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Pioneering Treatment Relieves Pelvic Pain

Pioneering Treatment Relieves Pelvic Pain

CREATED Jan 17, 2014

TROY, Mi. (Ivanhoe Newswire) - Millions suffer from urological problems. They try traditional treatments like sacral nerve stimulation to treat their pelvic or urinary pain, fecal or urinary incontinence—but still the problem persists. However, now a Michigan doctor has pioneered a treatment that could be the solution these patients are searching for.

"For months, my daughter and I went from doctor to doctor to doctor," Donna Pelto, told Ivanhoe.

"Right away we knew something was wrong, we just didn't know what," Becky Petrie, Donna's daughter, told Ivanhoe.

However, Donna knew how to describe her debilitating pain.

"You get your charcoal briquettes to the point where they're red and they're hot, and then stick them up in between your legs. That's what it feels like," Donna explained.

Beaumont urologist Kenneth Peters pioneered an outpatient procedure that would relieve her pain.

"We've developed a way to place the electrode at the pudendal, which is a nerve that comes further deeper into the pelvis," Kenneth M. Peters, MD, Chairman of Urology, Director of Beaumont Women's Urology Center, Beaumont Health System, told Ivanhoe.

An electrical pulse generator is connected to the electrode and implanted in the patient's buttock.

"It is a pacemaker for the nerves that control a lot of functions of the pelvis such as the bladder, the bowel, and the pelvic floor," Dr. Peters said.

The device sends a signal to the brain to ignore abnormal signals that cause bowel and urinary issues, or pelvic pain like Donna's. The level of relief is remotely controlled by the patient.

Since receiving the treatment, Donna says she feels a major difference.

"Every patient I see for the first time, I tell them they're going to be better because I believe it 100 percent," Dr. Peters said.

This procedure is not to be seen as a cure, but it is successful nearly 85 percent of the time in providing at least a 50 percent relief in symptoms.

RESEARCH SUMMARY

BACKGROUND: Pelvic pain is easy to identify because it is the lowest part of the pelvis and abdomen. This type of pain may be considered very intense and the pain is known to travel to the thighs, lower back, or buttocks. This pain is common in women and men and can come about from musculoskeletal sources, or from urinary or reproductive systems. (Source:http://www.mayoclinic.com/health/pelvic-pain/MY00124)

CAUSES: Women are more likely to experience pelvic pain more than men, but it is not unheard of for men to experience the same pain. In women, pelvic pain can stem from an issue in the reproductive organs. The pain may also arise from internal organs such as the colon or bladder. Common causes in men and women are:

SYMPTOMS: When symptoms occur, a person may find relief in lying down or resting. Pelvic pain may become extreme if one is standing for a long period of time or during exercise. Typical signs and symptoms are a constant severe pain, pressure in pelvis area, intermittent pain, and cramping or sharp pain. If any symptoms are to last more than six months, then pain can be described as chronic.  (Source: http://www.mayoclinic.com/health/chronic-pelvic-pain/DS00571/DSECTION=symptoms and http://women.webmd.com/causes-symptoms-chronic-pelvic-pain)

NEW TREATMENT: A pacemaker for the pelvic region of the body is now being used to control patient's pain. The pudendal nerve stimulation is a new treatment that stimulates the pudendal nerve to improve the function of internal organs. This method is preferred over the sacral nerve stimulation because there are no side effects to other parts of the body. The procedure is done as an outpatient as doctors place a small electrode in the pudendal nerve near the pelvis. Once the procedure is over, patients are able to control the stimulation of the nerve by a click of a button. (Source: http://www.neuromodulation.com/pudendal-nerve andhttp://womenshealth.beaumont.edu/pudendal-neuromodulation

INTERVIEW

Kenneth M. Peters, MD, Chairman of Urology, Director of Beaumont Women's Urology Center, Beaumont Health System, talks about a new treatment for patients with pelvic pain.

How do you measure the success of this procedure and how long can a patient expect the results to last? 

Dr. Peters:  The nice thing about neuromodulation is that we can do it in two stages.  So, you get to sort of test drive the car before you buy it.  In the first stage of the procedure, we put the patient under light sedation so we can place a little electrode down by the pudendal nerve. Then, we externalize that for two weeks.  So, they go home with a wire coming out of them, connected to a temporary pacemaker that sort of looks like a transistor radio.  It has a 9 volt battery and a volume dial on it.  However, the electronics in it allows us to program it differently so we can stimulate the nerve the way we think will work best for the patient.  Prior to having that test done, we have them fill out pain scores. For the two weeks, we let them see how their symptoms change over time.  We consider at least a 50% improvement in symptoms a success.  If they have a 50% improvement in symptoms, then we'll go ahead and implant the permanent pacemaker. It looks just like a heart pacemaker and this could be implanted in the body.  Now, there are no more wires coming out and then this will allow chronic stimulation for the patient. 

