Nonimplantable Peripheral Electrical Stimulation for Management of Chronic Pelvic Pain: An Umbrella Review.

Background: Chronic pelvic pain (CPP) is a complex and debilitating condition that significantly affects quality of life. Peripheral electrical stimulation (PES) has gained attention as a noninvasive or minimally invasive therapeutic and rehabilitative approach. However, its overall efficacy remains uncertain.

Objectives: This study aimed to synthesize current evidence on the effectiveness and safety of PES modalities for CPP management.

Materials and methods: A systematic search of PubMed, Embase, Cochrane Library, Scopus, and Web of Science was performed to identify systematic reviews and meta-analyses evaluating nonimplantable PES modalities, including transcutaneous electrical nerve stimulation (TENS), percutaneous tibial nerve stimulation (PTNS), and intravaginal electrical stimulation (IVES). Study selection, data extraction, and methodologic quality assessment were conducted independently by two reviewers. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess the quality of included reviews.

Results: A total of 15 systematic reviews were included, covering a range of PES modalities for CPP conditions such as vulvodynia, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), bladder pain syndrome, interstitial cystitis, and endometriosis-associated pelvic pain. Among the interventions, TENS and PTNS showed the most consistent evidence of pain reduction, particularly in CP/CPPS. IVES indicated potential benefits for dyspareunia and pelvic floor dysfunction, whereas the evidence for pudendal nerve stimulation remained limited. Most PES modalities were well-tolerated, with tolerable adverse events. However, the quality of evidence was generally low, with only two high-quality systematic reviews identified.

Conclusions: PES, particularly TENS and PTNS, appears to be a promising treatment for CPP, offering noninvasive pain relief with minimal adverse effects. However, the heterogeneity in study populations, treatment protocols, and outcome measures limits the certainty of conclusions. Future research should prioritize high-quality randomized controlled trials, standardized treatment protocols, and comparative effectiveness studies to refine clinical recommendations.