347.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The management of pain in chronic benign pancreatitis is complex. Celiac plexus neurolysis provides pain relief of variable duration. Neuromodulation of splanchnic nerves with electrodes and an implantable pulse generator system is an alternative to producing long-term pain relief with minimal complications in selected cases. METHODS A 36-year-old lady with intractable abdominal pain for five years from chronic benign pancreatitis presented to our pain clinic. Multiple pharmacotherapy regimens, surgery, and interventions produced temporary pain relief of variable duration and intensity. Following a successful trial of celiac plexus stimulation, neuromodulation of the splanchnic nerves was achieved with two permanently implanted octopolar leads at the T11/T12 area connected to an implantable pulse generator. RESULTS Eighteen months following the implant, the patient continues to derive satisfactory pain relief without any device related complications. Her opiate use is significantly reduced from 225 (486 mg morphine per day) to 12.5 (27 mg morphine per day) micrograms/h fentanyl patches and the fentanyl lozenges were stopped with an increase in appetite and of more than 8 kg in weight gain. The initial pain score visual analogue scale (VAS) 8-9/10 was reduced to VAS 0/10 since implantation. DISCUSSION The pain of chronic pancreatitis has both visceral and somatic components as evidenced by the lack of complete pain relief from celiac plexus block alone and the knowledge that in chronic disease, the pathology extends to extra pancreatic somatic tissues, particularly the retro-peritoneum. We postulate that the electrical field generated by the dual octrode system extends to include splanchnic nerves and other somatic innervation of the pancreas. CONCLUSION In our opinion, this is the first case of a successful long-term neuromodulation of splanchnic nerves with a permanently implanted device. The potential exists for its use in visceral abdominal pain of varied etiology, once more experience is obtained with this technique.
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Affiliation(s)
- Teodor Goroszeniuk
- The Pain Management & Neuromodulation Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
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Rigaud J, Delavierre D, Sibert L, Labat JJ. [Neurostimulation techniques in the therapeutic management of chronic pelvic and perineal pain]. Prog Urol 2010; 20:1116-23. [PMID: 21056393 DOI: 10.1016/j.purol.2010.08.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 08/16/2010] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Neuromodulation is a nonspecific analgesic treatment whose mechanism of action has not yet been elucidated. The purpose of this article is to review the techniques and results of neuromodulation in the management of chronic pelvic and perineal pain. MATERIAL AND METHODS A comprehensive review of the literature was performed by searching PUBMED for articles on the various neuromodulation techniques used in the management of chronic pelvic and perineal pain. RESULTS Several levels of neuromodulation of the somatic nervous system have been evaluated in the management of pelvic pain: transcutaneous electrical nerve stimulation (TENS), percutaneous nerve stimulation (PNS), nerve root or nerve trunk stimulation, spinal cord stimulation. An improvement was obtained in an average of two thirds of cases, but with declining efficacy over time. The various studies were difficult to compare due to the heterogeneous study populations and very diverse endpoints. Interesting studies on the value of autonomic nervous system intervention have been described, but with no specific trials of neuromodulation. CONCLUSION The place of neuromodulation in the management of patients with chronic pelvic and perineal pain has yet to be defined, as it is too frequently used as a last resort. It appears important to develop and analyse this treatment modality in large-scale, randomized, prospective studies.
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Affiliation(s)
- J Rigaud
- Clinique urologique, centre fédératif de pelvipérinéologie, hôpital Hôtel Dieu, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France.
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