I understand people are coming from all over for this procedure. Can you talk about that?

Dr. Peters: We opened the Women's Urology Center at Beaumont to service a need of patients with chronic pelvic pain.  The reason is that most women who suffer from this have gone from doctor to doctor seeking help. What became clear to us is that we really needed a multidisciplinary approach to not only evaluating, but treating this and that's what the Women's Urology Center at Beaumont is.  So, we have clinicians here who have been specifically trained in chronic pelvic pain like nurse practitioners and pelvic floor physical therapists. We have integrative medicine with acupuncture and guided imagery and massage therapy and then we have psychological services because these patients deal with a lot in their lives because of the chronic pain.  It affects their relationships, their life, and the time they can spend with their family.  So, because of that, we have become known across the country.  We have had patients in this past year from 26 different states and 4 different countries; we've had patients travel to Beaumont for neuromodulation from as far as Australia. 

Wow, that's amazing.  Are you teaching other doctors to perform the procedure and if so, where are they located?

Dr. Peters: We have had three courses to teach other physicians how to do pudendal neuromodulation. Several months ago, we had 70 clinicians from around the country. We are always trying to get the word out about it because we feel that it really can positively impact our patient's symptoms.  

Is the treatment covered by insurance? 

Dr. Peters: Well, insurance is always an issue with any implantable device.  Clearly sacral neuromodulation has been approved since 1997 and most insurance companies will cover it if they meet certain criteria.  None of this is covered for pain and most patients have a component of voiding dysfunction along with their pain. So, often they can get coverage through the bladder side of things as a justification to do this, but I have to say it is a work in progress to enlighten the insurance companies. A lot of times it's a lot of work on our side to have to direct conversations with the insurers to get them to approve this, but overall most of the time we can get it paid for.  If it's for pure pain then sometimes that's a difficult thing to do, but the insurance companies are starting to come around more and more.

Who is a good candidate for this procedure?  

Dr. Peters:  For this procedure, I look at it in several different layers of who would be a good candidate.  Number one, it is for both men and women.  We keep talking about women because we are in the Women's Urology Center, but it affects men too.  So, in my mind, anyone who has urinary frequency, urgency or urge incontinence who does not respond to standard therapies, including sacral neuromodulation, could benefit from pudendal neuromodulation.  Anybody who has significant chronic pelvic pain and what we call pelvic floor dysfunction or spasm of the pelvic floor, who have again failed traditional therapies or standard therapies, we do transvaginal trigger point injections into those muscles; we'll inject Botox into those muscles to break the spasm, and its after that if we just can't get them where they need to be. One great test to say who's a good candidate is a pudendal nerve block.  So, we work with our anesthesia pain specialist and they will do a block of the pudendal nerve like if you've ever had an injection for your back for back pain; it's similar to that, but they direct it to the pudendal nerve. And what we've found is that if a patient gets relief from that block, even if it's the day that they had it because everything is numb, then at least that tells us the symptoms are being driven through the pudendal nerve. If we can see that, then we have a very high success rate with modulating the nerve because prior to modulating the nerve, the only other thing people do for patients with pudendal neuropathy, or pudendal nerve issues, is they've been doing pudendal nerve entrapment surgery, which is  a major surgery.  However, this new procedure is very minimally invasive; it is an one hour outpatient procedure. The pudendal nerve entrapment surgery takes hours in the operating room, hospitalizations, and months of recovery. I think we should always modulate before we operate. 

In terms of the treatment of pelvic pain, this is obviously major, but where do you see the future in treating pelvic pain? What's next?

Dr. Peters: We are always looking for new ways to treat pelvic pain because even though how enthusiastic I am about stimulating the pudendal nerve, it doesn't help everybody either. I think that we're going to make huge strides in improving the care of patients with pelvic pain, just by educating our colleagues because I was never educated about the pelvic floor and its impact on pain. I think that we have a mission within ourselves and in our medical schools to train them how to identify patients and offer the appropriate treatment for the ones that we know can get better with pudendal nerve entrapment or pelvic floor pain, but I think that we're always looking for new ways to modulate the nerves.  We are using things like Botox to inject into the nerves and then there is a lot of device companies out there who have an interest in pain right now and I'm working with some of them on some new technologies.

What are the concerns of doctors who are not using this? And why aren't they?   

Dr. Peters: Most doctors don't do this and it's actually a higher skill set and I don't think most should do it. However, I do think those who do a lot of neuromodulation to help manage various symptoms should have an understanding of how to do this and be trained in it. That is something we are trying to work with industry and get them on board to actually do the studies that need to be done to make it FDA approved in order to make it more accessible for our patients.

FOR MORE INFORMATION, PLEASE CONTACT:

Kenneth M. Peters, MD
Chairman of Urology
Director of Beaumont Women's Urology Center
Beaumont Health System
kmpeters@beaumont.edu