Randomized trial of long-term effects of percutaneous tibial nerve stimulation on chronic pelvic pain

Objective To evaluate the long-term effects of percutaneous tibial nerve stimulation (PTNS) on quality of life in women with chronic pelvic pain.

Thirty-three women with chronic pelvic pain were randomized into PTNS (n = 16) or control (n = 17) groups. In PTNS group, weekly PTNS in 30-min sessions for 12 weeks was performed whereas the control group received no stimulation. Present pain intensity-visual analog scale (PPI-VAS), short-form McGill pain questionnaire (SF-MPQ), and SF-36 were used at baseline, 12-week, and 6-month follow-up for the evaluation of pain intensity and quality of life.

Two women (12.5 %) were cured, 7 (43.8 %) were much improved, 6 (37.5 %) were the same and 1 (6.3 %) was worse after PTNS. Two women (11.8 %) were improved, 10 (58.8 %) were the same, and 5 (29.4 %) were worse in the control group. Mean PPI-VAS of PTNS group at baseline, 12 weeks, and 6 months was 8.4 ± 1.1, 3.8 ± 3.5 and 4.5 ± 3.7, respectively. There was a significant improvement in PPI-VAS scores of PTNS group whereas no change was observed in the control group. There was a slight increase in the PPI-VAS scores of the PTNS group at 6-month, but the difference was not statistically significant. There was significant improvement in all domains of SF-MPQ and SF-36 in PTNS group with continuing effects at 6 months whereas no significant change was observed in the control group.

PTNS is a minimally invasive treatment method that leads to decrease in pain severity and improvement in quality of life in women with chronic pelvic pain with effects continuing at 6 months. Similar content being viewed by others

