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Pain Physician Sep 2023Endometriosis is a chronic common condition affecting 10% of reproductive-aged women globally. It is caused by the growth of endometrial-like tissue outside the uterine... (Review)
Review
BACKGROUND
Endometriosis is a chronic common condition affecting 10% of reproductive-aged women globally. It is caused by the growth of endometrial-like tissue outside the uterine cavity and leads to chronic pelvic pain, affecting various aspects of a woman's physical, mental, emotional, and social well-being. This highlights the importance of an understanding of the potential involvement of the nervous system and involved nerves as well as an effective multidisciplinary pain management.
OBJECTIVES
Our aim was to assess the current understanding of pain mechanisms in endometriosis and the effectiveness of different interventional pain management strategies.
STUDY DESIGN
Literature review.
METHODS
A search was conducted using multiple databases, including Google Scholar, MEDLINE (Ovid), PubMed, and Embase. We used keywords such as "endometriosis," "pain," pelvic pain, "management," and "anaesthesia" along with Boolean operators and MeSH terms. The search was limited to English language articles published in the last 15 years.
RESULTS
Nerve involvement is a well-established mechanism for pain generation in patients with endometriosis, through direct invasion, irritation, neuroangiogenesis, peripheral and central sensitization, and scar tissue formation. Endometriosis may also affect nerve fibers in the pelvic region, causing chronic pelvic pain, including sciatic neuropathy and compression of other pelvic nerves. Endometriosis can cause sciatica, often misdiagnosed due to atypical symptoms. Interventional pain management techniques such as superior hypogastric plexus block, impar ganglion block, S3 pulsed radiofrequency, myofascial pain trigger point release, peripheral nerve hydrodissection, and neuromodulation have been used to manage persistent and intractable pain with positive patient outcomes and improved quality of life.
LIMITATIONS
The complex and diverse clinical presentations of endometriosis make it challenging to compare the effectiveness of different pain management techniques.
CONCLUSION
Endometriosis is a complex condition causing various forms of pain including nerve involvement, scar tissue formation, and bowel/bladder symptoms. Interventional pain management techniques are effective for managing endometriosis-related pain.
KEY WORDS
Endometriosis, chronic pain, therapeutic interventions, interventional techniques, pain injections, visceral pain, peripheral pain.
Topics: Adult; Female; Humans; Chronic Disease; Cicatrix; Endometriosis; Pain Management; Pelvic Pain; Pelvis; Quality of Life
PubMed: 37774202
DOI: No ID Found -
Philosophical Transactions of the Royal... Mar 2015The pelvis performs two major functions for terrestrial mammals. It provides somewhat rigid support for muscles engaged in locomotion and, for females, it serves as the... (Comparative Study)
Comparative Study Review
The pelvis performs two major functions for terrestrial mammals. It provides somewhat rigid support for muscles engaged in locomotion and, for females, it serves as the birth canal. The result for many species, and especially for encephalized primates, is an 'obstetric dilemma' whereby the neonate often has to negotiate a tight squeeze in order to be born. On top of what was probably a baseline of challenging birth, locomotor changes in the evolution of bipedalism in the human lineage resulted in an even more complex birth process. Negotiation of the bipedal pelvis requires a series of rotations, the end of which has the infant emerging from the birth canal facing the opposite direction from the mother. This pattern, strikingly different from what is typically seen in monkeys and apes, places a premium on having assistance at delivery. Recently reported observations of births in monkeys and apes are used to compare the process in human and non-human primates, highlighting similarities and differences. These include presentation (face, occiput anterior or posterior), internal and external rotation, use of the hands by mothers and infants, reliance on assistance, and the developmental state of the neonate.
Topics: Adaptation, Biological; Animals; Biological Evolution; Female; History, Ancient; Humans; Labor Presentation; Midwifery; Parturition; Pelvis; Pregnancy; Primates; Species Specificity
PubMed: 25602069
DOI: 10.1098/rstb.2014.0065 -
Neurosurgery Clinics of North America Jan 2020Adult spinal deformity is a major contributor to pain and disability. It is a degenerative disease with a rigid spine. Spinopelvic parameters have been identified that... (Review)
Review
Adult spinal deformity is a major contributor to pain and disability. It is a degenerative disease with a rigid spine. Spinopelvic parameters have been identified that outline goals of operative intervention, as they have shown to significantly improve patient outcomes. Previously, this was accomplished with large, open fusions. Unfortunately, the adult spinal deformity population is often elderly with significant comorbidities. These extensive fusions have a high rate of morbidity and mortality. Technological advances have allowed minimally invasive approaches to be developed. These techniques have decreased operative morbidity without increasing health care spending.
