Bidirectional Spinal Cord Stimulation for Treatment-Resistant Neuropathic Pelvic Pain: A Case Study
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By
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Yakov Perper
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Alana Taub
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Jenifer Perper
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July 1, 2026
Clinical Report: Bidirectional Spinal Cord Stimulation for Treatment-Resistant Neuropathic Pelvic Pain
Overview
This case study presents a 63-year-old woman with treatment-resistant neuropathic pelvic pain following thoracic aortic aneurysm repair. A combined bidirectional spinal cord stimulation approach was attempted.
Background
Chronic pelvic pain affects a significant portion of the population and is often resistant to conventional treatments, leading to substantial impairment in quality of life. Spinal cord stimulation (SCS) has emerged as an intervention for refractory cases.
Data Highlights
No numerical data or trial data presented in the article.
Key Findings
- A 63-year-old woman experienced severe neuropathic pelvic pain post-thoracic aortic aneurysm repair.
- Multiple treatment modalities prior to SCS, including pharmacologic and interventional therapies, provided minimal relief.
- Combined bidirectional SCS involved anterograde thoracic and retrograde sacral lead placements.
- Technical difficulties were encountered during sacral lead placement, necessitating adjustments in technique.
- The patient developed hip pain with tonic sacral stimulation, leading to the discontinuation of this modality.
- High-frequency stimulation at the thoracic spine was continued as the primary treatment.
Clinical Implications
This case illustrates the complexities involved in implementing combined bidirectional spinal cord stimulation for refractory pelvic pain.
Conclusion
This case highlights the use of combined bidirectional spinal cord stimulation for refractory neuropathic pelvic pain.
Related Resources & Content
- Pain Medicine, 2023 -- Early outcomes with a flexible ECAP based closed loop using multiplexed spinal cord stimulation waveforms—single-arm study with in-clinic randomized crossover testing
- Pain Medicine, 2023 -- Systematic review and meta-analysis of conventional medical management in a patient population with refractory chronic pain suitable to receive a spinal cord stimulation system
- Pain Medicine, 2023 -- Evaluation of 60-Day Percutaneous Peripheral Nerve Stimulation for Lumbar Medial Branches Versus Standard Interventional Care in Chronic Low Back Pain: Results from a Multicenter Pragmatic Randomized Controlled Trial (RESET)
- Brain, 2023 -- Non-invasive closed-loop spinal stimulation enables individuals with paraplegia to regain control of leg movement
- EAU Guidelines on Chronic Pelvic Pain, 2026
- Dorsal root ganglion stimulation for patients with chronic pelvic pain: A retrospective review of patient experiences and long-term outcomes, 2024
- Durable multimodal and holistic response for physiologic closed-loop spinal cord stimulation supported by objective evidence from the EVOKE double-blind randomized controlled trial
- https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Chronic-Pelvic-Pain-2026.pdf
- Dorsal root ganglion stimulation for patients with chronic pelvic pain: A retrospective review of patient experiences and long-term outcomes - ScienceDirect
- Durable multimodal and holistic response for physiologic closed-loop spinal cord stimulation supported by objective evidence from the EVOKE double-blind randomized controlled trial - PMC
Based on findings from:
Combined bidirectional spinal cord stimulation for refractory neuropathic pelvic pain: a case report
Yakov Perper, Alana Taub, Jenifer Perper. Frontiers In Pain Research, 2026.
https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2026.1864829/full
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