Sacral neuromodulation in endometriosis – A promising treatment option for chronic pelvic pain

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY Acta Obstetricia et Gynecologica Scandinavica Pub Date : 2023-10-09 DOI:10.1111/aogs.14690

Adrian Zegrea, Emilia Ojala, Pia Suvitie, Pirita Varpe, Heikki Huhtinen, Johanna Mäkelä-Kaikkonen, Tero Rautio, Päivi Härkki, Sinikka Salmenkylä, Mika Ukkonen, Maija Lavonius, Tarja Pinta

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Abstract

Introduction

Chronic pelvic pain (CPP) affects over one fifth of women worldwide, and endometriosis is one of the most common causes. In the present study, we examined whether sacral neuromodulation (SNM) is effective in the treatment of refractory chronic pelvic pain in women with endometriosis.

Material and methods

This multicenter prospective pilot study was started in 2017 and includes patients with chronic pelvic pain with no other obvious pathology than endometriosis. Other treatment options have been tried or they are unsuitable. Patients underwent SNM implantation. The main outcome was postoperative pain reduction and secondary outcome was quality of life. The following questionnaires were used to assess the outcomes: Brief pain inventory (BPI), clinical global impression - improvement (CGI-I), 15D-measure of health-related quality of life, and Biberoglu and Behrman (B&B) score.

Results

A total of 35 patients underwent the SNM procedure and, at the time of analysis, 15 patients had returned one-year questionnaires. The patients had a history of endometriosis for a median of 5.5 (interquartile range 2–9) years, with no correlation between the severity of symptoms and the duration of the disease (p = 0.158). A total of 31 patients (89%) were implanted with the internal pulse generator. There were statistically significant changes in BPI pain-related items. Worst experienced daily pain decreased among those who returned 12-month questionnaires from median 9 to 5 (p = 0.006), average daily pain from 6 to 3.5 (p = 0.004), and least daily pain from 3 to 1 (p = 0.004). Based on the CGI questionnaire (n = 14), at 12 months nine patients (60%) experienced great improvement in their symptoms, three patients (20%) much improvement and two patients (13%) minimal improvement. None of the patients experienced worsening of their symptoms. There was a statistically significant change in overall 15D score at 1 month (p < 0.001), 6 months (p = 0.001) and 12 months (p = 0.018), when the results were compared to baseline values. Median B&B score also improved significantly and decreased from a baseline value of 8 (4–12) to 4.5 (0–6), p = 0.002.

Conclusions

Based on the preliminary findings of our study, SNM might be a promising treatment of CPP in endometriosis patients.

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子宫内膜异位症的骶神经调控-慢性盆腔疼痛的一种有前途的治疗选择。

引言：慢性盆腔疼痛（CPP）影响着全世界超过五分之一的女性，子宫内膜异位症是最常见的原因之一。在本研究中，我们检查了骶骨神经调控（SNM）在治疗子宫内膜异位症妇女顽固性慢性骨盆疼痛中是否有效。材料和方法：这项多中心前瞻性试点研究始于2017年，包括慢性盆腔疼痛患者，除子宫内膜异位症外没有其他明显病理。已经尝试过其他治疗方案，或者它们不合适。患者接受了SNM植入术。主要结果是术后疼痛减轻，次要结果是生活质量。以下问卷用于评估结果：简要疼痛清单（BPI）、临床总体印象改善（CGI-I）、健康相关生活质量的15D测量以及Biberoglu和Behrman（B&B）评分。结果：共有35名患者接受了SNM手术，在分析时，有15名患者返回了为期一年的问卷。患者有子宫内膜异位症病史的中位数为5.5年（四分位间距2-9），症状的严重程度与疾病的持续时间之间没有相关性（p = 0.158）。共有31名患者（89%）植入了内部脉冲发生器。BPI疼痛相关项目的变化具有统计学意义。在那些返回12个月问卷的人中，经历最严重的日常疼痛从中位数9降至5（p = 0.006），平均每日疼痛从6到3.5（p = 0.004），每日疼痛最少为3至1（p = 0.004）。基于CGI问卷（n = 14），12 9名患者（60%）症状有很大改善，3名患者（20%）症状有较大改善，2名患者（13%）症状有轻微改善。没有一名患者的症状恶化。在1 月份（p 结论：根据我们研究的初步结果，SNM可能是子宫内膜异位症患者CPP的一种有前景的治疗方法。

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来源期刊

Acta Obstetricia et Gynecologica Scandinavica 医学-妇产科学

CiteScore

8.00

自引率

4.70%

发文量

180

审稿时长

3-6 weeks

期刊介绍： Published monthly, Acta Obstetricia et Gynecologica Scandinavica is an international journal dedicated to providing the very latest information on the results of both clinical, basic and translational research work related to all aspects of women’s health from around the globe. The journal regularly publishes commentaries, reviews, and original articles on a wide variety of topics including: gynecology, pregnancy, birth, female urology, gynecologic oncology, fertility and reproductive biology.