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Journal of Nanobiotechnology Jun 2023Chronic pelvic pain syndrome (CPPS) is a typical symptom of chronic prostatitis (CP) in males that may cause abnormal urination, sexual dysfunction, or depression and...
BACKGROUND
Chronic pelvic pain syndrome (CPPS) is a typical symptom of chronic prostatitis (CP) in males that may cause abnormal urination, sexual dysfunction, or depression and significantly affect the quality of life of the patient. Currently, there is no effective treatment for CPPS due to its recurrence and intractability. For synergistic CPPS therapy, we developed pH/reactive oxygen species (ROS) dual-responsive dexamethasone (Dex) nanoformulations using a ROS-responsive moiety and phytochemical modified α-cyclodextrin (α-CD) as the carrier.
RESULTS
Dex release from the nanoformulations can be controlled in acidic and/or ROS-rich microenvironments. The fabricated Dex nanoformulations can also be efficiently internalized by lipopolysaccharide (LPS)-stimulated macrophages, prostatic epithelial cells, and stromal cells. Moreover, the levels of proinflammatory factors (e.g., TNF-α, IL-1β, and IL-17 A) in these cells were significantly decreased by Dex nanoformulations treatment through the release of Dex, phytochemical and elimination of ROS. In vivo experiments demonstrated notable accumulation of the Dex nanoformulations in prostate tissue to alleviate the symptoms of CPPS through the downregulation of proinflammatory factors. Interestingly, depression in mice may be relieved due to alleviation of their pelvic pain.
CONCLUSION
We fabricated Dex nanoformulations for the effective management of CPPS and alleviation of depression in mice.
Topics: Male; Mice; Animals; Chronic Pain; Glucocorticoids; Quality of Life; Depression; Reactive Oxygen Species; Pelvic Pain
PubMed: 37340409
DOI: 10.1186/s12951-023-01893-4 -
The Veterinary Clinics of North... Aug 2018Pain localized to the neck, back, and or pelvis can result in a profound effect on the horse's performance. These conditions can present with a varied and nonspecific... (Review)
Review
Pain localized to the neck, back, and or pelvis can result in a profound effect on the horse's performance. These conditions can present with a varied and nonspecific set of clinical signs. A careful and thorough examination of these areas by means of physical examination, lameness evaluation both in hand and under saddle, diagnostic anesthesia, and the use of multiple imaging modalities in combination is often necessary to have an accurate prognosis. Medical and surgical management where appropriate of the conditions highlighted in this article are discussed as well as their individual prognosis.
Topics: Animals; Back Pain; Horse Diseases; Horses; Lameness, Animal; Neck Pain; Pelvic Pain
PubMed: 29853156
DOI: 10.1016/j.cveq.2018.04.002 -
Obstetrics and Gynecology Oct 2019The pathophysiology of endometriosis-associated pain involves inflammatory and hormonal alterations and changes in brain signaling pathways. Although medical treatment... (Review)
Review
The pathophysiology of endometriosis-associated pain involves inflammatory and hormonal alterations and changes in brain signaling pathways. Although medical treatment can provide temporary relief, most patients can achieve long-term sustained pain relief when it is combined with surgical intervention. Owing to its complexity, there is an ongoing debate about how to optimally manage endometriosis-associated pain. We believe optimal management for this condition requires: 1) possible egg preservation in affected young patients with and without endometriomas; 2) preoperative medical suppression to inhibit ovulation and to avoid removal of functional cysts that might look like endometriomas; and 3) postoperative hormonal suppression to decrease recurrence, but this treatment should be modified according to disease severity, symptoms, and fertility goals.
Topics: Endometriosis; Female; Gynecologic Surgical Procedures; Humans; Pelvic Pain
PubMed: 31503153
DOI: 10.1097/AOG.0000000000003461 -
Frontiers in Endocrinology 2020Endometriosis is a complex, heterogeneous, chronic inflammatory condition impacting ~176 million women worldwide. It is associated with chronic pelvic pain, infertility,... (Review)
Review
Endometriosis is a complex, heterogeneous, chronic inflammatory condition impacting ~176 million women worldwide. It is associated with chronic pelvic pain, infertility, and fatigue, and has a substantial impact on health-related quality of life. Endometriosis is defined by the growth of endometrial-like tissue outside the uterus, typically on the lining of the pelvic cavity and ovaries (known as "lesions"). Macrophages are complex cells at the center of this enigmatic condition; they are critical for the growth, development, vascularization, and innervation of lesions as well as generation of pain symptoms. In health, tissue-resident macrophages are seeded during early embryonic life are vital for development and homeostasis of tissues. In the adult, under inflammatory challenge, monocytes are recruited from the blood and differentiate into macrophages in tissues where they fulfill functions, such as fighting infection and repairing wounds. The interplay between tissue-resident and recruited macrophages is now at the forefront of macrophage research due to their differential roles in inflammatory disorders. In some cancers, tumor-associated macrophages (TAMs) are comprised of tissue-resident macrophages and recruited inflammatory monocytes that differentiate into macrophages within the tumor. These macrophages of different origins play differential roles in disease progression. Herein, we review the complexities of macrophage dynamics in health and disease and explore the paradigm that under disease-modified conditions, macrophages that normally maintain homeostasis become modified such that they promote disease. We also interrogate the evidence to support the existence of multiple phenotypic populations and origins of macrophages in endometriosis and how this could be exploited for therapy.
