scholarly journals Percutaneous Tibial Nerve Stimulation (PTNS ) in Iatrogenic Chronic Vulvar Pain

2017 ◽  
pp. 43-50
Author(s):  
Pedro Carvaljo Moreira
Keyword(s):  
Key Words ◽  
Pelvic Pain ◽  
Nerve Stimulation ◽  
Tibial Nerve ◽  
Treatment Options ◽  
Treatment Protocol ◽  
Percutaneous Tibial Nerve Stimulation ◽  
Vulvar Pain ◽  
Tibial Nerve Stimulation ◽  
Patient Reported

Chronic vulvar pain (CVP), although being fairly prevalent, in most cases is not attributable to a specified disorder, i.e., presents as vulvodynia. There are, however, many disorders known to cause CVP, such as radiotherapy and surgery. There have been, so far, no reports in the literature of effective treatment options for Iatrogenic CVP. Percutaneous tibial nerve stimulation (PTNS) is a neurostimulation technique used in the treatment of urinary urgency, frequency, urge incontinence, and urinary retention. There has been increasing evidence of its benefits in improving other conditions, such as chronic pelvic pain or sexual dysfunction. We report a case of a 62 year-old woman with iatrogenic chronic vulvar pain (CVP) submitted to PTNS. The patient reported a consistent and dramatic decrease in both frequency and intensity of pain, assessed by the Brief Pain Inventory (BPI). A decrease in the pain interference with mood, normal work, and walking/mobility was also noted, as evaluated by BPI and EQ-5D questionnaires. Even though a relapse of symptoms was seen after the end of the treatment protocol, it was possible to achieve more permanent benefits after a maintenance scheme of PTNS, with the patient becoming almost asymptomatic. Neuromodulation treatments have been reported as effective in cases of vulvodynia, however reports using PTNS are rare. The tibial nerve is easily accessible and provides an optimal site for neurostimulation without the need of an operating room or anesthesia. The overall improvement registered in this case of CVP elicits a new area of research for PTNS. {Need key words.} Key words: Chronic pain, pelvic pain, vulvar diseases, neuromodulation, percutaneous electric nerve stimulation, tibial nerve

scholarly journals A novel combined anorectal biofeedback and percutaneous tibial nerve stimulation protocol for treating fecal incontinence

2020 ◽  
Vol 13 ◽  
pp. 175628482091638
Author(s):  
Yoav Mazor ◽  
Gillian M. Prott ◽  
Carol Sequeira ◽  
Michael Jones ◽  
Anastasia Ejova ◽  
...  
Keyword(s):  
Fecal Incontinence ◽  
Nerve Stimulation ◽  
Tibial Nerve ◽  
Treatment Options ◽  
Treatment Protocol ◽  
Patient Comfort ◽  
Future Research ◽  
Percutaneous Tibial Nerve Stimulation ◽  
Biofeedback Therapy ◽  
Tibial Nerve Stimulation

Background/Aims: Fecal incontinence (FI) is a common, debilitating condition that causes major impact on quality of life for those affected. Non-surgical treatment options include anorectal biofeedback therapy (BF) and percutaneous tibial nerve stimulation (PTNS), usually performed separately. The aims of the current study were to determine the feasibility, tolerability, safety, and efficacy of performing a combined BF and PTNS treatment protocol. Methods: Female patients with urge FI were offered a novel pilot program combining BF with PTNS. The treatment protocol consisted of 13 weekly sessions: an educational session, followed by 5 combined BF and PTNS sessions, 6 PTNS and a final combined session. Anorectal physiology and clinical outcomes were assessed throughout the program. For efficacy, patients were compared with BF only historical FI patients matched for age, parity, and severity of symptoms. Results: A total of 12/13 (93%) patients completed the full program. Overall attendance rate was 93% (157/169 sessions). Patient comfort score with treatment was rated high at 9.8/10 (SD 0.7) for PTNS and 8.6/10 (SD 1.7) for the BF component. No major side effects were reported. A reduction of at least 50% in FI episodes/week was achieved by 58% of patients by visit 6, and 92% by visit 13. No physiology changes were evident immediately following PTNS compared with before, but pressure during sustained anal squeeze improved by the end of the treatment course. Comparing outcomes with historical matched controls, reductions in weekly FI episodes were more pronounced in the BF only group at visit 6, but not week 13. Conclusions: In this pilot study, concurrent PTNS and anorectal biofeedback therapy has been shown to be feasible, comfortable, and low risk. The combined protocol is likely to be an effective treatment for FI, but future research could focus on optimizing patient selection.

