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Multicenter Study
. 2023 Dec;102(12):1634-1642.
doi: 10.1111/aogs.14690. Epub 2023 Oct 9.

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

Adrian Zegrea  1 , Emilia Ojala  2 , Pia Suvitie  2 , Pirita Varpe  2 , Heikki Huhtinen  2 , Johanna Mäkelä-Kaikkonen  3 , Tero Rautio  3 , Päivi Härkki  4 , Sinikka Salmenkylä  4 , Mika Ukkonen  5 , Maija Lavonius  2 , Tarja Pinta  1
Affiliations
Multicenter Study

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

Adrian Zegrea et al. Acta Obstet Gynecol Scand. 2023 Dec.

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.

Keywords: chronic pain; endometriosis; pelvic pain; sacral neuromodulation.

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Conflict of interest statement

All authors declare they have no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Patient flow chart.
FIGURE 2
FIGURE 2
Average BPI scores of the study population at 1‐month, 6‐month and 1‐year follow‐up. The gray area illustrates average scores at the beginning of the study.
FIGURE 3
FIGURE 3
Changes in 15D questionnaire.
FIGURE 4
FIGURE 4
Bigeroglu and Behrman score (range 0–3 per item) in the beginning (gray area) and 6 months after sacral neuromodulation (SNM) therapy.
FIGURE 5
FIGURE 5
Inclusion criteria and clinical global impression – improvement score (CGI‐I) at 12 months.
See this image and copyright information in PMC

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