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Efficacy of Neuromodulation Interventions for the Treatment of Sexual Dysfunction: A Systematic Review

      Abstract

      Objectives

      The primary aim of this review was to analyze the literature for the efficacy of neuromodulation interventions in treating both male and female sexual dysfunction.

      Materials and Methods

      Studies were identified from PubMed, Scopus, PsychINFO, CINAHL, and Cochrane. Results were synthesized qualitatively without pooling owing to the heterogeneous nature of outcome assessments.

      Results

      Overall findings from studies generally supported that neuromodulation interventions were associated with improvement in sexual function. Specific domains that improved in male patients included erectile function, desire, and satisfaction, whereas desire, arousal, orgasm, lubrication, quality of “sex life,” intercourse capability, and dyspareunia improved in female patients. Male ejaculation, orgasm, and intercourse capability were the only domains that continued to decline after the use of neuromodulation interventions, although this was only reported in one study.

      Conclusion

      Our review suggests that there may be promise and potential utility of neuromodulation in improving sexual dysfunction; however, further research is needed.

      Keywords

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      References

        • Shepardson R.L.
        • Carey M.P.
        Sexual dysfunctions.
        in: Friedman H.S. Encyclopedia of Mental Health. 2nd ed. Academic Press, 2016: 140-143https://doi.org/10.1016/B978-0-12-397045-9.00014-8
        • Heiman J.R.
        Sexual dysfunction: overview of prevalence, etiological factors, and treatments.
        J Sex Res. 2002; 39: 73-78https://doi.org/10.1080/00224490209552124
        • Meixel A.
        • Yanchar E.
        • Fugh-Berman A.
        Hypoactive sexual desire disorder: inventing a disease to sell low libido.
        J Med Ethics. 2015; 41: 859-862https://doi.org/10.1136/medethics-2014-102596
        • Lewis R.W.
        • Fugl-Meyer K.S.
        • Corona G.
        • et al.
        Definitions/epidemiology/risk factors for sexual dysfunction.
        J Sex Med. 2010; 7: 1598-1607https://doi.org/10.1111/j.1743-6109.2010.01778.x
        • Nappi R.E.
        • Cucinella L.
        • Martella S.
        • Rossi M.
        • Tiranini L.
        • Martini E.
        Female sexual dysfunction (FSD): prevalence and impact on quality of life (QoL).
        Maturitas. 2016; 94: 87-91https://doi.org/10.1016/j.maturitas.2016.09.013
        • Tahan M.
        • Saleem T.
        • Moshtagh M.
        • Fattahi P.
        • Rahimi R.
        Psychoeducational Group Therapy for sexual function and marital satisfaction in Iranian couples with sexual dysfunction disorder.
        Heliyon. 2020; 6e04586https://doi.org/10.1016/j.heliyon.2020.e04586
        • Atlantis E.
        • Sullivan T.
        Bidirectional association Between depression and sexual dysfunction: a systematic review and meta-analysis.
        J Sex Med. 2012; 9: 1497-1507https://doi.org/10.1111/j.1743-6109.2012.02709.x
        • Hentzen C.
        • Musco S.
        • Amarenco G.
        • Del Popolo G.
        • Panicker J.N.
        Approach and management to patients with neurological disorders reporting sexual dysfunction.
        Lancet Neurol. 2022; 21: 551-562
        • Calabrò R.S.
        Sexual dysfunction in neurological disorders: do we see just the tip of the iceberg?.
        Acta Biomed. 2018; 89: 274-275
        • Althof S.E.
        • Abdo C.H.N.
        • Dean J.
        • et al.
        International Society for Sexual Medicine’s guidelines for the diagnosis and treatment of premature ejaculation.
        J Sex Med. 2010; 7: 2947-2969https://doi.org/10.1111/j.1743-6109.2010.01975.x
        • Ohl D.A.
        • Quallich S.A.
        • Sønksen J.
