Spinal Cord Stimulation for Intractable Visceral Pain Originating from the Pelvic and Abdominal Region: A Narrative Review on a Possible New Indication for Patients with Therapy-Resistant Pain

Abstract

Aim

Visceral pain, characterized by pain that is diffuse and challenging to localize, occurs frequently and is difficult to treat. In cases where the pain becomes intractable despite optimal medical management, it can affect patients’ Quality of Life (QoL). Spinal Cord Stimulation (SCS) has emerged as a potential solution for intractable visceral pain.

Purpose

In this narrative review, we collected all evidence regarding the efficacy of SCS for visceral pain across various underlying conditions.

Methods

A comprehensive literature search was conducted in PubMed, Embase, and Web of Science in which articles published from October 1st, 1963 up to March 7th, 2023 were identified.

Results

Seventy articles were included in this review of which most were retrospective cohort studies, case series and case reports. The studies, often with a small number of participants, reported on SCS for chronic pancreatitis, anorectal pain and bowel disorders, gynaecological diagnoses, visceral pelvic pain, urological disorders and finally general visceral pain. They found positive effects on pain and/or symptom relief, opioid consumption, anxiety and depression and QoL. Complications occurred frequently but were often minor and reversible.

Conclusion

Better screening and selection criteria need to be established to optimally evaluate eligible patients who might benefit from SCS. A positive outcome of a sympathetic nerve block appears to be a potential indicator of SCS effectiveness. Additionally, women receiving SCS for endometriosis had a better outcome compared to other indications. Finally, SCS could also relief functional symptoms such as voiding problems and gastroparesis. Complications could often be resolved with revision surgery. Since SCS is expensive and not always covered by standard health insurance, the incorporation of cost-analyses is recommended. In order to establish a comprehensive treatment plan, including selection criteria for SCS, rigorous prospective, possibly randomized and controlled studies that are diagnosis-oriented, with substantial follow-up and adequate sample sizes, are needed.

Keywords:

• neuromodulation
• SCS
• spinal cord stimulation
• visceral pain
• chronic pelvic pain
• chronic pain

Disclosure

Matthanja Bieze and Annelotte Pauline van Haaps are co-first authors for this study. AH reports to have received a travel fee from Merck KgaA to visit the ESHRE 2022 congress in Milan. This is not related to this manuscript. LK reports to have received consulting fees from Avanos, FUS Mobile, Neuralace, Nevro, Xalud, Nalu Medical, Medtronic, Biotronik, SAOL Therapeutics, Gimer, Man and Science and Sollis. In addition, he reports to have received honoraria for lectures from Nevro, Avanos and Saluda. These are not related to this manuscript. LK also reports to participate in the Advisory Board of Avanos, Neuros, Neuralace, Biotronik, Presidio and PainTeq and finally reports to have stock options in Nalu Medical and Gamma Core. SL reports to have received consulting fees from Abbott, Avanos, Biotronik, Nalu Medical, Nevro, NeuraLace, Ethos Lab, PainTeq, Saluda, SPR Therapeutics and Vertos. In addition, he reports to have received honoraria from Averitas Pharma and Scilex Pharm. These are not related to this manuscript. SL also reports to previously have been president of the New Jersey Society of Interventional Pain Physicians, and is current treasurer of the American Society of Pain and Neuroscience. Finally, SL reports to have stock options in Nalu Medical and NeuroOne. KF reports to be part of the Education Committee Spine Intervention Society, of the Education Committee Neuromodulation Society, is a member of the Wisconsin Medical Board and is Vice President of Wisconsin American Society of Interventional Pain Management. MS reports to be a research consultant for Modoscript, Collegium and to have been an AdComm for Syneos Health. These are not related to this manuscript. VM reports to have received research grants from Guerbet, Merck KgaA and Ferring, which were made to the Amsterdam UMC. In addition, VM has received a lecture honorarium and payment from Guerbet for meeting attendance of the ESHRE 2022 congress in Milan. These are not related to this manuscript. JWK reports to have received consulting fees from Boston Scientific, Saluda, Nevro, Abbott and Medtronic. These are not related to this manuscript. He also reports to be a member of the Advisory Board of Boston Scientific, Saluda, Nevro, Abbott and Medtronic, and to be a board member of the BNS. The authors report no other conflicts of interest in this work.