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Clinical Obstetrics and Gynecology Mar 2019Patients with pelvic pain suffer from psychological conditions at a disproportionately high rate compared with their peers. We review environmental, genetic,... (Review)
Review
Patients with pelvic pain suffer from psychological conditions at a disproportionately high rate compared with their peers. We review environmental, genetic, inflammatory, and neurobiological factors that increase vulnerability to developing both of these conditions. We review treatment strategies for chronic pelvic pain in patients who have comorbid psychological conditions, including both nonpharmacologic and pharmacologic options.
Topics: Antidepressive Agents, Tricyclic; Anxiety; Catastrophization; Chronic Pain; Cognitive Behavioral Therapy; Depression; Female; Gabapentin; Humans; Off-Label Use; Pelvic Pain; Prevalence; Serotonin and Noradrenaline Reuptake Inhibitors; Twin Studies as Topic
PubMed: 30383545
DOI: 10.1097/GRF.0000000000000412 -
Current Opinion in Urology Mar 2024Chronic pelvic pain is much of a burden to those who suffer from it. Additionally, in many patients medical doctors, such as urologists are unable to identify a cause or... (Review)
Review
PURPOSE OF REVIEW
Chronic pelvic pain is much of a burden to those who suffer from it. Additionally, in many patients medical doctors, such as urologists are unable to identify a cause or clear pathology that can explain the pain. Still numerous patients and doctors keep on searching for a cause, focussing particularly on the pelvic organs. Lots of diagnostics and treatment methods are used but often without success. In recent years, we have gained increased insight into the mechanisms of pain and adapted the terminology accordingly.
RECENT FINDINGS
Two aspects of chronic pelvic pain have gained more attention. First, the myofascial aspects, especially the role of the pelvic floor muscles in maintaining the pain and as a therapeutic option. Second, the role of the brain and the psychological aspects intertwine with the pain and its consequences also open up for alternative management options. In terminology chronic pain is now included in the ICD-11, a historical change. Introducing chronic primary pain (no cause found) helps us to look away from the organ and deal with the patient as a whole human being.
SUMMARY
The findings reported here are helpful for your daily practice. Looking from a broad perspective gives the patient the feeling of being seen and heard. Working together in a multidisciplinary team makes your work easier and gives more satisfaction.
VIDEO ABSTRACT
http://links.lww.com/COU/A44.
Topics: Humans; Chronic Pain; Urinary Bladder; Myofascial Pain Syndromes; Pelvic Pain; Pelvis
PubMed: 37823725
DOI: 10.1097/MOU.0000000000001134 -
Current Urology Reports Oct 2022The purpose of this paper is to review the most recent literature on non-surgical therapeutic options for chronic pelvic pain in females. (Review)
Review
PURPOSE OF REVIEW
The purpose of this paper is to review the most recent literature on non-surgical therapeutic options for chronic pelvic pain in females.
RECENT FINDINGS
Chronic pelvic pain can arise from virtually any organ system in the human body. If a precise etiology is identified, the management of chronic pelvic pain can be tailored accordingly. In some cases, patients with chronic pelvic pain can remain without a specific diagnosis. In these circumstances, adequate symptom control can still be achieved even if no underlying disorder is found. Although chronic pelvic pain is often a difficult disorder to manage, several non-surgical management options exist. Employing a multidisciplinary approach, most patients can achieve adequate symptom relief, usually without the need for surgical intervention.
Topics: Chronic Disease; Chronic Pain; Female; Humans; Pelvic Pain
PubMed: 36066815
DOI: 10.1007/s11934-022-01110-z -
Current Medical Research and Opinion Nov 2019This review presents modern information on the anatomy of pelvic veins, mechanisms of development of pelvic congestion syndrome (PCS) and venous pelvic pain (VPP),... (Review)
Review
This review presents modern information on the anatomy of pelvic veins, mechanisms of development of pelvic congestion syndrome (PCS) and venous pelvic pain (VPP), methods for verifying the venous nature of pelvic pain, as well as opportunities of various surgical interventions on the gonadal veins in treatment of PCS and relief of its most severe symptom, VPP. A comparative analysis of resection and embolization treatment methods and their effects on VPP, as well as rates of postprocedural complications, was carried out. The issues of elimination of specific compression syndromes causing occurrence of VPP, by using open, endoscopic and endovascular techniques are addressed.