        • Brackett N.L.
        • Lynne C.M.
        Anejaculation and retrograde ejaculation.
        Urol Clin North Am. 2008; 35 (viii): 211-220
        • Mobley D.F.
        • Khera M.
        • Baum N.
        Recent advances in the treatment of erectile dysfunction.
        Postgrad Med J. 2017; 93: 679-685https://doi.org/10.1136/postgradmedj-2016-134073
        • Facelle T.M.
        • Sadeghi-Nejad H.
        • Goldmeier D.
        Persistent genital arousal disorder: characterization, etiology, and management.
        J Sex Med. 2013; 10: 439-450https://doi.org/10.1111/j.1743-6109.2012.02990.x
        • Steege J.F.
        • Zolnoun D.A.
        Evaluation and treatment of dyspareunia.
        Obstet Gynecol. 2009; 113: 1124-1136
        • Yaraghi M.
        • Ghazizadeh S.
        • Mohammadi F.
        • et al.
        Comparing the effectiveness of functional electrical stimulation via sexual cognitive/behavioral therapy of pelvic floor muscles versus local injection of botulinum toxin on the sexual functioning of patients with primary vaginismus: a randomized clinical trial.
        Int Urogynecol J. 2019; 30: 1821-1828https://doi.org/10.1007/s00192-018-3836-7
        • Goldstein I.
        • Alexander J.L.
        Practical aspects in the management of vaginal atrophy and sexual dysfunction in perimenopausal and postmenopausal women.
        J Sex Med. 2005; 2: 154-165https://doi.org/10.1111/j.1743-6109.2005.00131.x
        • Sarrel P.M.
        Effects of hormone replacement therapy on sexual psychophysiology and behavior in postmenopause.
        J Womens Health Gend Based Med. 2000; 9: S25-S32https://doi.org/10.1089/152460900318830
        • Arthur S.S.
        • Dorfman C.S.
        • Massa L.A.
        • Shelby R.A.
        Managing female sexual dysfunction.
        Urol Oncol. 2022; 40: 359-365https://doi.org/10.1016/j.urolonc.2021.06.006
        • Kershaw V.
        • Jha S.
        Female sexual dysfunction.
        Obstet Gynaecol. 2022; 24: 12-23https://doi.org/10.1111/tog.12778
        • Hagedorn J.M.
        • Pittelkow T.P.
        • Hunt C.L.
        • D’Souza R.S.
        • Lamer T.J.
        Current perspectives on spinal cord stimulation for the treatment of cancer pain.
        J Pain Res. 2020; 13: 3295-3305https://doi.org/10.2147/JPR.S263857
        • Feloney M.P.
        • Stauss K.
        • Leslie S.W.
        Sacral Neuromodulation.
        StatPearls Publishing, 2022
        • Pettigrew R.I.
        • Heetderks W.J.
        • Kelley C.A.
        • et al.
        Epidural spinal stimulation to improve bladder, bowel, and sexual function in individuals With spinal cord injuries: a framework for clinical research.
        IEEE Trans Bio Med Eng. 2017; 64: 253-262https://doi.org/10.1109/TBME.2016.2637301
        • Page M.J.
        • Shamseer L.
        • Tricco A.C.
        Registration of systematic reviews in PROSPERO: 30,000 records and counting.
        Syst Rev. 2018; 7: 32https://doi.org/10.1186/s13643-018-0699-4
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.
        BMJ. 2009; 339: b2700https://doi.org/10.1136/bmj.b2700
        • Higgins J.P.
        • Altman D.G.
        • Gøtzsche P.C.
        • et al.
        The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials.
        BMJ. 2011; 343: d5928
        • Wells G.
        • Shea B.
        • O’Connell D.
        • et al.
        Newcastle-Ottawa Quality Assessment Scale Cohort Studies.
        University of Ottawa, 2014
        • Chu D.K.
        • Akl E.A.
        • Duda S.
        • et al.
        Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis.
        Lancet. 2020; 395: 1973-1987
        • Sasson C.
        • Rogers M.A.
        • Dahl J.
        • Kellermann A.L.
        Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis.
        Circ Cardiovasc Qual Outcomes. 2010; 3: 63-81
        • Yih J.M.
        • Killinger K.A.
        • Boura J.A.
        • Peters K.M.
