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Scandinavian Journal of Pain Jan 2018Individuals with non-acute pain are challenged with variable pain responses following surgery as well as psychological challenges, particularly depression and...
BACKGROUND AND AIMS
Individuals with non-acute pain are challenged with variable pain responses following surgery as well as psychological challenges, particularly depression and catastrophizing. The purpose of this study was to compare pre- and postoperative psychosocial tests and the associated presence of sensitization on a cohort of women undergoing elective laparoscopic surgery for non-acute pain defined as pain sufficient for surgical investigation without persistent of chronic pain.
METHODS
The study was a secondary analysis of a previous report (Am J Obstet Gynecol 2014 Oct;211(4):360-8.). The study was a prospective cohort trial of 77 women; 61 with non-acute pain and 16 women for a tubal ligation. The women had the following tests: Pain Disability Index, Pain Catastrophizing Scale, CES-D (Center for Epidemiologic Studies Depression Scale) depression scale and the McGill Pain Scale (short form) as well as their average pain score and the presence of pain sensitization. All test scores were correlated together and comparisons were done using paired t-test.
RESULTS
There were reductions in pain and psychosocial test scores that were significantly correlated. Pre-operative sensitization indicated greater changes in psychosocial tests.
CONCLUSIONS
There was a close association of tests of psychosocial status with average pain among women having surgery on visceral tissues. Incorporation of these tests in the pre- and postoperative evaluation of women having laparoscopic surgery appears to provide a means to a broader understanding of the woman's pain experience.
Topics: Adult; Catastrophization; Dysmenorrhea; Elective Surgical Procedures; Endometriosis; Female; Humans; Laparoscopy; Middle Aged; Pain Threshold; Pain, Postoperative; Pelvic Pain; Pelvis; Prospective Studies; Sterilization, Tubal; Treatment Outcome; Young Adult
PubMed: 29794284
DOI: 10.1515/sjpain-2017-0127 -
The Journal of Urology Jun 2023Symptom heterogeneity in interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome, collectively termed urological chronic pelvic...
PURPOSE
Symptom heterogeneity in interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome, collectively termed urological chronic pelvic pain syndrome, has resulted in difficulty in defining appropriate clinical trial endpoints. We determine clinically important differences for 2 primary symptom measures, pelvic pain severity and urinary symptom severity, and evaluate subgroup differences.
MATERIALS AND METHODS
The Multidisciplinary Approach to the Study of Chronic Pelvic Pain Symptom Patterns Study enrolled individuals with urological chronic pelvic pain syndrome. We defined clinically important differences by associating changes in pelvic pain severity and urinary symptom severity over 3 to 6 months with marked improvement on a global response assessment using regression and receiver operating characteristic curves. We evaluated clinically important differences for absolute and percent change and examined differences in clinically important differences by sex-diagnosis, presence of Hunner lesions, pain type, pain widespreadness, and baseline symptom severity.
RESULTS
An absolute change of -4 was clinically important in pelvic pain severity among all patients, but clinically important difference estimates differed by pain type, presence of Hunner lesions, and baseline severity. Pelvic pain severity clinically important difference estimates for percent change were more consistent across subgroups and ranged from 30% to 57%. The absolute change urinary symptom severity clinically important difference was -3 for female participants and -2 for male participants with chronic prostatitis/chronic pelvic pain syndrome only. Patients with greater baseline severity required larger decreases in symptoms to feel improved. Estimated clinically important differences had lower accuracy among participants with low baseline symptoms.
CONCLUSIONS
A reduction of 30%-50% in pelvic pain severity is a clinically meaningful endpoint for future therapeutic trials in urological chronic pelvic pain syndrome. Urinary symptom severity clinically important differences are more appropriately defined separately for male and female participants.
Topics: Humans; Male; Female; Prostatitis; Pelvic Pain; Chronic Pain; Cystitis, Interstitial; Depression
PubMed: 36848118
DOI: 10.1097/JU.0000000000003394 -
Human Fertility (Cambridge, England) Dec 2023Pelvic congestion syndrome (PCS) in females and varicoceles in males may be regarded as closely related conditions since the main pathophysiological cause for both... (Review)
Review
Pelvic congestion syndrome (PCS) in females and varicoceles in males may be regarded as closely related conditions since the main pathophysiological cause for both processes is pelvic venous insufficiency. Varicoceles are more prevalent amongst sub-fertile males, with an approximate incidence of 15% in the general male population. PCS is commonly diagnosed amongst premenopausal multiparous women, representing one of the leading causes of chronic pelvic pain. Both conditions appear to be predominantly left-sided and are associated with oxidative stress and pro-inflammatory cascades with subsequent effects on fertility. Clinical examination and pelvic ultrasonography play an essential role in the assessment of varicoceles, PCS and chronic pelvic pain. Venography is generally considered as a gold-standard procedure for both conditions. There is still much debate on how these conditions should be managed. This review article provides a comparative analysis of the underlying pathophysiological mechanisms of both PCS and varicoceles, their impact on fertility, as well as their clinical management.
