Hypothesis / aims of study
When a clinical examination and subsequent investigations fail to identify any pathological process such as anal fissure, abscess, fistula or so on, the patients with anal or rectal pain are described as having functional anorectal pain. The Rome IV diagnostic criteria for functional bowel disorders classify functional anorectal pain into chronic proctalgia and proctalgia fugax. The management of patients with functional anorectal pain can be both challenging and frustrating. Recent studies have indicated that Spinal Cord Stimulation can improve pain symptoms in patients with chronic pelvic pain.
Study design, materials and methods
Patients with functional anorectal pain were enrolled in this study after informed consent was given. At baseline, all patients underwent anal manometry and the score obtained from the visual analogue scale (VAS) was recorded. Patients were asked to evaluate the level of pain on a visual analog scale of 0 to 10.
First Stage: Patient is placed Jack-Knife position with local anesthesia. The guide needles are inserted into the epidural space from L3-4 or L4-5. The electrodes are advanced into Th12-L1 or S3 foremen and placed.
The nerves were stimulated using the Spinal Cord Stimulating System (Medtronic. MA, USA). This included pairs of leads with 6 electrodes.
Second stage: The generator is implanted in the pocket under skin and the wound is closed with absorbable sutures.
Interpretation of results
The efficacy is not enough because of more than 60% of patients had less 50% of improvement of the pain. However, this procedure is the last step for the patients with severe un-controled pain.