        Changes in sexual functioning in women after neuromodulation for voiding dysfunction.
        J Sex Med. 2013; 10: 2477-2483https://doi.org/10.1111/jsm.12085
        • Lombardi G.
        • Mondaini N.
        • Macchiarella A.
        • Cilotti A.
        • Del Popolo G.D.
        Clinical female sexual outcome after sacral neuromodulation implant for lower urinary tract symptom (LUTS).
        J Sex Med. 2008; 5: 1411-1417https://doi.org/10.1111/j.1743-6109.2008.00812.x
        • Jadav A.M.
        • Wadhawan H.
        • Jones G.L.
        • Wheldon L.W.
        • Radley S.C.
        • Brown S.R.
        Does sacral nerve stimulation improve global pelvic function in women?.
        Colorectal Dis. 2013; 15: 848-857https://doi.org/10.1111/codi.12181
        • Jarrett M.E.D.
        • Nicholls R.J.
        • Kamm M.A.
        Effect of sacral neuromodulation for faecal incontinence on sexual activity.
        Colorectal Dis. 2005; 7: 523-525https://doi.org/10.1111/j.1463-1318.2005.00815.x
        • Parnell B.A.
        • Howard Jr., J.F.
        • Geller E.J.
        The effect of sacral neuromodulation on pudendal nerve function and female sexual function.
        Neurourol Urodyn. 2015; 34: 456-460https://doi.org/10.1002/nau.22579
        • Zaer H.
        • Rasmussen M.M.
        • Zepke F.
        • Bodin C.
        • Domurath B.
        • Kutzenberger J.
        Effect of spinal anterior root stimulation and sacral deafferentation on bladder and sexual dysfunction in spinal cord injury.
        Acta Neurochir (Wien). 2018; 160: 1377-1384https://doi.org/10.1007/s00701-018-3557-1
        • Zabihi N.
        • Mourtzinos A.
        • Maher M.G.
        • Raz S.
        • Rodríguez L.V.
        The effects of bilateral caudal epidural S2–4 neuromodulation on female sexual function.
        Int Urogynecol J Pelvic Floor Dysfunct. 2008; 19: 697-700https://doi.org/10.1007/s00192-007-0504-8
        • Pauls R.N.
        • Marinkovic S.P.
        • Silva W.A.
        • Rooney C.M.
        • Kleeman S.D.
        • Karram M.M.
        Effects of sacral neuromodulation on female sexual function.
        Int Urogynecol J Pelvic Floor Dysfunct. 2007; 18: 391-395https://doi.org/10.1007/s00192-006-0168-9
        • Gill B.C.
        • Swartz M.A.
        • Firoozi F.
        • et al.
        Improved sexual and urinary function in women with sacral nerve stimulation.
        Neuromodulation. 2011; 14 ([discussion: 443]): 436-443https://doi.org/10.1111/j.1525-1403.2011.00380.x
        • Meloy T.S.
        • Southern J.P.
        Neurally augmented sexual function in human females: a preliminary investigation.
        Neuromodulation. 2006; 9: 34-40https://doi.org/10.1111/j.1525-1403.2006.00040.x
        • Ingber M.S.
        • Ibrahim I.A.
        • Killinger K.A.
        • Diokno A.C.
        • Peters K.M.
        Neuromodulation and female sexual function: does treatment for refractory voiding symptoms have an added benefit?.
        Int Urogynecol J Pelvic Floor Dysfunct. 2009; 20: 1055-1059https://doi.org/10.1007/s00192-009-0900-3
        • van der Aa H.E.
        • Hermens H.
        • Alleman E.
        • Vorsteveld H.
        Sacral anterior root stimulation for bladder control in patients with a complete lesion of the spinal cord.
        Acta Neurochir (Wien). 1995; 134: 88-92https://doi.org/10.1007/BF01428511
        • van der Aa H.E.
        • Alleman E.
        • Nene A.
        • Snoek G.
        Sacral anterior root stimulation for bladder control: clinical results.
        Arch Physiol Biochem. 1999; 107: 248-256https://doi.org/10.1076/apab.107.3.248.4330
        • Marcelissen T.
        • Van Kerrebroeck P.
        • de Wachter S.
        Sacral neuromodulation as a treatment for neuropathic clitoral pain after abdominal hysterectomy.
        Int Urogynecol J. 2010; 21: 1305-1307https://doi.org/10.1007/s00192-010-1145-x
        • Lombardi G.
        • Mondaini N.
        • Giubilei G.
