SLIDE 1
M L Sharma Consultant in Pain Medicine and Neuromodulation, Liverpool
26/03/2019
26/03/2019
M L Sharma Consultant in Pain Medicine and Neuromodulation, - - PowerPoint PPT Presentation
M L Sharma Consultant in Pain Medicine and Neuromodulation, - - PowerPoint PPT Presentation
M L Sharma Consultant in Pain Medicine and Neuromodulation, Liverpool 26/03/2019 26/03/2019 Clear pathway Patient selection (MDT) Trial of SNS Implantation of SNS Outcomes Offered to only for a small number of refractory
SLIDE 2
SLIDE 3
Clear pathway
- Patient selection (MDT)
- Trial of SNS
- Implantation of SNS
Outcomes
26/03/2019
Offered to only for a small number of refractory cases with huge impact on QOL
SLIDE 4
Bladder instability (OAB) Faecal incontinence Pelvic pain +/- above symptoms Medically refractory as assessed by referrers Large MDT
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SLIDE 5
Under local and
sedation
Under 60 min Day case
procedure
Need for
programming
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SLIDE 6
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Perineal pain Pudendal neuralgia Vulvodynia Coccygodynia Abdomino-pelvic pain Interstitial cystitis Rectal pain/proctalgia fugax Chronic pelvic pain
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Retrospective notes review Age, duration of pain Pain intensity and type Psychological factors (anxiety, depression) Localised or diffuse pain Post surgical or not Physical disability
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12 patients implanted with SNS for pain 7 successful
- 4 had >50% pain relief
- 3 had 30-35% pain relief
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10 20 30 40 50 60 70 Average Pain Worst Pain
Percentage Reduction in average Numeric Rating Pain Scores (1 Year after SNS Implant)
Group A Group B
SLIDE 10
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10 20 30 40 50 60 70 Age in years (Mean) Duration of pain years (Mean) BPI (Interference Mean) HADS (Anxiety Mean) HADS (Depression Mean) ODI (Mean) Localized pain (%age of patients)
Baseline Data (Potential Predictors)
Group A Group B
SLIDE 11
Though all patients had successful trial of
SNS, only 60% had meaningful long term success
No correlation between baseline anxiety,
depression, disability and outcomes with SNS
Localized pain description better predictors
- f response
26/03/2019
SLIDE 12
We now share this data with potential new
patients
Prospective audit with improved dataset
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SLIDE 13
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