Obturator Neuromodulation with Laparoscopic Placement of an Obturator Lead for the Treatment of Intractable Opioid-Dependent Chronic Pelvic Pain due to Obturator Neuralgia

Chronic pelvic pain (CPP) is a common condition in women that can have a devastating effect on quality of life. Some of the most severe forms of CPP are related to peripheral nerve injuries, causing persistent neuropathic pain. We present a case of a young woman with severe opioid-dependent chronic pelvic and right groin pain due to obturator neuralgia. She had failed a multitude of treatments, including multiple medications, manual physical therapy, nerve blocks, surgical neurolysis, and spinal cord stimulation, without significant benefit. She underwent a trial of peripheral neuromodulation of the obturator nerve with laparoscopic placement of a quadripolar lead. During the 6-day trial, she experienced almost complete relief of her pain; therefore, she underwent permanent implantation of an intermittent pulse generator. Over the next 6 months, she was completely weaned off chronic opioids. At 23 months postimplantation, she had essentially no pain and was no longer receiving any analgesic, antidepressant, or membrane-stabilizing medications. (C) 2018 AAGL. All rights reserved.