        • Macchiarella A.
        • Lecconi F.
        • Del Popolo G.
        Sacral neuromodulation for lower urinary tract dysfunction and impact on erectile function.
        J Sex Med. 2008; 5: 2135-2140https://doi.org/10.1111/j.1743-6109.2008.00948.x
        • Darrow D.
        • Balser D.
        • Netoff T.I.
        • et al.
        Epidural spinal cord stimulation facilitates immediate restoration of dormant motor and autonomic supraspinal pathways after chronic neurologically complete spinal cord injury.
        J Neurotrauma. 2019; 36: 2325-2336https://doi.org/10.1089/neu.2018.6006
        • Whiteside J.L.
        • Walters M.D.
        • Mekhail N.
        Spinal cord stimulation for intractable vulvar pain. A case report.
        J Reprod Med. 2003; 48: 821-823
        • Banakhar M.A.
        • Youness A.
        Sacral neuromodulation for lower urinary tract symptoms: effect of therapy on Saudi patient sexual function.
        Sex Med. 2021; 9100388https://doi.org/10.1016/j.esxm.2021.100388
        • Banakhar M.
        • Gazwani Y.
        • Kelini M.E.
        • Al-Shaiji T.
        • Hassouna M.
        Effect of sacral neuromodulation on female sexual function and quality of life: are they correlated?.
        Can Urol Assoc J. 2014; 8: E762-E767https://doi.org/10.5489/cuaj.2300
        • de Oliveira P.S.
        • Reis J.P.
        • de Oliveira T.R.
        • et al.
        The impact of sacral neuromodulation on sexual dysfunction.
        Curr Urol. 2019; 12: 188-194https://doi.org/10.1159/000499307
        • Zoorob D.
        • Deis A.S.
        • Lindsay K.
        Refractory sexual arousal subsequent to sacral neuromodulation.
        Case Rep Obstet Gynecol. 2019; 20197519164https://doi.org/10.1155/2019/7519164
        • Kelly S.L.
        • Radley S.C.
        • Brown S.R.
        Does percutaneous tibial nerve stimulation improve global pelvic function in women with faecal incontinence?.
        Colorectal Dis. 2016; 18: O158-O163https://doi.org/10.1111/codi.13329
        • Elkattah R.
        • Trotter-Ross W.
        • Huffaker R.K.
        Percutaneous tibial nerve stimulation as an off-label treatment of clitoral pain.
        Female Pelvic Med Reconstr Surg. 2014; 20: e1-e4
        • Musco S.
        • Serati M.
        • Lombardi G.
        • et al.
        Percutaneous tibial nerve stimulation improves female sexual function in women with overactive bladder syndrome.
        J Sex Med. 2016; 13: 238-242
        • Marinello F.G.
        • Jiménez L.M.
        • Talavera E.
        • et al.
        Percutaneous tibial nerve stimulation in patients with severe low anterior resection syndrome: randomized clinical trial.
        Br J Surg. 2021; 108: 380-387https://doi.org/10.1093/bjs/znaa171
        • van Balken M.R.
        • Vergunst H.
        • Bemelmans B.L.H.
        Sexual functioning in patients with lower urinary tract dysfunction improves after percutaneous tibial nerve stimulation.
        Int J Impot Res. 2006; 18 ([discussion: 476]): 470-475
        • Signorello D.
        • Seitz C.C.
        • Berner L.
        • et al.
        Impact of sacral neuromodulation on female sexual function and his correlation with clinical outcome and quality of life indexes: a monocentric experience.
        J Sex Med. 2011; 8: 1147-1155https://doi.org/10.1111/j.1743-6109.2010.02189.x
        • Jones C.L.
        • Fischer J.R.
        • Hernandez S.L.
        Sacral neuromodulation for the treatment of persistent genital arousal disorder.
        Obstet Gynecol. 2016; 128: 321-323
        • Ismail M.B.
        • Abdullhussein W.Q.
        The safety and efficacy of sacral neuromodulation on refractory urgency urinary and fecal incontinence in Iraqi patients.
        Medico-Leg Update. 2021; 21: 575
        • Andy U.U.
        • Amundsen C.L.
        • Honeycutt E.
        • et al.
        Sacral neuromodulation versus onabotulinumtoxinA for refractory urgency urinary incontinence: impact on fecal incontinence symptoms and sexual function.
