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Diseases of the Colon & Rectum
Published in: Diseases of the Colon & Rectum 8/2007

01-08-2007

Permanent Sacral Nerve Stimulation for Treatment of Functional Anorectal Pain: Report of a Case

Authors: Thomas C. Dudding, M.R.C.S., Carolynne J. Vaizey, M.D., F.R.C.S.(Gen.), F.C.S.(S.A.), Michael E. Jarrett, M.A., M.R.C.S., Richard G. Cohen, M.D., F.R.C.S., Michael A. Kamm, M.D., F.R.C.P., F.R.A.C.P.

Published in: Diseases of the Colon & Rectum | Issue 8/2007

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Purpose

Patients with functional anorectal pain in the absence of an organic cause often have symptoms that are resistant to conventional medical and behavioral therapy. This study assessed the use of sacral nerve stimulation in the treatment of this condition.

Methods

A 56-year-old, female subject with an 18-month history of intermittent severe anorectal pain, in the absence of any evacuatory disorder or gross pathology, underwent temporary then subsequent permanent sacral nerve stimulation. Treatment efficacy was measured by verbal pain scores obtained at baseline, during screening, after screening, and subsequent follow-up.

Results

Temporary sacral nerve stimulation of the left S3 root (3–5 V; 14 Hz; 210 μsec) resulted in total alleviation of the patient’s symptoms. A verbal pain score of 10/10 preoperatively was reduced to 0/10 with no adverse effects from stimulation. On completing the trial evaluation, the symptoms of pain returned with a verbal pain score of 10/10. A permanent pulse generator was implanted with a Medtronic 3093 quadripolar electrode lead, placed in the left S3 foramen. Results of chronic stimulation showed that pain symptoms were again abolished with no recurrence of symptoms seen at one-year follow-up (1.3 V; 14 Hz; 210 μsec).

