Sacral Neuromodulation for the Treatment of Chronic Functional Anorectal Pain: A Single Center Experience

• Published in: Pain practice 2010-01, Vol.10 (1), p.49-53
• Main Authors: Govaert, Bas, Melenhorst, Jarno, Van Kleef, Maarten, Van Gemert, Wim G., Baeten, Cor G.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anus Diseases - physiopathology; Anus Diseases - therapy; Electric Stimulation Therapy - instrumentation; Electric Stimulation Therapy - methods; Electrodes, Implanted - standards; Electrodes, Implanted - statistics & numerical data; Female; functional anorectal pain; Humans; Lumbosacral Plexus - anatomy & histology; Lumbosacral Plexus - physiology; Lumbosacral Plexus - surgery; Male; Middle Aged; Outcome Assessment (Health Care) - methods; Pain Measurement - methods; Pelvic Pain - physiopathology; Pelvic Pain - therapy; Rectal Diseases - physiopathology; Rectal Diseases - therapy; Retrospective Studies; sacral nerve stimulation; sacral neuromodulation; Self Stimulation - physiology; Spinal Nerve Roots - anatomy & histology; Spinal Nerve Roots - physiology; Spinal Nerve Roots - surgery; therapy outcome; Treatment Outcome
• ISSN: 1530-7085; 1533-2500
• DOI: 10.1111/j.1533-2500.2009.00318.x

Introduction:  Treatment of functional anorectal pain disorders remains a challenge. The purpose of this study is to describe a single center experience with sacral neuromodulation for the treatment of chronic functional anorectal pain. Methods:  This is a retrospective study based on prospectively collected data of patients treated with sacral neuromodulation for functional anorectal pain from April 2005 to August 2008. Symptoms were analyzed using a visual analog scale pain score (0 to 10). A 7‐point Likert scale was used to rate global perceived effect. All patients had a percutaneous nerve evaluation and subsequent test stimulation to assess sacral neuromodulation outcome prior to permanent implantation. Patients were eligible for permanent sacral neuromodulation in case of a pain score 50% decrease in the pain score compared to baseline. Results:  Nine patients (2 males) were included in this study. Mean age was 53.8 years (27.6 to 74.0). Four patients (1 male) had successful test stimulation and were eligible for permanent implantation. Median pain score decreased from 8.0 (6.0 to 9.0) to 1.0 (0 to 2.0). All patients experienced a lasting improvement during the follow‐up till 24 months. Global perceived effect in successful patient was 1 (completely recovered) in one patient and 2 (much improved) in three patients. Conclusion:  This study showed that sacral neuromodulation can be a successful treatment for functional anorectal pain not responding to other treatments. Improvement obtained during test stimulation is a good predictor (diagnostic) for sustained success of permanent sacral neuromodulation.