Analgesic effect of interstitial and transvaginal electrical nerve stimulation in the treatment of women with chronic postpartum pelvic pain - Clinical study

Abstract: 11,6 % of women may develop pelvic pain after childbirth as a result of dysfunction of the pelvic floor muscles. According to some data, this pain syndrome can last more than 3 years; in most cases it has a highly pharmacoresistant form. In clinical practice, transvaginal electrical nerve stimulation (TVES) and interstitial electrical nerve stimulation of the pelvic floor muscles (VTES) are used in the treatment of this disease. However, the characteristics of the analgesic effect of these treatment methods have not been sufficiently studied and have not been compared with each other. The purpose of the study. To compare the analgesic effect TVES and VTES in the treatment of women with pelvic pain syndrome due to postpartum pelvic floor dysfunction. Material and methods. We observed 56 women with chronic pelvic pain syndrome due to postpartum dysfunction of the pelvic floor muscles. 28 women underwent electrical neurostimulation using an intravaginal double electrode using high-frequency low-amplitude (50 Hz-30 μs) and low-frequency high-amplitude (1 Hz-100 μs) modalities for 20 minutes. The number of sessions was 15 with procedures performed every other day. 28 women underwent a course of interstitial electrical neurostimulation of the pelvic floor muscles using high-frequency low-amplitude (50 Hz-30 μs) and low-frequency high-amplitude (1 Hz-100 μs) modalities for 20 minutes. The procedures failed 15 times, every other day. Pain was assessed using a visual analogue scale (VAS) and the McGill Pain Questionnaire (MPQ). Results. In all women studied, pain syndrome according to VAS exceeded 5 points and averaged 6.3±0.4 points in the TVES group and 6.4±0.4 points in the VTES group. The MPQ indicators on the sensory and affective scales were 20.1±1.2 and 14.2±0.9 points, respectively, in the group who attended the TVES course and 20.7±1.2 and 14.1±0.9, respectively, in the group who attended VTES course. After treatment, there was a decrease in pain syndrome determined by VAS to 49% (P≤0.01) against the background of TVES and 73% (P≤0.01) against the background of VTES. A reduction in pain on the MPQ was observed on the sensory scale of 31% (P≤0.01) in the TVES group and 64% (P≤0.01) in the VTES group. A decrease in pain on the affective scale was observed after TVES by 28.2% (p>1), and after VTES by 68.8% (P≤0.01). Conclusion. The use of VTES exceeds the analgesic effect of the method of TVES by 47% in the treatment of women with pelvic pain syndrome due to postpartum dysfunction of the pelvic floor muscles. At the same time, affective reactions to chronic pain syndrome significantly regress after VTES and respond to a lesser extent to the effects of TVES.