Minimally Invasive Office-Based Protocol Yields Preliminary Improvements in Pelvic Pain and Function.

BACKGROUND: Chronic pelvic pain (CPP) is difficult to treat, with many patients who have the condition continuing to live in pain despite numerous interventions. Patients frequently report opioid use, visits to emergency departments and urgent care clinics, and pain associated with working and functional everyday activities such as walking, sleeping, and sitting, reflecting a reduced quality of life overall. Patients with CPP have been known to spend over 15 years in pain prior to finding a suitable treatment option, often spending thousands of dollars on care. This situation presents a need for additional CPP treatment options that provide enduring relief across the multiple dimensions impacted by the condition. OBJECTIVES: To evaluate a minimally invasive, nonsurgical, office-based protocol involving a series of 6 ultrasound-guided pelvic peripheral nerve blocks and trigger point injections. This procedure is well tolerated, with patients able to resume normal activity following each appointment. STUDY DESIGN: A retrospective cohort study was conducted in 2660 male and female patients with CPP. SETTING: Patients completed the full treatment protocol at Pelvic Rehabilitation Medicine centers across the United States. METHODS: Patients who reported data during a new patient visit and a visit approximately 3 months after the initiation of the protocol were included in the analysis. Patients with missing or incomplete data on overall pain, emergency department and urgent care visits, opioid use, functional ability, and work productivity were excluded from analysis. Impact was assessed across these domains. RESULTS: Patients reported a 48.6% reduction in pain at the 3-month follow-up visit (P < 0.001). Fifty-five percent of the patients achieved at least 50% improvement in pain. Functional scores improved by 32.6%, with significant improvement observed across all functional gains analyzed (P < 0.001). Notably, patients exhibited a 43.1% reduction in pain associated with sleeping (P < 0.001). Emergency department and urgent care visits decreased by 89.4%, and opioid use decreased by 45.4% (P < 0.001). At 3 months, reports of 0 workdays missed due to pain increased by 36.9%, and reports of 0 hours of impaired productivity increased by 93.4% (P < 0.001). LIMITATIONS: Due to the retrospective nature of analysis, this study lacks a control group. However, prior research conducted by the organization demonstrated that the protocol led to greater improvement in all domains tested in this analysis, as opposed to a control group. CONCLUSIONS: This series of nerve block and injection procedures is associated with significant improvements in pain, emergency department and urgent care visits, opioid use, functional activities, and work productivity in patients with CPP. Notably, more than half of the patients in the study showed at least 50% improvement in pain. Further analysis of the longer-term efficacy of the protocol, particularly in comparison to a control group, is warranted.