[Interest of infiltration of Impar node in rebel vulvodynia: About a series of 8 cases]. / Intérêt de l'infiltration du ganglion Impar dans les vulvodynies rebelles : à propos d'une série de 8 cas.

INTRODUCTION: Vulvodynia is a common and debilitating disease, for which treatments are often of limits efficacy. As the Impar node receives nociceptive afferents from pelvis and perineum, it is a potential therapeutic target to treat pain in this region. The objective of the study was to evaluate the relevance of ropivacaine Impar node infiltration in patients suffering from rebel vulvodyny. METHODS: This was a retrospective, single-center study. The Impar node infiltrations were performed by a single operator in eight patients suffering from rebel vulvodynia. Ropivacaine and iopamidol were administered in prone position with a lateral approach under scanner. The anaesthetic diagnostic block of the Impar node was positive in all eight patients included in the study. Thereafter these patients benefited of 2 additional therapeutic infiltrations. Subsequently, an infiltration of the node with 100UI of botulinum toxin was performed in two patients with a bilateral approach under scanner. The analgesic efficacy was evaluated by a Visual Analogic Scale (VAS) before, immediately after, and at day 15 following the infiltration. A subjective evaluation of pain comprising the percentage of overall improvement and duration of analgesic efficacy was performed after the third infiltration. RESULTS: Comparison of the VAS before and immediately after the Impar block showed in the first anesthetic block a significant decrease in pain median VAS from 51/100 to 16/100 (P=0.01). Similarly, for the second block, VAS decreased from 52.5/100 to 15/100 (P=0.02). The maximal pain reported on Day 15, was significantly lower after the third infiltration than that after the first (P=0.03). Five patients reported an overall improvement in their quality of life of over 50%, which lasted an average of six weeks. A long lasting effectiveness was obtained in the two patients who benefited of the botulinum toxin. CONCLUSION: The infiltration of Impar node is an interesting technique for patients suffering of rebel vulvodynia. LEVEL OF EVIDENCE: 4.

[Electrophysiological studies of chronic pelvic and perineal pain]. / Explorations électrophysiologiques des douleurs pelvipérinéales chroniques.

OBJECTIVE: To describe electrophysiological studies, what they investigate, and their contribution and limitations in the assessment of pelvic and perineal pain. MATERIAL AND METHOD: Description of the electrophysiological techniques generally used to evaluate somatic nerves of the pelvic and perineal region (analytical electromyography, nerve conduction velocities, reflexology), their applications and the difficulties of interpretation. RESULTS: Electrophysiological studies can demonstrate signs in favour of peripheral neuropathy, specify the axonal and/or demyelinating type of lesion, and provide topographic arguments on the type of trunk or nerve root involved (pudendal nerve, sacral nerve roots, ilioinguinal or iliohypogastric nerve, genitofemoral nerve, obturator nerve). CONCLUSION: Electrophysiological studies require a technically skilled operator and can provide a better understanding of some types of pain, but are not sufficiently sensitive and specific. The conclusions of electrophysiological study reports must be closely correlated with clinical findings.

[Therapeutic education and alternative medicine]. / Éducation et thérapies parallèles dans la prise en charge thérapeutique des douleurs pelvipérinéales chroniques.

OBJECTIVE: To review the most common Complementary and Alternative Medical (CAM) therapies described for chronic pelvic pain care and to analyze their results as reported in the literature. MATERIAL AND METHODS: Review of articles and consensus conferences published on this subject in the Medline (PubMed) database, selected according to their scientific relevance. RESULTS: Lifestyle interventions have a positive impact on patients' self-management of their chronic pain. Positive outcomes are associated with well-balanced diet, dietary changes and certain dietary supplementations for bladder pain syndrome and chronic pelvic pain syndrome. Limited data exist supporting the use of acupuncture for chronic pelvic pain, endometriosis, bladder pain syndrome and urethral pain syndrome. There is no evidence for homeopathy and mesotherapy. CONCLUSIONS: Published data on many CAM therapies suggest their potential as complementary treatment options of chronic pelvic pain. As conventional treatments, CAM therapies warrant further studies to assist in their validation as permanent treatment options for this patient population.

[Neurostimulation techniques in the therapeutic management of chronic pelvic and perineal pain]. / Les techniques de neurostimulations dans la prise en charge thérapeutique des douleurs pelvipérinéales chroniques.

INTRODUCTION: Neuromodulation is a nonspecific analgesic treatment whose mechanism of action has not yet been elucidated. The purpose of this article is to review the techniques and results of neuromodulation in the management of chronic pelvic and perineal pain. MATERIAL AND METHODS: A comprehensive review of the literature was performed by searching PUBMED for articles on the various neuromodulation techniques used in the management of chronic pelvic and perineal pain. RESULTS: Several levels of neuromodulation of the somatic nervous system have been evaluated in the management of pelvic pain: transcutaneous electrical nerve stimulation (TENS), percutaneous nerve stimulation (PNS), nerve root or nerve trunk stimulation, spinal cord stimulation. An improvement was obtained in an average of two thirds of cases, but with declining efficacy over time. The various studies were difficult to compare due to the heterogeneous study populations and very diverse endpoints. Interesting studies on the value of autonomic nervous system intervention have been described, but with no specific trials of neuromodulation. CONCLUSION: The place of neuromodulation in the management of patients with chronic pelvic and perineal pain has yet to be defined, as it is too frequently used as a last resort. It appears important to develop and analyse this treatment modality in large-scale, randomized, prospective studies.

[Alternative treatments for interstitial cystitis]. / Les traitements de recours dans la cystite interstitielle.

Interstitial cystitis is the first cause of bladder pain. In case of failure of the usual treatments, several other modalities have been proposed. These therapeutic modalities are posterior sacral root neuromodulation, posterior tibial nerve stimulation, vanilloid agent intravesical instillation, intradetrusor botulinum toxin injections and surgery. A certain efficiency of each of these treatments in the interstitial cystitis has been reported. However, the evaluation of these treatments is limited and the level of evidence is too low to propose these treatments in routine.