Topics: Endometriosis; Female; Humans; Macrophages; Pelvic Pain; Peritoneal Diseases; Phenotype
PubMed: 32038499
DOI: 10.3389/fendo.2020.00007 -
Physical Medicine and Rehabilitation... Nov 2018Chronic pelvic pain is a common condition. Establishing a diagnosis can be complicated by the interplay between various organ systems, including urologic, gynecologic,... (Review)
Review
Chronic pelvic pain is a common condition. Establishing a diagnosis can be complicated by the interplay between various organ systems, including urologic, gynecologic, gastrointestinal, neurologic, endocrinological, psychological, and musculoskeletal. Frequently, the patient will have seen multiple providers and undergone multiple tests, as well as invasive procedures, before the musculoskeletal system is even considered in the differential diagnosis. Typically, the musculoskeletal and nervous systems become suspected culprits only once all other potential etiologies have been eliminated.
Topics: Chronic Pain; Humans; Pelvic Pain
PubMed: 30293630
DOI: 10.1016/j.pmr.2018.06.011 -
Current Opinion in Obstetrics &... Oct 2014The purpose of this review is to highlight the recent literature and emerging data describing clinical situations in which menstrual suppression may improve symptoms and... (Review)
Review
PURPOSE OF REVIEW
The purpose of this review is to highlight the recent literature and emerging data describing clinical situations in which menstrual suppression may improve symptoms and quality of life for adolescents. A variety of conditions occurring frequently in adolescents and young adults, including heavy menstrual bleeding, and dysmenorrhea as well as gynecologic conditions such as endometriosis and pelvic pain, can safely be improved or alleviated with appropriate menstrual management.
RECENT FINDINGS
Recent publications have highlighted the efficacy and benefit of extended cycle or continuous combined oral contraceptives, the levonorgestrel intrauterine device, and progestin therapies for a variety of medical conditions.
SUMMARY
This review places menstrual suppression in an historical context, summarizes methods of hormonal therapy that can suppress menses, and reviews clinical conditions for which menstrual suppression may be helpful.
Topics: Adolescent; Adolescent Health Services; Contraceptive Agents, Female; Contraceptives, Oral, Combined; Dysmenorrhea; Endometriosis; Female; Humans; Intrauterine Devices; Levonorgestrel; Menorrhagia; Pelvic Pain; Quality of Life; Treatment Outcome
PubMed: 25110977
DOI: 10.1097/GCO.0000000000000098 -
American Family Physician Feb 2016Chronic prostatitis is relatively common, with a lifetime prevalence of 1.8% to 8.2%. Risk factors include conditions that facilitate introduction of bacteria into the... (Review)
Review
Chronic prostatitis is relatively common, with a lifetime prevalence of 1.8% to 8.2%. Risk factors include conditions that facilitate introduction of bacteria into the urethra and prostate (which also predispose the patient to urinary tract infections) and conditions that can lead to chronic neuropathic pain. Chronic prostatitis must be differentiated from other causes of chronic pelvic pain, such as interstitial cystitis/bladder pain syndrome and pelvic floor dysfunction; prostate and bladder cancers; benign prostatic hyperplasia; urolithiasis; and other causes of dysuria, urinary frequency, and nocturia. The National Institutes of Health divides prostatitis into four syndromes: acute bacterial prostatitis, chronic bacterial prostatitis (CBP), chronic nonbacterial prostatitis (CNP)/chronic pelvic pain syndrome (CPPS), and asymptomatic inflammatory prostatitis. CBP and CNP/CPPS both lead to pelvic pain and lower urinary tract symptoms. CBP presents as recurrent urinary tract infections with the same organism identified on repeated cultures; it responds to a prolonged course of an antibiotic that adequately penetrates the prostate, if the urine culture suggests sensitivity. If four to six weeks of antibiotic therapy is effective but symptoms recur, another course may be prescribed, perhaps in combination with alpha blockers or nonopioid analgesics. CNP/CPPS, accounting for more than 90% of chronic prostatitis cases, presents as prostatic pain lasting at least three months without consistent culture results. Weak evidence supports the use of alpha blockers, pain medications, and a four- to six-week course of antibiotics for the treatment of CNP/CPPS. Patients may also be referred to a psychologist experienced in managing chronic pain. Experts on this condition recommend a combination of treatments tailored to the patient's phenotypic presentation. Urology referral should be considered when appropriate treatment is ineffective. Additional treatments include pelvic floor physical therapy, phytotherapy, and pain management techniques. The UPOINT (urinary, psychosocial, organ-specific, infection, neurologic/systemic, tenderness) approach summarizes the various factors that may contribute to presentation and can guide treatment.
