Analgesic efficacy of sacral neuromodulation for chronic pelvic cancer pain

Abstract

Background: Neuromodulation has provided promising results in chronic pain management. Sacral neurostimulation (SNS) is a neuromodulatory technique, where the sacral nerve roots are electrically stimulated. Objective: Evaluate the efficacy of the trial phase to control severe cancer pain in pelvic organs. Design: Pilot study. Methods: Chronic pelvic cancer pain patients were managed with morphine ≥ 60 mg daily, duloxetine 30 mg, and celecoxib 200 mg twice daily. Twenty-two adults were divided randomly into two equal groups: the SNS group (N = 11), received a sacral neurostimulator device and opioid analgesics, and the opioid group (N = 11), received increased opioid analgesics to control pain. Results: Visual analog scale scores were decreased in the SNS group at 24 h, 4 days, 1, and 2 weeks in SNS compared to the opioid group, medians (IQR) [4 (3–5) vs 6 (5–7), 3 (3–4) vs 5 (5–6), 3 (3–4) vs 5 (5–6), and 3 (3–3) vs 5 (4–6) P < 0.001], daily morphine consumption was reduced in the SNS group compared to the opioid group, median (IQR) [90 (60–90) mg vs 120 (120–150) mg, P < 0.001] and [30 (30–60) mg vs 150 (120–180) mg] during the first and second weeks. The SNS group had a better life quality compared to the opioid group after 2 weeks, median (IQR) was (123 (122.5–124) vs 117 (117–118.5) P < 0.001), respectively. Conclusion: The SNS trial device showed effectiveness in managing severe chronic pelvic cancer pain.

Keywords

• chronic pain
• pelvic cancer pain
• perineal cancer pain
• sacral neuromodulator
• sacral neuro-stimulator