Topics: Humans; Lordosis; Minimally Invasive Surgical Procedures; Neurosurgical Procedures; Pelvis; Scoliosis; Spine
PubMed: 31739921
DOI: 10.1016/j.nec.2019.08.013 -
Journal of Minimally Invasive Gynecology Feb 2021This video tutorial identifies key anatomic landmarks useful in identifying the path of the most commonly encountered pelvic nerves in benign gynecologic surgery. (Review)
Review
OBJECTIVE
This video tutorial identifies key anatomic landmarks useful in identifying the path of the most commonly encountered pelvic nerves in benign gynecologic surgery.
DESIGN
This is a narrated overview of commonly encountered pelvic nerves during benign gynecology, their origin, sensory, and motor function, as well as sequelae related to injury.
SETTING
The unintended injury of pelvic neural connections can be a complication of any pelvic surgery, however, surgery for malignancy or endometriosis may increase the likelihood of encountering these nerves. The majority of focus surrounding surgical nerve injury, however, relates to patient positioning [1]. Injury to the pelvic nerves can lead to lifelong sexual, bladder, and defecatory dysfunction [2].
INTERVENTIONS
We review the Genitofemoral, Lateral Femoral Cutaneous, Ilioinguinal, Obturator, Superior and Inferior Hypogastric nerves, Pelvic Splanchnic nerves, and the Sacral nerves. Surgical illustrations are used (Fig. 1) alongside real-time narrated video to help viewers recognize the normal course of commonly encountered pelvic nerves at the time of gynecologic surgery (Figs2-3).
CONCLUSION
The surgical management of complex pelvic disease can unfortunately carry significant patient morbidity [3]. The neural pathways traveling through the pelvis via the hypogastric nerves are responsible for proprioception, vaginal lubrication, and proper functioning or the urethral and anal sphincters [4]. Sparing these nerves during pelvic surgery, and especially when anatomic planes are distorted by pelvic disease, requires surgical expertise and an immense understanding of pelvic neuroanatomy [4,5]. Preservation of the pelvic neural pathways is necessary to deliver the best patient outcomes while minimizing unwanted surgical complications. This video tutorial also highlights the origin of these nerves, their anatomic location, procedures in which these nerves may be encountered, and what sequelae occur from their unintended injury.
Topics: Endometriosis; Female; Genital Neoplasms, Female; Gynecologic Surgical Procedures; Humans; Laparoscopy; Lumbosacral Plexus; Pelvis; Splanchnic Nerves; Urologic Neoplasms
PubMed: 32540500
DOI: 10.1016/j.jmig.2020.06.005 -
Zhonghua Wei Chang Wai Ke Za Zhi =... Mar 2023With the development of existing surgical techniques, equipment and treatment concepts, more and more medical centers begin to carry out extensive resection for...
With the development of existing surgical techniques, equipment and treatment concepts, more and more medical centers begin to carry out extensive resection for recurrent pelvic malignant tumors or those with multivisceral invasion. Exenteration may facilitate curative resection and improve the outcome of the patients. Therefore, pelvic exenteration has gradually become the standard of care for locally advanced pelvic malignancies. At present, pelvic exenteration leads to high intraoperative and postoperative complications and mortality, and therefore compromise the safety and long-term quality of life. Cumulating evidences suggest remnant cavity after exenteration might trigger the pathophysiological process and cause downstream complications which can be defined as empty pelvis syndrome. The literature related to empty pelvic syndrome was summarized, the possible cause of empty pelvic syndrome was analyzed. After the pelvic exenteration, the closed pelvic residual cavity formed continuous negative pressure with the gradual absorption of air in the cavity, bacterial propagation, and accumulation of fluid, which had an impact on the distribution of organs in the abdominal and pelvic cavity. At the same time, whether physical processes also play a role in the occurrence of empty pelvic syndrome remains to be explored. It is concluded that the diagnosis is mainly based on the patient's medical history, clinical manifestations and radiological findings, and the history of pelvic exenteration is the most important indicator in the diagnosis. In terms of prevention measures, we should identify the high-risk groups of the occurrence of empty pelvic syndrome, and then take accurate and individualized preventive measures. Various new biomaterials have more advantages in preventive pelvic cavity filling than traditional human tissue filling. Mesentery plays an important role in the morphology, peristalsis and arrangement of the small intestine. More attention should be paid to reducing the ectopic placement of the small intestine into the pelvic cavity by protecting the mesentery structure and restoring or rebuilding the mesentery morphology. In terms of treatment measures, there is still a lack of standard treatment pathway for empty pelvic syndrome.
Topics: Humans; Quality of Life; Neoplasm Recurrence, Local; Pelvis; Pelvic Exenteration; Pelvic Neoplasms; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 36925124
DOI: 10.3760/cma.j.cn441530-20221202-00502 -
Abdominal Radiology (New York) Jul 2020Nonobstructive azoospermia (NOA) can be caused by various diseases, including congenital disorders, endocrine disorders, infections, tumor or tumor-like diseases,... (Review)
Review
Nonobstructive azoospermia (NOA) can be caused by various diseases, including congenital disorders, endocrine disorders, infections, tumor or tumor-like diseases, vascular diseases, etc. Diagnosis of the underlying cause of NOA is complicated and challenging. In this study, we introduce an MR examination protocol for the etiological diagnosis of NOA, and demonstrate a series of NOA patients with different causes and imaging findings. Except for lesions of testes, the patients may also combine abnormalities of adrenal glands and central nervous system. In such cases, the patients could benefit from additional abdominal and intracranial scans.
