The Pain Cycle: Implications for the Diagnosis and Treatment of Pelvic Pain Syndromes

Karel Everaert, Jacques Devulder, Martine De Muynck, S. Stockman, H. Depaepe, Danny De Looze, Jeffrey Buyten, W. Oosterlinck
In: International Urogynecology Journal and Pelvic Floor Dysfunction · 2001 · vol. 12(1) , pp. 9–14 · doi:10.1007/s001920170087 · PMID:11294536 · W2058836166
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-12 ⓘ

Sacral nerve stimulation effectively treated therapy-resistant pelvic pain linked to pelvic floor dysfunction in patients who failed conservative treatments, with outcomes related to voiding dysfunction rather than pain location.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 · read from full text ⓘ

This paper reports treatment outcomes in 111 patients with chronic pelvic pain of mixed sex distribution and mean age in midlife, after excluding patients with identifiable causal treatment; conservative modalities (pelvic floor training, TENS, and intrarectal/intravaginal electrostimulation) were used, and sacral nerve stimulation was applied for therapy-resistant pain. The authors found that outcomes measured by VAS reduction and pain relief were associated with voiding dysfunction and dyschezia symptoms and with urodynamic evidence of dysfunctional voiding, rather than with pain localization or the specific conservative modality, and that outcome was inversely related to neuropathic pain. In a subset given test stimulation at the S3 root, 16 of 26 responded and 11 were implanted with follow-up averaging 36 months, with no late failures observed, but the paper explicitly notes the need for longer test stimulation due to a higher rate of initial false positives. Relevance to endometriosis: the paper is centrally about pelvic pain syndromes and sacral nerve stimulation, but it does not explicitly discuss endometriosis or adenomyosis in the provided text.

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Abstract: The aim of the study was to report our results of sacral nerve stimulation in patients with pelvic pain after failed conservative treatment. From 1992 to August 1998 we treated 111 patients (40 males, 71 females, ages 46 ± 16 years) with chronic pelvic pain. All patients with causal treatment were excluded from this study. Pelvic floor training, transcutaneous electrical nerve stimulation (TENS) and intrarectal or intravaginal electrostimulation were applied and sacral nerve stimulation was used for therapy-resistant pain. The outcome of conservative treatment and sacral nerve stimulation (VAS 50% pain relief) was related to symptoms of voiding dysfunction and dyschezia, and urodynamic proof of dysfunctional voiding, not to the pain localization or treatment modality. Outcome was inversely related to neuropathic pain. When conservative treatment failed, a test stimulation of the S3 root was effective in 16/26 patients, and 11 patients were implanted successfully with a follow-up of 36 ± 8 months. So far no late failures have been seen. A longer test stimulation is needed in patients with pelvic pain because of a higher incidence of initial false positive tests. Our conclusion is that sacral nerve stimulation is effective in the treatment of therapy-resistant pelvic pain syndromes linked to pelvic floor dysfunction. Similar content being viewed by others Author information Authors and Affiliations Additional information Rights and permissions About this article Cite this article Everaert, K., Devulder, J., De Muynck, M. et al. The Pain Cycle: Implications for the Diagnosis and Treatment of Pelvic Pain Syndromes . Int Urogynecol J 12, 9–14 (2001). https://doi.org/10.1007/s001920170087 Issue date: DOI: https://doi.org/10.1007/s001920170087

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