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

Front Pain Res (Lausanne). 2026 Jul 1;7:1864829. doi: 10.3389/fpain.2026.1864829. eCollection 2026.

ABSTRACT

INTRODUCTION: 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.

METHODS: 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.

CASE DESCRIPTION: 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.

CONCLUSION: 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 | PMC:PMC13368761 | DOI:10.3389/fpain.2026.1864829