Topics: Male; Humans; Female; Varicocele; Embolization, Therapeutic; Pelvic Pain; Pelvis; Venous Insufficiency
PubMed: 37190955
DOI: 10.1080/14647273.2023.2212846 -
American Journal of Reproductive... Feb 2023Endometriosis is a public health disorder affecting ∼ 247 million women globally and ∼ 42 million women in India. Women with endometriosis suffer from dysmenorrhea,... (Review)
Review
Endometriosis is a public health disorder affecting ∼ 247 million women globally and ∼ 42 million women in India. Women with endometriosis suffer from dysmenorrhea, chronic pelvic pain, dyspareunia, dyschezia, fatigue, depression, and infertility leading to significant socioeconomic impact and morbidity. The etiology of endometriosis is not understood well even after 100 years of research. Currently, there is no permanent cure for endometriosis. The inflammatory immune response is one of the important features of etiopathogenesis of endometriosis and therefore understanding the inflammatory immune response would lead to a better understanding of this enigmatic disorder and may also lead to biomarker discovery for diagnosis of endometriosis. We investigated the autoimmune etiology of endometriosis in the Indian population. Using the proteomics approach, anti-endometrial antibodies (AEAs) were detected in Indian women with endometriosis [anti-endometrial antibodies - tropomyosin 3 (TPM3), stomatin-like protein2 (SLP-2), and tropomodulin 3 (TMOD3)]. The studies on AEAs provided a better understanding of autoimmune mechanisms in endometriosis. All three subtypes of endometriosis; superficial peritoneal, ovarian endometrioma, and deep infiltrating endometriosis were reported in Indian women. In this review, we discuss our experiences of the inflammatory immune response, autoimmunity, comorbidities, and clinical phenotypes in women with endometriosis in India.
Topics: Humans; Female; Endometriosis; Pelvic Pain; Dysmenorrhea; Immunity; India
PubMed: 35751585
DOI: 10.1111/aji.13590 -
Current Opinion in Obstetrics &... Aug 2016The objective of this study is to review an evidence-based approach to surgical treatment of key chronic pelvic pain (CPP) contributors emphasizing the importance of... (Review)
Review
PURPOSE OF REVIEW
The objective of this study is to review an evidence-based approach to surgical treatment of key chronic pelvic pain (CPP) contributors emphasizing the importance of preoperative evaluation and counseling.
RECENT FINDINGS
CPP is a poorly understood but highly prevalent condition and there are limited, well constructed studies to guide effective, durable treatment. CPP arises from factors originating in multiple organ systems, including reproductive, urologic, gastrointestinal, and myofascial, all informing the central nervous system. For those with severe disabling conditions, who have a suboptimal response to medical management, surgical interventions can be offered for diagnostic evaluation and/or treatment. Leiomyoma, adenomyosis, adnexal disorder, pelvic adhesions, and pelvic varicosities are common considerations in the differential diagnosis of CPP amenable to surgical approach.
SUMMARY
Surgical treatments of CPP range from conservative/fertility-sparing approaches to extirpative therapy. Consistently, successful outcomes often are predicated on correctly identifying the abnormal peripheral pain process (which often is only part of the complete picture for these patients). Further research is needed to better guide clinicians as to when to choose surgical therapy vs. targeting secondary contributors to pelvic pain.
Topics: Chronic Disease; Dysmenorrhea; Female; Humans; Hysterectomy; Leiomyoma; Minimally Invasive Surgical Procedures; Patient Selection; Pelvic Pain; Practice Guidelines as Topic; Tissue Adhesions; Uterine Neoplasms
PubMed: 27285959
DOI: 10.1097/GCO.0000000000000281 -
Urologia Sep 2017Clinical practice guidelines for the management of bladder pain syndrome/chronic pelvic pain aim to help guide clinicians in diagnosing and treating patients they see on... (Review)
Review
Clinical practice guidelines for the management of bladder pain syndrome/chronic pelvic pain aim to help guide clinicians in diagnosing and treating patients they see on a day-to-day basis in the clinic. However, the approaches suggested by current clinical guidelines may not always align with the practicalities of routine clinical practice, where patient expectations must also be taken into consideration.
Topics: Cystitis, Interstitial; Humans; Pain Management; Pelvic Pain; Practice Guidelines as Topic
PubMed: 28862731
DOI: 10.5301/uj.5000260 -
Radiologic Clinics of North America May 2019Pelvic ultrasound with endovaginal ultrasound is often the imaging test of choice in the initial evaluation of nonpregnant women with pelvic pain. This article considers... (Review)
Review
Pelvic ultrasound with endovaginal ultrasound is often the imaging test of choice in the initial evaluation of nonpregnant women with pelvic pain. This article considers the sonographic observations and techniques useful in diagnosis of a variety of gynecologic causes of pelvic pain in these women, including ovarian hemorrhage, ovarian torsion, pelvic inflammatory disease, endometriosis (particularly deeply infiltrating endometriosis), endometriomas, adenomyosis, pelvic congestion syndrome, and malpositioned intrauterine contraceptive devices. Sonographic observations regarding a number of non-gynecologic causes of pelvic pain are also described.