Topics: Abdomen; Azoospermia; Humans; Magnetic Resonance Imaging; Male; Pelvis; Testis
PubMed: 31552463
DOI: 10.1007/s00261-019-02232-8 -
Trends in Endocrinology and Metabolism:... Jan 2015Endometriosis is an extremely prevalent estrogen-dependent condition characterized by the growth of ectopic endometrial tissue outside the uterine cavity, and is often... (Review)
Review
Endometriosis is an extremely prevalent estrogen-dependent condition characterized by the growth of ectopic endometrial tissue outside the uterine cavity, and is often presented with severe pain. Although the relationship between lesion and pain remains unclear, nerve fibers found in close proximity to endometriotic lesions may be related to pain. Also, women with endometriosis pain develop central sensitization. Endometriosis creates an inflammatory environment and recent research is beginning to elucidate the role of inflammation in stimulating peripheral nerve sensitization. In this review, we discuss endometriosis-associated inflammation, peripheral nerve fibers, and assess their potential mechanism of interaction. We propose that an interaction between lesions and nerve fibers, mediated by inflammation, may be important in endometriosis-associated pain.
Topics: Cell Communication; Disease Progression; Endometriosis; Estrogens; Female; Humans; Inflammation; Nerve Fibers; Pelvic Pain; Pelvis
PubMed: 25465987
DOI: 10.1016/j.tem.2014.10.003 -
Evolutionary Anthropology Oct 2023Recent research on the pelvis has clarified the flexibility of pelvic bones to manage nearly infinite possibilities in terms of selection and drift, while still... (Review)
Review
Recent research on the pelvis has clarified the flexibility of pelvic bones to manage nearly infinite possibilities in terms of selection and drift, while still maintaining excellent bipedalism. Despite this work, and the studies outlining the diversity of pelvic morphology across the hominin lineage, conversations continue to be stymied by distractions related to purported trade-offs that the different functions the pelvis must either allow for (e.g., parturition) or directly perform (e.g., attachment sites of muscles). Here we show that tight constraints on morphology are not evident in the pelvic variation of multiple human populations. We thus provide further evidence that human pelves are not geometrically similar and that pelvic morphology successfully balances the intersection of population history, active selective, and drift.
Topics: Animals; Humans; Pelvis; Pelvic Bones; Hominidae; Communication
PubMed: 37609957
DOI: 10.1002/evan.22001 -
Abdominal Radiology (New York) Nov 2018
Review
Topics: Achondroplasia; Humans; Pelvis; Radiography, Abdominal
PubMed: 29556700
DOI: 10.1007/s00261-018-1568-2 -
International Journal of Gynecological... Sep 2019The primary objective of this review was to study and analyze techniques of nerve-sparing radical hysterectomy so as to be able to characterize and elucidate intricate... (Review)
Review
AIM
The primary objective of this review was to study and analyze techniques of nerve-sparing radical hysterectomy so as to be able to characterize and elucidate intricate steps for the dissection of each component of the pelvic autonomic nerve plexuses during nerve-sparing radical hysterectomy.
METHODS
This review was based on a five-step study design that included searching for relevant publications, selecting publications by applying inclusion and exclusion criteria, quality assessment of the identified studies, data extraction, and data synthesis.
RESULTS
There are numerous differences in the published literature concerning nerve-sparing radical hysterectomy including variations in techniques and surgical approaches. Techniques that claim to be nerve-sparing by staying above the dissection level of the hypogastric nerves do not highlight the pelvic splanchnic nerve, do not take into account the intra-operative patient position, nor the fact that the bladder branches leave the inferior hypogastric plexus in a ventrocranial direction, and the fact that inferior hypogastric plexus will be drawn cranially with the vaginal walls (if this is not recognized and isolated earlier) above the level of hypogastric nerves by drawing the uterus cranially during the operation.
CONCLUSIONS
The optimal nerve-sparing radical hysterectomy technique has to be radical (type C1) and must describe surgical steps to highlight all three components of the pelvic autonomic nervous system (hypogastric nerves, pelvic splanchnic nerves, and the bladder branches of the inferior hypogastric plexus). Recognizing the pelvic splanchnic nerves in the caudal parametrium and the isolation of the bladder branches of the inferior hypogastic plexus requires meticulous preparation of the caudal part of the ventral parametrium.
Topics: Female; Humans; Hypogastric Plexus; Hysterectomy; Pelvis; Splanchnic Nerves; Urinary Bladder
PubMed: 31326949
DOI: 10.1136/ijgc-2019-000410