Pelvic Congestion Syndrome Pain Relieved With SCS
Alexander E. Yakovlev, MD, Angela M. Parmentier, APNP • Comprehensive Pain Management of the Fox Valley, SC 820 East Grant Street, Suite 335 • Appleton, Wisconsin, USA
Background:
Pelvic congestion syndrome has become increasingly recognized as a cause of chronic pelvic pain. The cause is the presence of varicose veins in the pelvic and lower abdominal quadrants, which can occur as a result of pregnancy or for unknown reason.1
Introduction:
In this case report a 26-year-old primipara experiencing constant, aching, throbbing lower quadrant abdominal pain, following the uneventful vaginal birth of a viable female infant. After greater than one year of intractable pain, further diagnostic evaluation including pelvic venography, exploratory aparoscopy, and pelvic ultrasound the diagnosis of pelvic congestion syndrome was made and treatment options were explored. Patient trialed various medications including NSAIDS, Medroxyprogestone acetate, Lyrica, Gabapentin, Carbamazepine, Cymbalta, Amitriptyline over a period of 18 months, before starting chronic low dose opioid therapy. Since surgical removal of the numerous affected veins or a hysterectomy was not options for this patient desiring future pregnancies, SCS was trialed.
Methods:
Patient underwent successful trial with two 8 electrode leads positioned in the posterior epidural space at the level of T6, T7, and T8.
Results:
During SCS trial the patient reported 75-85% pain relief in her pelvis and abdomen, and was implanted 2 weeks later with permanent leads and (Medtronic Inc., Minneapolis, MN) rechargeable generator.
Usage: Patient uses stimulation nearly 24 hours a day
Pain Relief: Reports stimulation present throughout lower abdomen and pelvis. Able to program out areas of unwanted stimulation coverage
Opioid Use: Patient completed eliminated opioid use
Non-Pain Metrics: reports improvement of functional capacity, improved depressive symptoms, reports better sleep, and working with her obstetrician in attempts to conceive her second child
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Conclusion:
Based on the outcome observed, and its reversible nature, SCS represents an attractive treatment option for select patients with pelvic congestion syndrome.
Reference:
Reginald P. Pelvic congestion. Vision: The International Pelvic Pain Society. 2001; 4:2.
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