Topics: Contrast Media; Diagnosis, Differential; Female; Genital Diseases, Female; Humans; Pelvic Pain; Sensitivity and Specificity; Ultrasonography
PubMed: 30928080
DOI: 10.1016/j.rcl.2019.01.010 -
Current Opinion in Obstetrics &... Aug 2024In this review article, we discuss myofascial-related chronic pelvic pain, pathophysiology, symptomology, and management options. (Review)
Review
PURPOSE OF REVIEW
In this review article, we discuss myofascial-related chronic pelvic pain, pathophysiology, symptomology, and management options.
RECENT FINDINGS
Despite high prevalence of myofascial pelvic pain, screening is not routinely performed by providers. Treatment modalities include pelvic floor physical therapy, pelvic floor trigger point injections with anesthetics or botulinum toxin A and cryotherapy. Other adjunct modalities, such as muscle relaxants and intravaginal benzodiazepines, are used, but data regarding their effectiveness is sparse.
SUMMARY
Myofascial pelvic pain is an important, though overlooked component of chronic pelvic pain. Multimodal, multidisciplinary approach including patient education, pelvic floor physical therapy, and trigger point injections is the mainstay of the management of myofascial pelvic pain.
Topics: Humans; Pelvic Pain; Female; Chronic Pain; Myofascial Pain Syndromes; Pelvic Floor; Physical Therapy Modalities; Botulinum Toxins, Type A; Trigger Points; Cryotherapy
PubMed: 38837702
DOI: 10.1097/GCO.0000000000000966 -
The Journal of Urology Mar 2024We sought to systematically review and summarize the peer-reviewed literature on urologic chronic pelvic pain syndrome flares, including their terminology,... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
We sought to systematically review and summarize the peer-reviewed literature on urologic chronic pelvic pain syndrome flares, including their terminology, manifestation, perceived triggers, management and prevention strategies, impact on quality of life, and insights into pathophysiologic mechanisms, as a foundation for future empirical research.
MATERIALS AND METHODS
We searched 6 medical databases for articles related to any aspect of symptom exacerbations for interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome. A total of 1486 abstracts and 398 full-text articles were reviewed, and data were extracted by at least 2 individuals.
RESULTS
Overall, we identified 59 articles, including 36 qualitative, cross-sectional, or case-control; 15 cohort-based; and 8 experimental articles. The majority of studies described North American patients with confirmed diagnoses. "Flare" was a commonly used term, but additional terminology (eg, exacerbation) was also used. Most flares involved significant increases in pain intensity, but less data were available on flare frequency and duration. Painful, frequent, long-lasting, and unpredictable flares were highly impactful, even over and above participants' nonflare symptoms. A large number of perceived triggers (eg, diet, stress) and management/prevention strategies (eg, analgesics, thermal therapy, rest) were proposed by participants, but few had empirical support. In addition, few studies explored underlying biologic mechanisms.
CONCLUSIONS
Overall, we found that flares are painful and impactful, but otherwise poorly understood in terms of manifestation (frequency and duration), triggers, treatment, prevention, and pathophysiology. These summary findings provide a foundation for future flare-related research and highlight gaps that warrant additional empirical studies.
Topics: Humans; Male; Quality of Life; Cross-Sectional Studies; Prostatitis; Cystitis, Interstitial; Pelvic Pain; Chronic Pain
PubMed: 38109700
DOI: 10.1097/JU.0000000000003820 -
Nature Reviews. Urology Jan 2018Genital pain is a prevalent, complex, and disabling health concern in women. Efforts to study this chronic pain condition have been complicated by the fact that genital... (Review)
Review
Genital pain is a prevalent, complex, and disabling health concern in women. Efforts to study this chronic pain condition have been complicated by the fact that genital pain is heterogeneous and exists at the intersection of different biopsychosocial disciplines. Thus, organization of theoretical ideas and empirical findings across research areas is required to improve our understanding of how biopsychosocial factors affect the development and maintenance of the pain, the reporting of symptoms, and the choice of treatment. In the past, the study of physical markers has received the most research attention; an assimilation of the psychosocial variables underlying genital pain is, therefore, particularly needed to inform the field about the rapidly growing literature and stimulate interdisciplinary work. Current research lacks specificity, fails to capture the unique features of different pain conditions, and yields conflicting evidence, which makes it difficult to draw uniform conclusions. Although considerable advances have been made, confusion remains at the nosological, aetiological, theoretical, methodological, and treatment levels. This lack of consensus has important theoretical and clinical implications because inconsistent criteria and empirical disagreement can lead to misdiagnoses and interfere with the development of sound theoretical models and effective treatments to manage female genital pain and its physical and psychological sequelae.
Topics: Anesthetics, Local; Biomedical Research; Chronic Pain; Cognitive Behavioral Therapy; Diagnostic Errors; Diagnostic and Statistical Manual of Mental Disorders; Female; Genital Diseases, Female; Humans; Mindfulness; Models, Psychological; Pain Measurement; Pelvic Pain; Psychological Theory; Sexual Partners
PubMed: 29182603
DOI: 10.1038/nrurol.2017.187