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Schmerz (Berlin, Germany) Dec 2023The pain phenomena caused by endometriosis are manifold. In addition to nociceptive pain there is also a nociplastic reaction with central sensitization. Atypical... (Review)
Review
BACKGROUND
The pain phenomena caused by endometriosis are manifold. In addition to nociceptive pain there is also a nociplastic reaction with central sensitization. Atypical symptoms, such as acyclic lower abdominal pain, radiating pain, nonspecific bladder and intestinal complaints or even depression increasingly occur in addition to the classical cyclic complaints, such as severe dysmenorrhea, cyclic lower abdominal pain, dyspareunia, dysuria and dyschezia. Due to the diffuse range of symptoms, affected patients often consult not just gynecologists but also specialists from other disciplines (internal medicine, gastroenterology, orthopedics, pain therapy, psychology etc.).
OBJECTIVE
The complexity of endometriosis is presented. The resulting approaches to multimodal interdisciplinary holistic treatment are described.
RESULTS
Interdisciplinary concepts should be involved in the optimal treatment of endometriosis patients along with hormonal and surgical treatment, mostly under the supervision of a gynecologist and pain management, dietary changes, psychological support and physiotherapeutic management should also be included. This article provides an overview of possible treatment strategies for chronic symptomatic endometriosis.
CONCLUSION
Based on multimodal treatment strategies and regarding the complex pathophysiological alterations of this disease, the complex complaints that significantly impair the quality of life of endometriosis patients can be greatly improved.
Topics: Female; Humans; Endometriosis; Pelvic Pain; Dysmenorrhea; Quality of Life; Abdominal Pain
PubMed: 37626190
DOI: 10.1007/s00482-023-00747-0 -
Clinical Obstetrics and Gynecology Dec 2022As our understanding of chronic pain conditions, including endometriosis-related pain and chronic pelvic pain evolves, the evaluation and management of patients should... (Review)
Review
As our understanding of chronic pain conditions, including endometriosis-related pain and chronic pelvic pain evolves, the evaluation and management of patients should reflect our increasing appreciation of the role of central sensitization, comorbid conditions and biopsychosocial factors on the pain experience and treatment outcomes. This review provides a systematic approach to persistent pain in patients with endometriosis. Expanding the evaluation and treatment of endometriosis-related pain by all health care providers could limit unnecessary surgical interventions and best meet our patient's needs.
Topics: Female; Humans; Endometriosis; Pelvic Pain; Chronic Pain; Chronic Disease; Treatment Outcome
PubMed: 35467583
DOI: 10.1097/GRF.0000000000000712 -
Ceska Gynekologie 2023There are many types of pelvic pain. Pelvic plexus pain, coccyx pain, pain from episiotomy scars, and vulvodynia are frequently seen in postpartum women. The aim of this...
OBJECTIVE
There are many types of pelvic pain. Pelvic plexus pain, coccyx pain, pain from episiotomy scars, and vulvodynia are frequently seen in postpartum women. The aim of this study was to conduct a systematic review of studies on pelvic pain in postpartum women to assess the effect of physiotherapy interventions on each type of pain.
METHODS
A comprehensive literature review was conducted by searching on PubMed, Ovid Embase and Scopus Web of Science using the key words - pelvic pain, women after childbirth, pelvic girdle pain, coccygodynia, episiotomy, vulvodynia, and physiotherapy. The author reviewed all the identified articles and selected articles for inclusion according to relevance to the topic.
CONCLUSION
Based on the analysis of the above studies, it can be concluded that a comprehensive physiotherapy designed for postpartum women that includes manual techniques, behavioral techniques, relaxation of hypo-tonic and shortened muscles and strengthening of hypotonic muscles can positively affect a wide range of pain and associated dysfunctions of the pelvic floor and trunk muscles.
Topics: Female; Humans; Pregnancy; Parturition; Pelvic Pain; Physical Therapy Modalities; Postpartum Period; Vulvodynia
PubMed: 37344188
DOI: 10.48095/cccg2023214 -
Interventional Cardiology Clinics Jul 2022Pelvic venous disorders are inter-related pathologic conditions caused by reflux and obstruction in the pelvic veins. It can present a spectrum of clinical features... (Review)
Review
Pelvic venous disorders are inter-related pathologic conditions caused by reflux and obstruction in the pelvic veins. It can present a spectrum of clinical features based on the route of transmission of venous hypertension to either distal or caudal venous reservoirs. Imaging can help to visualize pelvic vascular and visceral structures to rule out other gynecologic, gastrointestinal, and urologic diseases. Endovascular treatment, owing to its low invasive nature and high success rate, has become the mainstay in the management of pelvic venous disorders. This article reviews the pathophysiology, clinical presentations, and diagnostic and therapeutic approaches to pelvic venous disorders.
Topics: Female; Humans; Pelvic Pain; Vascular Diseases
PubMed: 35710285
DOI: 10.1016/j.iccl.2022.03.003 -
Seminars in Reproductive Medicine Mar 2018Chronic pelvic pain (CPP) is a recurring and/or constant pain of at least six months duration that has resulted in either functional or psychological disability that can... (Review)
Review
Chronic pelvic pain (CPP) is a recurring and/or constant pain of at least six months duration that has resulted in either functional or psychological disability that can require interventional treatments. Chronic pelvic pain can be visceral, somatic, neuropathic, or a combination. Patients with CPP often suffer from concurrent bowel or bladder dysfunction, sexual dysfunction, depression, and anxiety. The complexity of chronic pelvic pain can be challenging to treat, which can lead to frustration for both patients and their physicians. Treatment should involve a comprehensive and multi-modal approach involving psychosocial support, counseling, physical therapy, medication management, and interventional procedures. This manuscript will focus both on the etiologies and the interventional treatment options for chronic pelvic pain.