Conclusions

Sacral nerve stimulation may be of benefit in the treatment of functional anorectal pain resistant to conventional treatments. The mechanism of action is not known. Further prospective evaluation of a series of patients is required using pain scoring, quality of life, and psychologic assessment to aid selection.
Literature
1.
Ger, GC, Wexner, SD, Jorge, JM,  et al. 1993Evaluation and treatment of chronic intractable rectal pain—a frustrating endeavorDis Colon Rectum36139145PubMedCrossRef
2.
Mazza, L, Formento, E, Fonda, G 2004Anorectal and perineal pain: new pathophysiological hypothesisTech Coloproctol87783PubMedCrossRef
3.
Whitehead, WE, Wald, A, Diamant, NE, Enck, P, Pemberton, JH, Rao, SS 1999Functional disorders of the anus and rectumGut45II55II59PubMedCrossRef
4.
Grimaud, JC, Bouvier, M, Naudy, B, Guien, C, Salducci, J 1991Manometric and radiologic investigations and biofeedback treatment of chronic idiopathic anal painDis Colon Rectum34690695PubMedCrossRef
5.
Grant, SR, Salvati, EP, Rubin, RJ 1975Levator syndrome: an analysis of 316 casesDis Colon Rectum18161163PubMedCrossRef
6.
7.
Gilliland, R, Heymen, JS, Altomare, DF, Vickers, D, Wexner, SD 1997Biofeedback for intractable rectal pain: outcome and predictors of successDis Colon Rectum40190196PubMedCrossRef
8.
Heah, SM, Ho, YH, Tan, M, Leong, AF 1997Biofeedback is effective treatment for levator ani syndromeDis Colon Rectum40187189PubMedCrossRef
9.
Palsson, OS, Heymen, S, Whitehead, WE 2004Biofeedback treatment for functional anorectal disorders: a comprehensive efficacy reviewAppl Psychophysiol Biofeedback29153174PubMedCrossRef
10.
Billingham, RP, Isler, JT, Friend, WG, Hostetler, J 1987Treatment of levator syndrome using high-voltage electrogalvanic stimulationDis Colon Rectum30584587PubMedCrossRef
11.
Hull, TL, Milsom, JW, Church, J, Oakley, J, Lavery, I, Fazio, V 1993Electrogalvanic stimulation for levator syndrome: how effective is it in the long-term?Dis Colon Rectum36731733PubMedCrossRef
12.
Oliver, GC, Rubin, RJ, Salvati, EP, Eisenstat, TE 1985Electrogalvanic stimulation in the treatment of levator syndromeDis Colon Rectum28662663PubMedCrossRef
13.
Sohn, N, Weinstein, MA, Robbins, RD 1982The levator syndrome and its treatment with high-voltage electrogalvanic stimulationAm J Surg144580582PubMedCrossRef
14.
Kenefick, NJ, Nicholls, RJ, Cohen, RG, Kamm, MA 2002Permanent sacral nerve stimulation for treatment of idiopathic constipationBr J Surg89882888PubMedCrossRef
15.
Everaert, K, Devulder, J, Muynck, M,  et al. 2001The pain cycle: implications for the diagnosis and treatment of pelvic pain syndromesInt Urogynecol J Pelvic Floor Dysfunct12914PubMedCrossRef
16.
Mannheimer, JF, Lampe, GN 1988Clinical transcutaneous electrical nerve stimulation8th ed.FA Davis CompanyPhiladelphia
17.
Kurvers, HA 1998Reflex sympathetic dystrophy: facts and hypothesesVasc Med3207214PubMed
18.
Kemler, MA, Barendse, GA, Kleef, M,  et al. 2000Spinal cord stimulation in patients with chronic reflex sympathetic dystrophyN Engl J Med343618624PubMedCrossRef
19.
Linderoth, B, Fedorcsak, I, Meyerson, BA 1989Is vasodilatation following dorsal column stimulation mediated by antidromic activation of small diameter afferents?Acta Neurochir Suppl (Wien)4699101
20.
Linderoth, B, Herregodts, P, Meyerson, BA 1994Sympathetic mediation of peripheral vasodilation induced by spinal cord stimulation: animal studies of the role of cholinergic and adrenergic receptor subtypesNeurosurgery35711719PubMedCrossRef
21.
Tanaka, S, Barron, KW, Chandler, MJ, Linderoth, B, Foreman, RD 2003Role of primary afferents in spinal cord stimulation-induced vasodilation: characterization of fiber typesBrain Res959191198PubMedCrossRef
22.
Kemler, MA, Barendse, GA, Kleef, M, Egbrink, MG 2000Pain relief in complex regional pain syndrome due to spinal cord stimulation does not depend on vasodilationAnesthesiology9216531660PubMedCrossRef
23.
Kenefick, NJ, Emmanuel, A, Nicholls, RJ, Kamm, MA 2003Effect of sacral nerve stimulation on autonomic nerve functionBr J Surg9012561260PubMedCrossRef
24.
25.
Hanai, F 2000Effect of electrical stimulation of peripheral nerves on neuropathic painSpine2518861892PubMedCrossRef
26.
Sheldon, R, Kiff, ES, Clarke, A, Harris, ML, Hamdy, S 2004Cortical reorganization induced by sacral nerve stimulation in patients with faecal incontinenceColorectal Dis623
Metadata
Title
Permanent Sacral Nerve Stimulation for Treatment of Functional Anorectal Pain: Report of a Case
Authors
Thomas C. Dudding, M.R.C.S.
Carolynne J. Vaizey, M.D., F.R.C.S.(Gen.), F.C.S.(S.A.)
Michael E. Jarrett, M.A., M.R.C.S.
Richard G. Cohen, M.D., F.R.C.S.
Michael A. Kamm, M.D., F.R.C.P., F.R.A.C.P.
Publication date
01-08-2007
Publisher
Springer-Verlag
Published in
Diseases of the Colon & Rectum / Issue 8/2007
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-007-0215-8

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