Korean J Pain.  2010 Mar;23(1):60-64.

Sacral Nerve Stimulation for Treatment of Chronic Intractable Anorectal Pain: A Case Report

• Yang KS
• Kim YH
• Park HJ
• Lee MH
• Kim DH
• Moon DE

Abstract

Despite recent methodological advancement of the practical pain medicine, many cases of the chronic anorectal pain have been intractable. A 54-year-old female patient who had a month history of a constant severe anorectal pain was referred to our clinic for further management. No organic or functional pathology was found. In spite of several modalities of management, such as medications and nerve blocks had been applied, the efficacy of such treatments was not long-lasting. Eventually, she underwent temporary then subsequent permanent sacral nerve stimulation. Her sequential numerical rating scale for pain and pain disability index were markedly improved. We report a successful management of the chronic intractable anorectal pain via permanent sacral nerve stimulation. But further controlled studies may be needed.

Keyword

anorectal pain; sacral nerve stimulation

MeSH Terms

Female
Humans
Middle Aged
Nerve Block

Figure

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  Fig. 1 Fluoroscopic images of anteroposterior (A) and lateral (B) projections. (A) The right-sided quadripolar electrode is placed via 15-gauge Tuohy needle at L3-4 intervetebral space, and left-sided electrode is threading via another needle at L4-5 intervertebral space. (B) Fluoroscopic lateral view; each quadripolar electrode is placed at bilateral S2-3 foramen.

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  Fig. 2 A post operative abdominal anteroposterior X-ray image. A permanently implanted pulse generator is shown at left lower abdominal quadrant.

Reference

1. Whitehead WE, Wald A, Diamant NE, Enck P, Pemberton JH, Rao SS. Functional disorders of the anus and rectum. Gut. 1999; 45(Suppl 2):II55–II59. PMID: 10457046.

2. Plancarte R, Amescua C, Patt RB, Aldrete JA. Superior hypogastric plexus block for pelvic cancer pain. Anesthesiology. 1990; 73:236–239. PMID: 2382849.

3. Bosscher H. Blockade of the superior hypogastric plexus block for visceral pelvic pain. Pain Pract. 2001; 1:162–170. PMID: 17129292.

4. Alo KM, Yland MJ, Redko V, Feler C, Naumann C. Lumbar and sacral nerve root stimulation (NRS) in the treatment of chronic pain: a novel anatomic approach and neurostimulation technique. Neuromodulation. 1999; 2:23–31.

5. Tanagho EA, Schmidt RA. Electrical stimulation in the clinical management of the neurogenic bladder. J Urol. 1988; 140:1331–1339. PMID: 3057221.

6. Siegel S, Paszkiewicz E, Kirkpatrick C, Hinkel B, Oleson K. Sacral nerve stimulation in patients with chronic intractable pelvic pain. J Urol. 2001; 166:1742–1745. PMID: 11586214.

7. Falletto E, Masin A, Lolli P, Villani R, Ganio E, Ripetti V, et al. Is sacral nerve stimulation an effective treatment for chronic idiopathic anal pain? Dis Colon Rectum. 2009; 52:456–462. PMID: 19333046.

8. Govaert B, Melenhorst J, van Kleef M, van Gemert WG, Baeten CG. Sacral neuromodulation for the treatment of chronic functional anorectal pain: a single center experience. Pain Pract. 2009; [in press].

9. Aló KM, Holsheimer J. New trends in neuromodulation for the management of neuropathic pain. Neurosurgery. 2002; 50:690–703. PMID: 11904018.

10. Ger GC, Wexner SD, Jorge JM, Lee E, Amaranath LA, Heymen S, et al. Evaluation and treatment of chronic intractable rectal pain--a frustrating endeavor. Dis Colon Rectum. 1993; 36:139–145. PMID: 8425417.

11. Reig E, Abejón D, del Pozo C, Insausti J, Contreras R. Thermocoagulation of the ganglion impar or ganglion of walther: description of a modified approach. Preliminary results in chronic, nononcological pain. Pain Pract. 2005; 5:103–110. PMID: 17177756.

12. North RB, Roark GL. Spinal cord stimulation for chronic pain. Neurosurg Clin N Am. 1995; 6:145–155. PMID: 7696870.

13. Feler CA, Whitworth LA, Fernandez J. Sacral neuromodulation for chronic pain conditions. Anesthesiol Clin North America. 2003; 21:785–795. PMID: 14719719.

14. Feler CA, Whitworth LA, Brookoff D, Powell R. Recent advances: sacral nerve root stimulation using a retrograde method of lead insertion for the treatment of pelvic pain due to interstitial cystitis. Neuromodulation. 1999; 3:211–216.

15. Calvillo O, Esses SI, Ponder C, D'Agostino C, Tanhui E. Neuroaugmentation in the management of sacroiliac joint pain. Report of two cases. Spine. 1998; 23:1069–1072. PMID: 9589549.

16. Alo KM. Lead positioning and programming strategies in the treatment of complex pain. Neuromodulation. 1999; 2:165–170.