Topics: Chronic Pain; Female; Humans; Neuralgia; Pain Management; Pelvic Pain; Somatoform Disorders; Visceral Pain
PubMed: 30566982
DOI: 10.1055/s-0038-1676104 -
BJOG : An International Journal of... Jan 2017
Topics: Adult; Female; Hemostasis, Surgical; Humans; Middle Aged; Pelvic Pain; Uterine Myomectomy
PubMed: 28012271
DOI: 10.1111/1471-0528.14320 -
European Journal of Obstetrics,... Feb 2017Pain is the central symptom in endometriosis and often persists despite treatment of the disease. Multiple mechanisms underlie endometriosis-associated pain including... (Review)
Review
Pain is the central symptom in endometriosis and often persists despite treatment of the disease. Multiple mechanisms underlie endometriosis-associated pain including nociception, inflammation, and alterations in peripheral and central nervous system pain processing. As also occuring in other chronic conditions, pain in endometriosis is often associated with psychological distress and fatigue, both of which may amplify pain. It is hoped that in the future methods of phenotyping women on the basis of the underlying pain mechanisms will be developed, likely combining a critical evaluation of clinical symptoms and signs with laboratory and imaging tests. Optimal pain relief for an individual is more likely if her specific contributory pain mechanisms are identified and appropriately addressed. Such methods may also improve the selection of patients for clinical trials, potentially increasing the probability of identifying novel treatments for the many women with endometriosis for whom acceptable analgesia is not achieved.
Topics: Endometriosis; Female; Humans; Pain Management; Pelvic Pain; Stress, Psychological
PubMed: 27522645
DOI: 10.1016/j.ejogrb.2016.07.497 -
Current Rheumatology Reviews 2016Chronic pelvic pain in men has often been misdiagnosed as prostatitis. After excluding serious or acute urological, neurological or colorectal conditions, it is... (Review)
Review
Chronic pelvic pain in men has often been misdiagnosed as prostatitis. After excluding serious or acute urological, neurological or colorectal conditions, it is essential to approach these patients with a much more comprehensive criteria. Thoughtful interview and methodical physical examination can very often reveal pelvic floor muscle dysfunction, Myofascial pain syndromes, Functional Somatic Syndrome/Central Sensitization Syndromes and/or psychosocial distress. One must be aware that many of these syndromes frequently overlap. Acknowledgement of these conditions and validation of both their physical and psychological distress is paramount to creating trust and confidence in the patient. These are the cornerstones for empowerment and self-care required in the management of chronic pelvic pain.
Topics: Chronic Pain; Humans; Male; Pelvic Pain; Prostatitis; Self Care; Stress, Psychological; Urology
PubMed: 26717951
DOI: 10.2174/1573397112666151231110656 -
Journal of Midwifery & Women's Health Mar 2021Myofascial pelvic pain is a common, nonarticular musculoskeletal disorder characterized by the presence of myofascial trigger points in the lower abdominal wall and/or... (Review)
Review
Myofascial pelvic pain is a common, nonarticular musculoskeletal disorder characterized by the presence of myofascial trigger points in the lower abdominal wall and/or pelvic floor muscles. Myofascial pelvic pain is involved in an estimated 22% to 94% of cases of chronic pelvic pain, which is one of the most common gynecologic conditions in the United States. Myofascial pelvic pain may exist independently or in conjunction with disorders such as vaginismus, dysmenorrhea, and endometriosis and is frequently a causative factor in sexual pain or dyspareunia. This article reviews the pathophysiology, assessment, and treatment options for myofascial pelvic pain, with a particular focus on trigger point injections. Increased recognition and treatment of this commonly overlooked diagnosis has the potential to improve care and outcomes for many patients suffering from chronic pelvic pain.
Topics: Chronic Pain; Dysmenorrhea; Endometriosis; Female; Humans; Myofascial Pain Syndromes; Pelvic Pain
PubMed: 33788379
DOI: 10.1111/jmwh.13224 -
Seminars in Ultrasound, CT, and MR Dec 2023Acute pelvic pain is defined as a new symptom that has been present for less than 3 months. It is a common symptom seen in 15%-24% of women and is the indication for... (Review)
Review
Acute pelvic pain is defined as a new symptom that has been present for less than 3 months. It is a common symptom seen in 15%-24% of women and is the indication for 20% of laparoscopies and 2%-10% of outpatient gynecologic visits. The pregnancy status and correlation of the physical symptoms with clinical findings are important. Ultrasound is the imaging modality of choice, not only to diagnose gynecological causes, but also bowel or urinary tract related causes of pelvic pain. When an ultrasound scan is inconclusive, a computed tomography scan is the preferred means of additional imaging and is particularly useful in gastrointestinal and urogenital causes of pelvic pain. Gynecological causes of acute pelvic pain include uterine, tubal, or ovarian pathology; non-gynecological causes include bowel diseases, such as appendicitis and diverticulitis; urogenital causes such as ureteral, bladder stones, and urinary tract infection as well as vascular causes. Ultrasound imaging alone may provide a definitive diagnosis in underlying conditions that require prompt medical or surgical intervention in gynecological conditions, such as ovarian torsion, ectopic pregnancy, and non-gynecological condition, such as in acute appendicitis.
Topics: Pregnancy; Female; Humans; Appendicitis; Genital Diseases, Female; Pregnancy, Ectopic; Pelvic Pain; Ultrasonography; Ureteral Calculi
PubMed: 37832696
DOI: 10.1053/j.sult.2023.10.004