Topics: Adrenergic alpha-Antagonists; Anti-Bacterial Agents; Chronic Disease; Diagnostic Imaging; Humans; Male; Pain Measurement; Pelvic Pain; Physical Therapy Modalities; Prostatitis; Risk Factors
PubMed: 26926816
DOI: No ID Found -
The Surgical Clinics of North America Jun 2016Pain occurs in the male genitourinary organs as for any organ system in response to traumatic, infectious, or irritative stimuli. A knowledge and understanding of... (Review)
Review
Pain occurs in the male genitourinary organs as for any organ system in response to traumatic, infectious, or irritative stimuli. A knowledge and understanding of chronic genitourinary pain can be of great utility to practicing nonurologists. This article provides insight into the medical and surgical management of subacute and chronic pelvic, inguinal, and scrotal pain. The pathophysiology, diagnosis, and medical and surgical treatment options of each are discussed.
Topics: Groin; Humans; Male; Pain; Pain Management; Pelvic Pain; Testicular Diseases; Urogenital System
PubMed: 27261797
DOI: 10.1016/j.suc.2016.02.014 -
Journal of Minimally Invasive Gynecology Dec 2021To assess the prevalence of myofascial pain in women undergoing uncomplicated, minimally invasive hysterectomy for chronic pelvic pain, to identify clinical and...
STUDY OBJECTIVE
To assess the prevalence of myofascial pain in women undergoing uncomplicated, minimally invasive hysterectomy for chronic pelvic pain, to identify clinical and demographic factors associated with preoperative myofascial pain, and examine the association between myofascial pain and postoperative pain in hysterectomy patients.
DESIGN
A retrospective cohort study.
SETTING
A tertiary care teaching hospital.
PATIENTS
A total of 353 adult women who underwent uncomplicated, minimally invasive hysterectomy between January 2014 and 2016.
INTERVENTIONS
All women underwent a preoperative pelvic floor examination. Myofascial pain was diagnosed as tenderness and reproduction of pain symptoms in at least 2 of 6 pelvic floor muscles. Demographics, comorbidities, and intraoperative characteristics were compared between women with and without preoperative myofascial pain.
MEASUREMENTS AND MAIN RESULTS
Of the 353 women who underwent hysterectomy, the prevalence of myofascial pain was 42.7% (86.0% in patients with chronic pelvic pain [CPP] compared with 13.7% without CPP). Women with myofascial pain were more likely younger, Caucasian, sexually active, and with comorbid pain conditions. Patients with myofascial pain used a greater number of adjuvant pain medications before surgery including opiates (29.5%) but were only half as likely to use muscle relaxants (12.1%) for preoperative pain control. Contrastingly, in women without myofascial pain before surgery, controlled substances such as opiates (8%, p <.01) and benzodiazepines (3%, p <.01) were used at a three- fold lower frequency. Postoperative pain score was higher in patients with myofascial pain, with 37% reporting a visual analog scale score greater than 5 at the routine postoperative visit compared with only 1% of patients without myofascial pain.
CONCLUSION
Myofascial pelvic pain must be considered in the evaluation of CPP, especially in surgical candidates. Women with myofascial pelvic use a greater amount of pain medication preoperatively and have higher pain scores postoperatively. Identification of these high-risk patients before surgery may improve pre and postoperative pain management with a multimodal therapy approach.
Topics: Adult; Chronic Pain; Female; Humans; Hysterectomy; Pelvic Floor; Pelvic Pain; Retrospective Studies
PubMed: 34147694
DOI: 10.1016/j.jmig.2021.06.009 -
Human Reproduction Update 2014Chronic pelvic pain (CPP) is a significant public health problem with 1 million affected women in the UK. Although many pathologies are associated with CPP, the pain... (Review)
Review
BACKGROUND
Chronic pelvic pain (CPP) is a significant public health problem with 1 million affected women in the UK. Although many pathologies are associated with CPP, the pain experienced is often disproportionate to the extent of disease identified and frequently no pathology is found (chronic pelvic pain syndrome). The central nervous system (CNS) is central to the experience of pain and chronic pain conditions in general are associated with alterations in both the structure and function of the CNS. This review describes the available evidence for central changes in association with conditions presenting with CPP.
METHODS
A detailed literature search was performed to identify relevant papers, however, this is not a systematic review.
RESULTS
CPP is associated with central changes similar to those identified in other pain conditions. Specifically these include, alterations in the behavioural and central response to noxious stimulation, changes in brain structure (both increases and decreases in the volume of specific brain regions), altered activity of both the hypothalamic-pituitary-adrenal axis and the autonomic nervous system (ANS) and psychological distress.
CONCLUSIONS
The evidence reviewed in this paper demonstrates that CPP is associated with significant central changes when compared with healthy pain-free women. Moreover, the presence of these changes has the potential to both exacerbate symptoms and to predispose these women to the development of additional chronic conditions. These findings support the use of adjunctive medication targeting the CNS in these women.
Topics: Brain; Chronic Pain; Endometriosis; Female; Humans; Hypothalamo-Hypophyseal System; Pelvic Pain; Pituitary-Adrenal System; Stress, Psychological
PubMed: 24920437
DOI: 10.1093/humupd/dmu025