ACOG Committee on Practice Bulletins–Gynecology (2004) ACOG Practice Bulletin No: 51. Chronic pelvic pain. Obstet Gynecol 103(3):589–605 Howard FM (2003) The role of laparoscopy in the chronic pelvic pain patient. Clin Obstet Gynecol 46(4):749–766 Walker EA, Katon WJ, Jemelka R (1991) The prevalence of chronic pelvic pain and irritable bowel syndrome in two university clinics. J Psychosom Obstet Gynecol 12:65–75 Jamieson DJ, Steege JF (1996) The prevalence of dysmenorrhea, dyspareunia, pelvic pain and irritable bowel syndrome in primary care practices. Obstet Gynecol 87(1):55–58 Hulka JF, Peterson HB, Phillips JM (1993) Operative laparoscopy. American Association of Gynecologic Laparoscopists 1991 membership survey. J Reprod Med 38:569–571 Walter M, Sammer U, Kessler TM (2012) Chronisches Schmerzsyndrom des Beckens. Neurostimulation, Neuromodulation und Akupunktur. Urologe 51:1683–1691 Gambone JC, Mittman BS, Munro MG (2002) Consensus statement for the management of chronic pelvic pain and endometriosis: proceeding of an expert-panel consensus project. Fertil Steril 78:96 Zermann DH, Ishiooka M, Doggweiler R, Schubert J, Schmidt RA (2001) The male chronic pelvic pain syndrome. World J Urol 19:173–179 Evaraert K, Devulder J, De Muynck M (2001) The pain cycle: implications for the diagnosis and treatment of pelvic pain syndromes. Int Urogynecol J Pelvic Floor Dysfunct 12(1):9–14 Klingler HC, Pycha A, Schmidbauer J, Marberger M (2000) Use of peripheral neuromodulation of the S3 region for treatment of detrusor overactivity: a urodynamic-based study. Urology 56(5):766–771 Govier FE, Litwiller S, Nitti V, Kreder KJ Jr, Rosenblatt P (2001) Percutaneous afferent neuromodulation for the refractory overactive bladder: results of a multicenter study. J Urol 165(3):1193–1198 Van Balken MR, Vandoninck V, Gisolf KWH et al (2001) Posterior tibial nerve stimulation as neuromodulative treatment of lower urinary tract dysfunction. J Urol 166:914–918 Onal M, Ugurlucan FG, Yalcin O (2012) The effects of posterior tibial nerve stimulation on refractory overactive bladder syndrome and bladder circulation. Arch Gynecol Obstet 286(6):1453–1457 Gungor Ugurlucan F, Karamustafaoglu B, Yalcin O (2012) Posterior tibial nerve stimulation for the treatment of voiding dysfunction 8 years after radical hysterectomy. Arch Gynecol Obstet 286(2):545–547 McGuire EJ, Zhang SC, Horwinski ER, Lytton B (1983) Treatment of motor and sensory detrusor instability by electric stimulation. J Urol 129:78–79 Van Balken MR, Vandoninck V, Messelink BJ, Vergunst H, Heesakkers JPFA, Debruyne FMJ, Bemelmans BLH (2003) Percutaneous tibial nerve stimulation as neuromodulative treatment of chronic pelvic pain. Eur Urol 43:158–163 Gokyildiz S, Kizilkaya Beji N, Yalcin O, Istek A (2012) Effects of percutaneous tibial nerve stimulation therapy on chronic pelvic pain. Gynecol Obstet Invest 73(2):99–105 Cooperberg MR, Stoller ML (2005) Percutaneous neuromodulation. Urol Clin N Am 32:71–78 Stoller M (1999) Afferent nerve stimulation for pelvic floor dysfunction. Eur Urol 35:16 Pinar R (1995) Quality of life of patients with diabetes mellitus and examination of the factors affecting the quality of life (in Turkish). In: Thesis, Istanbul University Health Sciences Institute thesis of doctorate, Istanbul Melzack R (1987) The Short-form McGill pain questionnaire. Pain 30(2):191–197 Mayer RD, Howard FM (2008) Sacral nerve stimulation: neuromodulation for voiding dysfunction and pain. Neurotherapeutics 5(1):107–113 Sikiru L, Shmaila H, Muhammed SA (2008) Transcutaneous electrical nerve stimulation (TENS) in the symptomatic management of chronic prostatitis/chronic pelvic pain syndrome: a placebo-control randomized trial. Int Braz J Urol 34(6):708–713 Dionisi B, Anglana F, Inghirami P, Lippa P, Senatori R (2008) Use of transcutaneous electrical stimulation and biofeedback for the treatment of vulvodynia (vulvar vestibular syndrome): result of 3 years of experience. Minerva Ginecol 60(6):485–491 Biemans JMAE, van Balken MR (2013) Efficacy and effectiveness of percutaneous tibial nerve stimulation in the treatment of pelvic organ disorders: a systematic review. Neuromodulation 16:25–34 Vandoninck V, Van Balken MR, Agro EF (2002) Posterior tibial nerve stimulation in the treatment of urge incontinence. Neurourol Urodyn 22:17 Amarenco G, Ismael SS, Even-Schneider A, Raibaut P, Demaille-Wlodyka S, Parratte B, Kerdraon J (2003) Urodynamic effect of acute transcutaneous posterior tibial nerve stimulation in overactive bladder. J Urol 169(6):2210–2215 Bemelmans BLH, Mundy AR, Craggs MD (1999) Neuromodulation by implant for treating lower urinary tract symptoms and dysfunction. Eur Urol 36(2):81–91 Melzack R, Wall PD (1965) Pain mechanisms: a new theory. Science 150(699):971–979 Oosterwijk RFA, Meyler WJ, Henley EJ, Scheer SS, Tannenbaum J (1994) Pain control with TENS and team nerve stimulators: a review. Crit Rev Phys Rehabil Med 6(3):219–258 Chang CJ, Huang ST, Hsu K, Lin A, Stoller ML, Lue TF (1998) Electroacupuncture decreases c-fos expression in the spinal cord induced by noxious stimulation of the rat bladder. J Urol 160(6 Pt 1):2274–2279 Hrobjartsson A, Gotzsche PC (2001) Is the placebo powerless? An analysis of clinical trials comparing placebo with no treatment. N Engl J Med 344:1594–1602 Acknowledgments This work was supported by Scientific Research Projects Coordination Unit of Istanbul University. Authors convey sincere gratitude for the support. Conflict of interest The authors declare no conflict of interest. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Istek, A., Gungor Ugurlucan, F., Yasa, C. et al. Randomized trial of long-term effects of percutaneous tibial nerve stimulation on chronic pelvic pain. Arch Gynecol Obstet 290, 291–298 (2014). https://doi.org/10.1007/s00404-014-3190-z Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00404-014-3190-z