scholarly journals Percutaneous Tibial Nerve Stimulation in Chronic Post-Surgical Anorectal Pain: A Case Report

2021 ◽  
pp. 1-6
Author(s):  
Marta Pacheco ◽  
João Xavier ◽  
Olga Santos ◽  
Carina Raposo ◽  
Ana Margarida Regalado
Keyword(s):  
Nerve Stimulation ◽  
Negative Impact ◽  
Tibial Nerve ◽  
Pain Syndrome ◽  
Brief Pain Inventory ◽  
Lower Urinary Tract Dysfunction ◽  
Percutaneous Tibial Nerve Stimulation ◽  
Tibial Nerve Stimulation ◽  
Anorectal Pain ◽  
Patient Reported

<b><i>Introduction:</i></b> Anorectal pain is a symptom with a negative impact on quality of life and it can sometimes develop into a chronic pain syndrome. Structural anorectal pain is treated according to the underlying pathology. In situations of chronic post-surgical pain that is refractory to conventional therapeutic approaches, percutaneous tibial nerve stimulation (PTNS) is an option. PTNS is a neurostimulation technique used in the treatment of lower urinary tract dysfunction. There has been increasing evidence of its benefits for improving other conditions, such as chronic pelvic pain (CPP) and faecal incontinence (FI). <b><i>Case Presentation:</i></b> We report a case of a 45-year-old woman with chronic post-surgical anorectal pain (CPAP) treated with PTNS. The patient reported a consistent and dramatic decrease in both the frequency and intensity of pain, assessed by the Brief Pain Inventory (BPI). A decrease in the pain interference with mood, normal work, and walking/mobility was also noted, as evaluated by BPI and EQ-5D-3L questionnaires. <b><i>Discussion:</i></b> Neuromodulation treatments have been reported as effective for anorectal pain, but reports on the use of PTNS are rare. The tibial nerve is easily accessible and provides an optimal site for neurostimulation without the need of an operating room or anaesthesia. The overall improvement observed in this case of chronic anorectal pain suggests a potential new area of research for PTNS.

Percutaneous Tibial Nerve Stimulation as Neuromodulative Treatment of Chronic Pelvic Pain

2003 ◽  
Vol 43 (2) ◽  
pp. 158-163 ◽  
Author(s):  
Michael R van Balken ◽  
Vera Vandoninck ◽  
Bert J Messelink ◽  
Henk Vergunst ◽  
John P.F.A Heesakkers ◽  
...  
Keyword(s):  
Pelvic Pain ◽  
Nerve Stimulation ◽  
Chronic Pelvic Pain ◽  
Tibial Nerve ◽  
Percutaneous Tibial Nerve Stimulation ◽  
Tibial Nerve Stimulation

scholarly journals Management of overactive bladder review: the role of percutaneous tibial nerve stimulation

2017 ◽  
Vol 25 (4) ◽  
pp. 245-54
Author(s):  
Elita Wibisono ◽  
Harrina E. Rahardjo
Keyword(s):  
Overactive Bladder ◽  
Nerve Stimulation ◽  
Tibial Nerve ◽  
Botulinum Toxin Injection ◽  
Treatment Options ◽  
Bladder Function ◽  
World Population ◽  
Percutaneous Tibial Nerve Stimulation ◽  
Tibial Nerve Stimulation

Overactive bladder (OAB) is a common condition that is experienced by around 455 million people (11% of the world population) and associated with significant impact in patients’ quality of life. The first line treatments of OAB are conservative treatment and anti-muscarinic medication. For the refractory OAB patients, the treatment options available are surgical therapy, electrical stimulation, and botulinum toxin injection. Among them, percutaneous tibial nerve stimulation (PTNS) is a minimally invasive option that aims to stimulate sacral nerve plexus, a group of nerve that is responsible for regulation of bladder function. After its approval by food and drug administration (FDA) in 2007, PTNS revealed considerable promise in OAB management. In this review, several non-comparative and comparative studies comparing PTNS with sham procedure, anti-muscarinic therapy, and multimodal therapy combining PTNS and anti-muscarinic had supportive data to this consideration.

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