Mrs. C.

Mrs. C. is a 37 year old female who presented to our clinic in 1999 with a 3 ½ year history of severe pelvic pain following a hysterectomy. She indicated that her pelvic pain began in 1994 but was only sporadic in nature. At that time, her gynecologist diagnosed her as having a symptomatic uterine fibroid. Initially she was treated with birth control pills which proved unsuccessful in reducing the size of her fibroid or managing her pain. As a result, in 1999, she underwent a trans-abdominal hysterectomy sparing the ovaries. When she awoke from surgery, she noted numbness in her perineal region and had difficulty controlling her bladder. Her bladder control improved however she developed burning and shooting pain through her pelvis and perineal region which was exacerbated by urination, bowel movement, and sexual intercourse.

At the time of presentation to Georgia Pain Physicians, Mrs. C. was reported that she was depressed, estranged from her husband, urinated 20-30 times per day, and experienced a continual pain in the pelvic region of a 6-7/10 which increased to 9-10/10 three to four times per day. The pain exacerbations were often brought on by urination and occasionally by bowel movements. She was taking six to eight hydrocodone pain pills per day which had been prescribed by her primary care physician without substantial benefit. She had not been sexually active since 1997 due to the severity of pain.

After history and physical examination was performed a tentative diagnosis of interstitial cystitis was entertained. A pelvic CT scan, urodynamic studies, and urine cultures were obtained. The CT scan demonstrated no abnormalities other than the absence of her uterus however the urodynamic studies demonstrated a very small volume bladder with extreme detrusor (pelvic floor) excitability which was consistent with the diagnosis of interstitial cystitis.

A course of membrane stabilizers was initiated. This direction of care was pursued for four months and included six different membrane stabilizers. She did have a noticeable reduction in pain with Neurontin at a dose of 800 mg three times per day but had intolerable drowsiness and reduction in mental acuity so this medication was stopped. She had no pain relief with Pyridium. As a result, spinal cord stimulation was pursued.

Spinal cord stimulation (SCS) is in the United States is usually used for chronic lumbar radiculopathy or complex regional pain syndrome (CRPS, RSD). Interstitial cystitis, which may be a form of CRPS, often responds quite well the SCS. To perform this technique, an epidural needle is placed in the epidural space and one or two SCS leads are advanced to the S3 and S4 nerve roots. The nerves are stimulated which places paresthesia in the perineal region. This treatment method is performed as a temporary test to evaluate its effectiveness at blocking the transmission of pain signals to the brain and then is implanted as a permanent device if the test proves successful.

In February, 2000, Mrs. C underwent a SCS test of 10 days. She experienced 80% reduction in pain and improved bladder capacity. She was implanted with the device in March, 2000. She has maintained an average pain relief of 60-70%, improved bladder capacity, and has resumed sexual activity with her husband. She is off all medications except for an antidepressant. She is very pleased with the results of the therapy.