        Am J Obstet Gynecol. 2019; 221: 513.e1-513.e15https://doi.org/10.1016/j.ajog.2019.06.018
        • Galan V.
        • Scowcroft J.
        • Chang P.
        • et al.
        10-kHz spinal cord stimulation treatment for painful diabetic neuropathy: results from post-hoc analysis of the SENZA-PPN study.
        Pain Manag. 2020; 10: 291-300https://doi.org/10.2217/pmt-2020-0033
        • D’Souza R.S.
        • Langford B.
        • Dombovy-Johnson M.
        • Abd-Elsayed A.
        Neuromodulation interventions for the treatment of painful diabetic neuropathy: a systematic review.
        Curr Pain Headache Rep. 2022; 26: 365-377https://doi.org/10.1007/s11916-022-01035-9
        • Rowald A.
        • Komi S.
        • Demesmaeker R.
        • et al.
        Activity-dependent spinal cord neuromodulation rapidly restores trunk and leg motor functions after complete paralysis.
        Nat Med. 2022; 28: 260-271https://doi.org/10.1038/s41591-021-01663-5
        • Wagner F.B.
        • Mignardot J.B.
        • Le Goff-Mignardot C.G.
        • et al.
        Targeted neurotechnology restores walking in humans with spinal cord injury.
        Nature. 2018; 563: 65-71https://doi.org/10.1038/s41586-018-0649-2
        • Melzack R.
        Gate control theory: on the evolution of pain concepts.
        Pain Forum. 1996; 5: 128-138https://doi.org/10.1016/S1082-3174(96)80050-X
        • Crosby N.D.
        • Janik J.J.
        • Grill W.M.
        Modulation of activity and conduction in single dorsal column axons by kilohertz-frequency spinal cord stimulation.
        J Neurophysiol. 2017; 117: 136-147
        • Chakravarthy K.
        • Fishman M.A.
        • Zuidema X.
        • Hunter C.W.
        • Levy R.
        Mechanism of action in burst spinal cord stimulation: review and recent advances.
        Pain Med. 2019; 20: S13-S22https://doi.org/10.1093/pm/pnz073
        • Strand N.H.
        • D’Souza R.
        • Wie C.
        • et al.
        Mechanism of action of peripheral nerve stimulation.
        Curr Pain Headache Rep. 2021; 25: 47https://doi.org/10.1007/s11916-021-00962-3
        • Abd-Elsayed A.
        • D’Souza R.S.
        Peripheral nerve stimulation: the evolution in pain medicine.
        Biomedicines. 2021; 10: 18https://doi.org/10.3390/biomedicines10010018
        • Khunda A.
        • McCormick C.
        • Ballard P.
        Sacral neuromodulation and sexual function: a systematic review and meta-analysis of the literature.
        Int Urogynecol J. 2019; 30: 339-352https://doi.org/10.1007/s00192-018-3841-x
        • Pinheiro Sobreira Bezerra L.R.
        • Britto D.F.
        • Ribeiro Frota I.P.
        • et al.
        The impact of urinary incontinence on sexual function: a systematic review.
        Sex Med Rev. 2020; 8: 393-402https://doi.org/10.1016/j.sxmr.2019.06.009
        • Jha S.
        • Ammenbal M.
        • Metwally M.
        Impact of incontinence surgery on sexual function: a systematic review and meta-analysis.
        J Sex Med. 2012; 9: 34-43https://doi.org/10.1111/j.1743-6109.2011.02366.x
        • Lundby L.
        • Krogh K.
        • Buntzen S.
        • Laurberg S.
        Temporary sacral nerve stimulation for treatment of irritable bowel syndrome: a pilot study.
        Dis Colon Rectum. 2008; 51: 1074-1078https://doi.org/10.1007/s10350-008-9255-y
        • Laumann E.O.
        • Paik A.
        • Rosen R.C.
        Sexual dysfunction in the United States: prevalence and predictors.
        JAMA. 1999; 281: 537-544https://doi.org/10.1001/jama.281.6.537
        • Kershaw V.
        • Khunda A.
        • McCormick C.
        • Ballard P.
        The effect of percutaneous tibial nerve stimulation (PTNS) on sexual function: a systematic review and meta-analysis.
        Int Urogynecol J. 2019; 30: 1619-1627https://doi.org/10.1007/s00192-019-04027-3
        • Kessler A.
