Neuromodulation for Chronic Pelvic Pain: A Single-Institution Experience With a Collaborative Team.
Adult
Aged
Aged, 80 and over
Chronic Pain
/ diagnosis
Cohort Studies
Female
Follow-Up Studies
Humans
Male
Middle Aged
Neuralgia
/ diagnosis
Pain Measurement
/ methods
Patient Care Team
Pelvic Pain
/ diagnosis
Surveys and Questionnaires
Transcutaneous Electric Nerve Stimulation
/ methods
Treatment Outcome
Young Adult
Chronic pain
Dorsal root ganglion stimulation
Intrathecal pain pump
Neuromodulation
Pelvic pain
Journal
Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914
Informations de publication
Date de publication:
15 03 2021
15 03 2021
Historique:
received:
10
04
2020
accepted:
10
10
2020
pubmed:
30
12
2020
medline:
12
5
2021
entrez:
29
12
2020
Statut:
ppublish
Résumé
Secondary to the complex care, involved specialty providers, and various etiologies, chronic pelvic pain patients do not receive holistic care. To compare our general and neuromodulation cohorts based on referrals, diagnosis, and therapy and describe our neuromodulation patients. A multidisciplinary team was established at our center. The intake coordinator assessed demographics and facilitated care of enrolled patients. Outcomes were compared using minimal clinical important difference of current Numerical Rating Scale (NRS) between patients with neuropathic pain who received neuromodulation and those who did not. The neuromodulation cohort completed outcome metrics at baseline and recent follow-up, including NRS score (best, worst, and current), Oswestry Disability Index (ODI), Beck Depression Inventory, and Pain Catastrophizing Scale. Over 7 yr, 233 patients were referred to our consortium and 153 were enrolled. A total of 55 patients had neuropathic pain and 44 of those were managed medically. Eleven underwent neuromodulation. A total of 45.5% patients of the neuromodulation cohort were classified as responders by minimal clinically important difference compared to 26.6% responders in the control cohort at most recent follow-up (median 25 and 33 mo, respectively). Outcome measures revealed improvement in NRS at worst (P = .007) and best (P = .025), ODI (P = .014), and Pain Catastrophizing Scale Rumination (P = .043). Eleven percent of patients were offered neuromodulation. There were more responders in the neuromodulation cohort than the conservatively managed neuropathic pain cohort. Neuromodulation patients showed significant improvement at 29 mo in NRS best and worst pain, disability, and rumination. We share our algorithm for patient management.
Sections du résumé
BACKGROUND
Secondary to the complex care, involved specialty providers, and various etiologies, chronic pelvic pain patients do not receive holistic care.
OBJECTIVE
To compare our general and neuromodulation cohorts based on referrals, diagnosis, and therapy and describe our neuromodulation patients.
METHODS
A multidisciplinary team was established at our center. The intake coordinator assessed demographics and facilitated care of enrolled patients. Outcomes were compared using minimal clinical important difference of current Numerical Rating Scale (NRS) between patients with neuropathic pain who received neuromodulation and those who did not. The neuromodulation cohort completed outcome metrics at baseline and recent follow-up, including NRS score (best, worst, and current), Oswestry Disability Index (ODI), Beck Depression Inventory, and Pain Catastrophizing Scale.
RESULTS
Over 7 yr, 233 patients were referred to our consortium and 153 were enrolled. A total of 55 patients had neuropathic pain and 44 of those were managed medically. Eleven underwent neuromodulation. A total of 45.5% patients of the neuromodulation cohort were classified as responders by minimal clinically important difference compared to 26.6% responders in the control cohort at most recent follow-up (median 25 and 33 mo, respectively). Outcome measures revealed improvement in NRS at worst (P = .007) and best (P = .025), ODI (P = .014), and Pain Catastrophizing Scale Rumination (P = .043).
CONCLUSION
Eleven percent of patients were offered neuromodulation. There were more responders in the neuromodulation cohort than the conservatively managed neuropathic pain cohort. Neuromodulation patients showed significant improvement at 29 mo in NRS best and worst pain, disability, and rumination. We share our algorithm for patient management.
Identifiants
pubmed: 33372201
pii: 6054605
doi: 10.1093/neuros/nyaa537
pmc: PMC7956019
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
819-827Informations de copyright
© Congress of Neurological Surgeons 2020.
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