The clinical value of EMG and SSEP in diagnosing chronic pelvic pain syndrome; a systematic review

BACKGROUND: Chronic pelvic pain syndrome (CPPS) is pain in the region of the lower pelvis for three months or longer. Which is often accompanied by complaints of organ systems in the lower abdomen. CPPS is often a subjective diagnosis where electrodiagnostic tests are recommended as a supplement in defining a diagnosis. OBJECTIVE: Synthesize the clinical studies that describe electrodiagnostic testing in humans with a clinical diagnosis of CPPS. EVIDENCE REVIEW: Registered in PROSPERO (CRD42024510404). A systematic search in Medline/PubMed, Embase, CINAHL, and Web of science, from inception till February 2024, complemented with reference examining. Two reviewers independently reviewed titles, abstracts, and full-text papers, and performed data extraction. Reviews were excluded, and papers were included if patients were clinically diagnosed with CPPS and underwent EMG and/or SSEP. The QUADAS-2 tool was used to assess the quality of studies. FINDINGS: Fourteen papers were included concerning EMG and/or SSEP, nine papers reported on EMG and five on SSEP. In total, 432 patients clinically diagnosed with CPPS underwent electrodiagnostic testing. 152/277 patients showed abnormalities on EMG and 102/155 patients had abnormal findings on SSEP. Due to the lack of quantitative data, no meta-analysis could be performed. CONCLUSIONS: Abnormalities on electrodiagnostic testing are seen in half of the patients with CPPS, and therefore not recommended as a substitute in the diagnostic process. The low number of patients enrolled in this review needs to be taken into consideration when interpreting the results. Further research on the sensitivity of EMG and/or SSEP in PN is recommended.