        • Sollie S.
        • Challacombe B.
        • Briggs K.
        • Van Hemelrijck M.
        The global prevalence of erectile dysfunction: a review.
        BJU Int. 2019; 124: 587-599
        • Epstein L.J.
        • Palmieri M.
        Managing chronic pain with spinal cord stimulation.
        Mt Sinai J Med. 2012; 79: 123-132https://doi.org/10.1002/msj.21289
        • Yakovlev A.E.
        • Timchenko A.A.
        • Parmentier A.M.
        Spinal cord stimulation and sacral nerve stimulation for postlaminectomy syndrome with significant low back pain.
        Neuromodulation. 2014; 17: 763-765https://doi.org/10.1111/ner.12144
        • Thomas H.N.
        • Thurston R.C.
        A biopsychosocial approach to women’s sexual function and dysfunction at midlife: a narrative review.
        Maturitas. 2016; 87: 49-60https://doi.org/10.1016/j.maturitas.2016.02.009
        • Berry M.D.
        • Berry P.D.
        Contemporary treatment of sexual dysfunction: reexamining the biopsychosocial model.
        J Sex Med. 2013; 10: 2627-2643https://doi.org/10.1111/jsm.12273
        • D’Souza R.S.
        • Langford B.
        • Wilson R.E.
        • et al.
        The state-of-the-art pharmacotherapeutic options for the treatment of chronic non-cancer pain.
        Expert Opin Pharmacother. 2022; 23: 775-789https://doi.org/10.1080/14656566.2022.2060741
        • Jackson G.
        Sexual dysfunction and diabetes.
        Int J Clin Pract. 2004; 58: 358-362https://doi.org/10.1111/j.1368-5031.2004.00180.x
        • Maiorino M.I.
        • Bellastella G.
        • Esposito K.
        Diabetes and sexual dysfunction: current perspectives.
        Diabetes Metab Syndr Obes. 2014; 7: 95-105https://doi.org/10.2147/DMSO.S36455
        • Fairbanks F.
        • Abdo C.H.
        • Baracat E.C.
        • Podgaec S.
        Endometriosis doubles the risk of sexual dysfunction: a cross-sectional study in a large amount of patients.
        Gynecol Endocrinol. 2017; 33: 544-547https://doi.org/10.1080/09513590.2017.1302421
        • Hagedorn J.M.
        • Romero J.
        • Ha C.T.
        • Bendel M.A.
        • D’Souza R.S.
        Paresthesia-based versus high-frequency spinal cord stimulation: a retrospective, real-world, single-center comparison.
        Neuromodulation Technol Neural Interface. 2022; 25: 710-718
        • D’Souza R.S.
        • Strand N.
        Neuromodulation with burst and tonic stimulation decreases opioid consumption: a post hoc analysis of the success using neuromodulation With BURST (SUNBURST) randomized controlled trial.
        Neuromodulation. 2021; 24: 135-141https://doi.org/10.1111/ner.13273
        • D’Souza R.S.
        • Olatoye O.O.
        • Butler C.S.
        • Barman R.A.
        • Ashmore Z.M.
        • Hagedorn J.M.
        Adverse events associated with 10-kHz dorsal column spinal cord stimulation: a 5-year analysis of the manufacturer and user facility device experience (MAUDE) database.
        Clin J Pain. 2022; 38: 320-327
        • Langford B.
        • Hooten W.M.
        • D’Souza S.
        • Moeschler S.
        • D’Souza R.S.
        YouTube as a source of medical information about spinal cord stimulation.
        Neuromodulation. 2021; 24: 156-161https://doi.org/10.1111/ner.13303
        • Hagedorn J.M.
        • Lam C.M.
        • D’Souza R.S.
        • et al.
        Explantation of 10 kHz spinal cord stimulation devices: a retrospective review of 744 patients followed for at least 12 months.
        Neuromodulation. 2021; 24: 499-506https://doi.org/10.1111/ner.13359
        • Yadav A.
        • Hagedorn J.M.
        • D’Souza R.S.
        • Engle A.M.
        • Deer T.R.
        Effect of patient characteristics on reported outcomes over 12 months following lumbar radiofrequency ablation: a retrospective review of 500 patients.
        Pain Pract. 2021; 21: 152-159https://doi.org/10.1111/papr.12938

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