A Multimodal Approach Combining Low-Intensity Shock Wave Therapy and Transcutaneous Electrical Nerve Stimulation for Refractory Chronic Pelvic Pain in Women.

Introduction Chronic pelvic pain is a prevalent and multifactorial condition that significantly impacts quality of life. Multimodal management strategies targeting different pain pathways may offer improved clinical outcomes. This exploratory study aimed to evaluate whether a structured multimodal pelvic floor rehabilitation protocol combining low-intensity shock wave therapy (LiSWT) and transcutaneous electrical nerve stimulation (TENS) was associated with pain reduction in women with refractory chronic pelvic pain. Methods This study was designed as a single-arm pre-post study without a control group. It was conducted in 44 women with refractory chronic pelvic pain. All participants underwent a structured pelvic floor rehabilitation program consisting of 12 weekly sessions. TENS was applied weekly, and LiSWT was administered in eight sessions during the treatment period. Pain severity was measured with the Visual Analog Scale (VAS) before initiation of therapy and after completion of the rehabilitation program. Pre- and post-treatment VAS scores were compared using a paired-samples t-test. Results Final analysis included 44 women with refractory chronic pelvic pain. Mean pain scores decreased from 9.3 before treatment to 1.2 after treatment, demonstrating a statistically significant reduction. Conclusion The combination of LiSWT and TENS was associated with a clinically meaningful short-term reduction in pain among women with refractory chronic pelvic pain. These preliminary findings support the potential role of multimodal therapeutic strategies targeting different mechanisms involved in chronic pain. Further randomized controlled studies with long-term follow-up are required to confirm these results, isolate the contribution of each modality, and evaluate the durability of response.