EC Gynaecology

Chronic pelvic pain (CPP) in women is multifactorial and often refractory to conventional therapies. Neuromodulation-targeting sacral roots, the pudendal nerve, and, more recently, the dorsal root ganglion (DRG)-has emerged as a useful option for carefully selected patients. Evidence supports sacral neuromodulation (SNM) for refractory pelvic pain syndromes (including bladder pain syndrome), growing-though still heterogeneous-support for pudendal peripheral nerve stimulation (PNS), and promising but low- to-moderate quality data for DRG stimulation in neuropathic pelvic pain. This review synthesizes current mechanisms, patient selection, procedural approaches, outcomes, safety, and a practical algorithm for clinical use.

 Keywords:Chronic Pelvic Pain (CPP); Neuromodulation (NM); Dorsal Root Ganglion (DRG); Sacral Nerve Stimulation (SNS); Sacral Neuromodulation (SNM); Peripheral Nerve Stimulation (PNS)

1. SNM and long-term CPP outcomes: Sacral neuromodulation shows significant pain reduction and quality of life improvements in women with chronic pelvic pain, with effects maintained over long follow-up.
2. PTNS evidence: PTNS reduces pain intensity and improves quality of life and sexual pain in women with CPP.
3. TENS systematic review: TENS provides mild pain relief in CPP, with effectiveness varying by stimulation parameters.
4. Neuromodulation systematic review: Peripheral nerve stimulation appears promising; SNM and PTNS exhibit evidence of pain improvement, with PNS less studied.
5. PNS applications: Pudendal stimulation may outperform SNM in some refractory pain settings, with targeted relief.