Background Chronic pelvic pain (CPP) is a pervasive, difficult to treat condition affecting up to 26% of the global female and 8.2% of the global male population. Considered a form of chronic regional pain syndrome (CRPS), it is medically complex and often refractory to multimodal management. Neuromodulation has become increasingly popular in treatment of chronic neuropathic pain conditions, including CPP and CRPS. Dorsal column spinal cord stimulation and dorsal root ganglion stimulation have had some success for managing CPP meanwhile peripheral nerve stimulators (PNS) have been suggested as another viable option. However, few studies in the literature have reported successful use of PNS in treatment of CPP. Here, we detail a possible technique for pudendal PNS lead placement for management of CPP.
Method This article describes a novel cephalad to caudad fluoroscopic guided technique for pudendal nerve PNS lead placement and implantation.
Results A cephalad to caudal-medial fluoroscopic guided approach as described within to successfully implant a percutaneous pudendal nerve PNS for management of CPP.
Conclusions The pudendal nerve PNS lead placement technique noted within can be used to avoid many of the important neurovascular structures near the pelvic outlet. Further studies are needed to validate the safety and efficacy of this therapy modality but it may be a viable management option for patients with medically refractory CPP.
- CHRONIC PAIN
- Pain Management
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Contributors UL conceptualized the manuscript and cared for the study patient. SAK performed the cadaveric dissections. CML and UL reviewed the data and clinical information for this study. CML, SAK, and UL wrote and critically reviewed the manuscript before submission.
Funding Study was funded by Nalu Medical provided an unrestricted grant for funding for the artist anatomic drawings used within.
Competing interests UL is a consultant for Nalu Medical.
Provenance and peer review Not commissioned; internally peer reviewed.