“Pioneering Treatment Relieves Pelvic Pain”
Kenneth M. Peters, MD
Kenneth M. Peters, MD, Chairman of Urology, Director of Beaumont Women’s Urology
Center, Beaumont Health System, talks about a new treatment for patients with pelvic
pain.
How do you measure the success of this procedure and how long can a patient
expect the results to last?
Dr. Peters: The nice thing about neuromodulation is that we can do it in two stages.
So, you get to sort of test drive the car before you buy it. In the first stage of the
procedure, we put the patient under light sedation so we can place a little electrode
down by the pudendal nerve. Then, we externalize that for two weeks. So, they go
home with a wire coming out of them, connected to a temporary pacemaker that sort of
looks like a transistor radio. It has a 9 volt battery and a volume dial on it. However, the
electronics in it allows us to program it differently so we can stimulate the nerve the way
we think will work best for the patient. Prior to having that test done, we have them fill
out pain scores. For the two weeks, we let them see how their symptoms change over
time. We consider at least a 50% improvement in symptoms a success. If they have a
50% improvement in symptoms, then we’ll go ahead and implant the permanent
pacemaker. It looks just like a heart pacemaker and this could be implanted in the body.
Now, there are no more wires coming out and then this will allow chronic stimulation for
the patient.
I understand people are coming from all over for this procedure. Can you talk
about that?
Dr. Peters: We opened the Women’s Urology Center at Beaumont to service a need of
patients with chronic pelvic pain. The reason is that most women who suffer from this
have gone from doctor to doctor seeking help. What became clear to us is that we really
needed a multidisciplinary approach to not only evaluating, but treating this and that’s
what the Women’s Urology Center at Beaumont is. So, we have clinicians here who
have been specifically trained in chronic pelvic pain like nurse practitioners and pelvic
floor physical therapists. We have integrative medicine with acupuncture and guided
imagery and massage therapy and then we have psychological services because these
patients deal with a lot in their lives because of the chronic pain. It affects their
relationships, their life, and the time they can spend with their family. So, because of
that, we have become known across the country. We have had patients in this past year
from 26 different states and 4 different countries; we’ve had patients travel to Beaumont
for neuromodulation from as far as Australia.
Wow, that’s amazing. Are you teaching other doctors to perform the procedure
and if so, where are they located?
Dr. Peters: We have had three courses to teach other physicians how to do pudendal
neuromodulation. Several months ago, we had 70 clinicians from around the country.
We are always trying to get the word out about it because we feel that it really can
positively impact our patient’s symptoms.
Is the treatment covered by insurance?
Dr. Peters: Well, insurance is always an issue with any implantable device. Clearly
sacral neuromodulation has been approved since 1997 and most insurance companies
will cover it if they meet certain criteria. None of this is covered for pain and most
patients have a component of voiding dysfunction along with their pain. So, often they
can get coverage through the bladder side of things as a justification to do this, but I
have to say it is a work in progress to enlighten the insurance companies. A lot of times
it’s a lot of work on our side to have to direct conversations with the insurers to get them
to approve this, but overall most of the time we can get it paid for. If it’s for pure pain
then sometimes that’s a difficult thing to do, but the insurance companies are starting to
come around more and more.
Who is a good candidate for this procedure?
Dr. Peters: For this procedure, I look at it in several different layers of who would be a
good candidate. Number one, it is for both men and women. We keep talking about
women because we are in the Women’s Urology Center, but it affects men too. So, in
my mind, anyone who has urinary frequency, urgency or urge incontinence who does
not respond to standard therapies, including sacral neuromodulation, could benefit from
pudendal neuromodulation. Anybody who has significant chronic pelvic pain and what
we call pelvic floor dysfunction or spasm of the pelvic floor, who have again failed
traditional therapies or standard therapies, we do transvaginal trigger point injections into
those muscles; we’ll inject Botox into those muscles to break the spasm, and its after
that if we just can’t get them where they need to be. One great test to say who’s a good
candidate is a pudendal nerve block. So, we work with our anesthesia pain specialist
and they will do a block of the pudendal nerve like if you’ve ever had an injection for your
back for back pain; it’s similar to that, but they direct it to the pudendal nerve. And what
we’ve found is that if a patient gets relief from that block, even if it’s the day that they had
it because everything is numb, then at least that tells us the symptoms are being driven
through the pudendal nerve. If we can see that, then we have a very high success rate
with modulating the nerve because prior to modulating the nerve, the only other thing
people do for patients with pudendal neuropathy, or pudendal nerve issues, is they’ve
been doing pudendal nerve entrapment surgery, which is a major surgery. However,
this new procedure is very minimally invasive; it is an one hour outpatient procedure.
The pudendal nerve entrapment surgery takes hours in the operating room,
hospitalizations, and months of recovery. I think we should always modulate before we
operate.
In terms of the treatment of pelvic pain, this is obviously major, but where do you
see the future in treating pelvic pain? What’s next?
Dr. Peters: We are always looking for new ways to treat pelvic pain because even
though how enthusiastic I am about stimulating the pudendal nerve, it doesn’t help
everybody either. I think that we’re going to make huge strides in improving the care of
patients with pelvic pain, just by educating our colleagues because I was never educated
about the pelvic floor and its impact on pain. I think that we have a mission within
ourselves and in our medical schools to train them how to identify patients and offer the
appropriate treatment for the ones that we know can get better with pudendal nerve
entrapment or pelvic floor pain, but I think that we’re always looking for new ways to
modulate the nerves. We are using things like Botox to inject into the nerves and then
there is a lot of device companies out there who have an interest in pain right now and
I’m working with some of them on some new technologies.
What are the concerns of doctors who are not using this? And why aren’t they?
Dr. Peters: Most doctors don’t do this and it’s actually a higher skill set and I don’t think
most should do it. However, I do think those who do a lot of neuromodulation to help
manage various symptoms should have an understanding of how to do this and be
trained in it. That is something we are trying to work with industry and get them on board
to actually do the studies that need to be done to make it FDA approved in order to
make it more accessible for our patients.
This information is intended for additional research purposes only. It is not to be
used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any
medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no
responsibility for the depth or accuracy of physician statements. Procedures or
medicines apply to different people and medical factors; always consult your
physician on medical matters.
If you would like more information, please contact:
Kenneth M. Peters, MD
Chairman of Urology
Director of Beaumont Women’s Urology Center
Beaumont Health System
kmpeters@beaumont.edu
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