Functional Electrotherapy for Pelvic Pain

Pelvic pain can become chronic when symptoms persist for more than 3 to 6 months. Therefore, it's crucial to ensure rapid management by a healthcare professional. The management is multifaceted but also involves helping patients find strategies for self-managing the pain in their daily lives. Did you know that TENS can be a self-management tool for this clientele?

EVA: A SELF-MANAGEMENT TOOL FOR PAIN FOR WOMEN

Let's remember that transcutaneous electrical nerve stimulation (TENS) relies on the body's endogenous pain management mechanisms. It's a natural and safe method that can assist women with various pathologies, such as primary and secondary dysmenorrhea, vulvodynia, vestibulodynia, deep dyspareunia, vaginismus, and various neuralgias affecting the pelvic region. Let's take a closer look.

DYSMENORRHEA

Primary dysmenorrhea (PD) is defined by lower abdomen cramps occurring just before or during menstruation in women, without any identifiable pelvic pathology. Studies suggest that it could affect between forty-five (45%) and ninety-five percent (95%) of women. For ten (10%) to fifteen (15%) percent of these women, the pain is strong enough to interfere with daily life.

Secondary dysmenorrhea involves menstrual pain associated with an underlying pelvic pathology, such as endometriosis, adenomyosis, or uterine fibroids. Among clients suffering from endometriosis, at least 20% of patients still present painful symptoms following medical treatments.

Various strategies can be employed to manage the pain of dysmenorrhea with TENS, such as placement at the nerve roots innervating the uterus and application on the painful territory. Several studies show that TENS is a safe, well-tolerated tool demonstrating its effectiveness in relieving the pains of primary and secondary dysmenorrhea. Moreover, pain management with TENS can also be optimized with the application of thermotherapy (heat). Some studies have even shown a reduction in NSAID intake with the application of TENS.

Its use can also be functional, thus improving the quality of life and function of patients during painful episodes.

VULVODYNIA AND VESTIBULODYNIA

Many women suffer from vulvodynia, i.e., vulvar pain lasting more than 3 months without an identifiable cause. Vestibulodynia, a subcategory of vulvodynia, manifests as pain localized more precisely at the vaginal entrance (vulvar vestibule). Its prevalence could be present in up to 28% of women throughout their lifetime. It is, once again, underestimated.

The pain can be spontaneous, provoked, or mixed. It can be exacerbated by sexual intercourse, the insertion of a tampon, wearing tight clothing, prolonged sitting, or activities such as bicycling. We can therefore understand the adverse effects of this pain in women's lives. It has impacts on the quality of life and sexual life of women.

Vulvodynia and vestibulodynia have been the subjects of several studies in recent years. The application of TENS has been studied with the use of a vaginal probe as well as external application on the labia majora. In studies, internal or external application in self-management significantly reduced vulvar pain and improved sexual functions in the short and medium term. Other strategies can also be used, such as application at the corresponding nerve roots if the patient cannot tolerate direct stimulation at the genital organs in the presence of allodynia, dysesthesia, or when used functionally.

DEEP DYSPAREUNIA AND VAGINISMUS

Deep dyspareunia is not a pathology itself. It's pain during deep penetration. About 61% of women will experience this pain during their lifetime. The pain is only felt during deep penetration and may be increased after the ovulation period or in the premenstrual period. It can be associated with an acute or chronic pathology, such as endometriosis. It can also be caused by congenital malformation, nerve dysfunction, menopause, or injuries such as episiotomy or other genital procedures.

Vaginismus is often confused with deep dyspareunia. It is defined by recurrent and persistent muscle spasms of the outer third of the vagina interfering with vaginal penetration. It affects between 1 and 6% of women and is caused by a secondary conditioning response to unfavorable physical or psychological stimuli. Certain medical causes can be associated, such as vaginal tract infection, vestibulodynia, menopause, previous genital surgical trauma, and prior radiotherapy.

These two issues can be associated with unfavorable psychological experiences. Therefore, it's important to work in tandem with other health professionals who can help these patients.

Several studies on various pelvic-perineal pathologies have used the deep dyspareunia scale to study the effects of TENS internally or externally. These studies reported significant effects on the deep dyspareunia scale and pain.

Thus, the use of TENS in self-management could be an intervention in addition to the physical and psychological rehabilitation of patients.

NEURALGIAS

Several nerves innervate the pelvic-perineal region: iliohypogastric, ilioinguinal, genitofemoral (border nerve syndrome), not to forget the pudendal nerve innervating the vulvar territory.

Neuralgias of the pelvic-perineal region such as the border nerve syndrome and pudendal neuralgia can occur at different times in a woman's life: following an appendectomy, childbirth, cesarean section, surgery, during a lumbar sympathetic block, prolonged pressure, or trauma.

TENS is well known for managing neuropathic pain. It can also be used in a pelvic-perineal context. Different application strategies can be used in pain self-management depending on the signs and symptoms of patients, such as the painful pathway or the presence of allodynia.

In conclusion, EVA offers several TENS programs. Its use in self-care can become an ally for the patient and the healthcare professional. The success of the modality relies on teaching and educating the patient to maximize pain management strategies.

At SET, our priority is to support you in the pelvic-perineal rehabilitation of your patients, focusing on close collaboration to maximize the effectiveness of home treatment. We understand the importance of clear and precise communication to identify and meet the specific needs of each patient.

Thanks to our recommendation tool, we facilitate the establishment of a care plan tailored to your therapeutic goals, thus strengthening the outcomes of rehabilitation for the benefit of the patient.

To explore how our expertise in functional electrotherapy can enrich your practice and improve the rehabilitation journey of your patients, we invite you to communicate with one of our experts.

Together, let's progress towards a comprehensive approach from the clinic to the home of your patients for optimal results.

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