Combined bidirectional spinal cord stimulation for refractory neuropathic pelvic pain: a case report.

Authors

Yakov Perper, Alana Taub, Jenifer Perper

Published in

Frontiers in pain research (Lausanne, Switzerland). Volume 7. Pages 1864829. Epub Jul 01, 2026.

Abstract

Refractory neuropathic pelvic pain significantly impairs quality of life and is notoriously difficult to treat. We present the case of a 63-year-old woman who developed severe pelvic pain following emergency open thoracic aortic aneurysm repair. Despite extensive pharmacologic, non-pharmacologic, and interventional treatments, she experienced minimal relief.
To address her pain, we attempted a novel approach termed "Combined Bidirectional": anterograde (thoracic) and retrograde (sacral) spinal cord stimulator (SCS) placement, accompanied by combination therapy-high-frequency stimulation (HFX) at the thoracic spine and tonic stimulation at the sacral spine.
Technical difficulties complicated retrograde sacral placement, and we discussed our approach to managing these challenges. Additionally, the patient developed unexpected hip pain with tonic sacral stimulation, prompting discontinuation of this modality and continuation of HFX thoracic stimulation alone.
This case underscores both the potential advantages and challenges of combined bidirectional SCS for pelvic pain. Further research is warranted to clarify the efficacy and optimal application of this novel approach for refractory neuropathic pelvic pain.

PMID:
42460410
Bibliographic data and abstract were imported from PubMed on 16 Jul 2026.

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