da Silva Freitas Tiago, Barbosa de Oliveira Antonio Jorge, Golovac Stanley, Assumpcao de Monaco Bernardo
Functional Neurosurgery - Syrian Lebanese Hospital, Brasilia, DF, Brazil; Functional Neurosurgery, Base Hospital, Brasilia, DF, Brazil.
The Pain Institute, Lecanto, FL, USA.
Neuromodulation. 2025 Jul;28(5):825-831. doi: 10.1016/j.neurom.2024.11.007. Epub 2024 Dec 24.
Chronic pelvic pain (CPP) is a multifaceted condition that poses significant challenges in clinical management owing to its complex and varied pathophysiology, including neuropathic, somatic, visceral, and musculoskeletal components. Endometriosis is frequently associated with CPP, necessitating a comprehensive, multimodal treatment strategy. This approach typically includes physical and behavioral therapy, pharmacologic interventions, surgical management of endometriosis, and various pain-modulating procedures. Neuromodulation, particularly spinal cord stimulation (SCS), has been used in refractory cases; however, its use is often met with limited success and a notable rate of explants. This case series presents nine patients with intractable CPP secondary to endometriosis, unresponsive to conventional treatments, who were treated with dorsal root ganglion stimulation (DRG-S).
Between 2022 and 2023, ten patients with severe CPP secondary to endometriosis, unresponsive to various multimodal treatments-including previous interventional pain procedures, gynecologic surgery, and in some cases, SCS-were recruited for this prospective study. Of these, nine patients underwent permanent DRG-S, with bilateral L1 and S2 DRG-S leads placed (four leads per patient). Patients were assessed for pain intensity using the visual analog scale (VAS), narcotic consumption, and quality of life (QoL) using the 12-item short-form (SF-12) survey, with a 12-month follow-up period. Nonparametric statistical analyses were conducted using SPSS.
One patient was excluded from the study owing to a lack of pain relief during the DRG-S trial. The remaining nine patients underwent permanent bilateral L1 and S2 DRG-S placement. Significant improvement in pain scores was observed and sustained throughout the follow-up period (VAS 9 ± 1.5-2 ± 2.0; p = 0.003), along with a marked reduction in opioid consumption, with four patients becoming completely free of narcotics (p = 0.046). SF-12 physical scores improved by 60.2 ± 7.8 (p = 0.006), and SF-12 mental scores improved by 45.9 ± 2.76 (p = 0.01).
Bilateral L1 and S2 DRG-S yielded robust and sustained outcomes, including significant improvements in pain scores, reduced narcotic consumption, and enhanced QoL over a 12-month follow-up period.
慢性盆腔疼痛（CPP）是一种多方面的病症，由于其复杂多样的病理生理学，包括神经病理性、躯体性、内脏性和肌肉骨骼性成分，在临床管理中带来了重大挑战。子宫内膜异位症常与CPP相关，因此需要全面的多模式治疗策略。这种方法通常包括物理和行为疗法、药物干预、子宫内膜异位症的手术管理以及各种疼痛调节程序。神经调节，特别是脊髓刺激（SCS），已用于难治性病例；然而，其使用往往成效有限且移除率较高。本病例系列介绍了9例因子宫内膜异位症导致的顽固性CPP患者，这些患者对传统治疗无反应，接受了背根神经节刺激（DRG-S）治疗。
2022年至2023年期间，招募了10例因子宫内膜异位症导致严重CPP且对包括先前介入性疼痛程序、妇科手术以及在某些情况下的SCS在内的各种多模式治疗无反应的患者进行这项前瞻性研究。其中，9例患者接受了永久性DRG-S治疗，双侧L1和S2 DRG-S电极植入（每位患者4根电极）。使用视觉模拟量表（VAS）评估疼痛强度，使用12项简短形式（SF-12）调查问卷评估麻醉药品消耗量和生活质量（QoL），随访期为12个月。使用SPSS进行非参数统计分析。
1例患者因DRG-S试验期间疼痛未缓解而被排除在研究之外。其余9例患者接受了永久性双侧L1和S2 DRG-S植入。在整个随访期内观察到疼痛评分有显著改善且持续改善（VAS从9±1.5降至2±2.0；p = 0.003），同时麻醉药品消耗量显著减少，4例患者完全停用麻醉药品（p = 0.046）。SF-12身体评分提高了60.2±7.8（p = 0.006），SF-12心理评分提高了45.9±2.76（p = 0.01）。
双侧L1和S2 DRG-S产生了强劲且持续的效果，包括在12个月的随访期内疼痛评分显著改善、麻醉药品消耗量减少以及生活质量提高。