Topics: Embolization, Therapeutic; Endovascular Procedures; Female; Humans; Pelvic Pain; Pelvis; Varicose Veins
PubMed: 31188059
DOI: 10.1080/03007995.2019.1631059 -
Obstetrics and Gynecology Clinics of... Dec 2019Ultrasonography (US) is often the first-line imaging study used to evaluate women who present with acute or chronic pelvic pain. Detection of nongynecologic causes of... (Review)
Review
Ultrasonography (US) is often the first-line imaging study used to evaluate women who present with acute or chronic pelvic pain. Detection of nongynecologic causes of pelvic pain is critical, because delay in diagnosis can cause significant morbidity and mortality. Evaluation of these entities requires a variety of transducers to achieve optimal imaging depth and changes in patient positioning. Specific imaging techniques (such as graded compression) may be required if bowel pathology is suspected. Contrast-enhanced ultrasonography is increasingly used to improve detection of certain entities. The US appearance of common gastrointestinal and urinary tract-related causes of pelvic pain is reviewed.
Topics: Diagnosis, Differential; Female; Humans; Pelvic Pain; Ultrasonography
PubMed: 31677752
DOI: 10.1016/j.ogc.2019.07.007 -
Vascular and Endovascular Surgery Jul 2023Chronic pelvic pain (CPP) is a prevalent condition in middle-aged women that represents a heavy social impact on the quality of life of those females. Treatment of...
Chronic pelvic pain (CPP) is a prevalent condition in middle-aged women that represents a heavy social impact on the quality of life of those females. Treatment of pelvic congestion syndrome is a complex and controversial issue, but treatment can be one of 3 lines: medical therapy, endovascular treatment, and surgical intervention. The endovascular line was first introduced in 1993 and has been popular over other lines of treatment methods. This retrospective study was conducted in a tertiary university hospital over 24 months, from March 2019 to March 2021. Forty patients with PGS were managed by left ovarian vein TCFS. The Institutional Review Board waived the need for ethics approval or informed consent to use anonymized and retrospectively analyzed data. The mean age of enrolled women was 33.80 ± 6.54 years, ranging between 20 and 45 years. Trans-catheter ethanolamine foam embolization is an effective and safe method to treat pelvic and atypical lower limb varices.
Topics: Middle Aged; Humans; Female; Adult; Sclerotherapy; Retrospective Studies; Quality of Life; Treatment Outcome; Pelvic Pain; Varicose Veins; Pelvis; Chronic Pain; Embolization, Therapeutic
PubMed: 36692078
DOI: 10.1177/15385744231154332 -
Seminars in Reproductive Medicine Jan 2017The recognition and management of endometriosis in the adolescent patient is challenging. A strong clinical suspicion for endometriosis should be maintained in the... (Review)
Review
The recognition and management of endometriosis in the adolescent patient is challenging. A strong clinical suspicion for endometriosis should be maintained in the adolescent who suffers from acyclic pelvic pain as well as absenteeism from school and lack of participation in daily activities. Risk factors include the presence of an obstructive Mullerian anomaly, a family history of endometriosis, and conditions that prolong exposure to endogenous and exogenous estrogens. Empiric medical therapy with nonsteroidal anti-inflammatory drugs and combined oral contraceptive pills may be considered in most adolescents with endometriosis. Failure of empiric therapy may warrant diagnostic laparoscopy, which affords a concomitant opportunity for treatment via excision of endometriosis. Endometriotic implants in the adolescent tend to be more atypical, appearing red/flame-like, clear/polypoid, or vesicular. Endometriosis tends to recur more often in adolescents when compared with adults, and the role of postoperative medical therapy for the suppression of disease progression is not entirely clear. Current knowledge on the impact of adolescent endometriosis on future fertility is limited but overall reassuring.
Topics: Adolescent; Age of Onset; Anti-Inflammatory Agents, Non-Steroidal; Contraceptives, Oral, Hormonal; Endometriosis; Female; Humans; Laparoscopy; Pelvic Pain; Predictive Value of Tests; Prevalence; Risk Factors; Treatment Outcome
PubMed: 27992932
DOI: 10.1055/s-0036-1597121 -
Pain Research & Management 2023Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a complex male dysfunction, mostly seen in young and middle-aged men with a history of more than... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a complex male dysfunction, mostly seen in young and middle-aged men with a history of more than 3 months. As a traditional therapy of Traditional Chinese Medicine, acupuncture has been proven an effective method to treat CP/CPPS in recent years. Though some meta-analyses on acupuncture for chronic prostatitis were published in 2018 and 2019, most of the included studies were low in quality according to the JADAD score (JADAD < 4). The conclusions of acupuncture for CP/CPPS remain indefinite.
PURPOSE
This review aims to evaluate the efficacy of acupuncture for CP/CPPS by including high-quality literature only (JADAD ≥ 4) to provide a reliable basis for clinical applications and research.
METHOD
Nine electronic databases were searched from inception to March 1, 2022, and only randomized controlled trials (RCT) with high-quality (JADAD ≥ 4) were included. Data were analyzed using Review Manager 5.3. and was verified through trial sequential analysis (TSA). We carried out a sensitivity analysis for the heterogeneity ( ≥ 50%). Publication bias was explored using a funnel plot.
RESULT
Ten RCTs (11 trials) of high-quality methodology involving 798 patients were included. Meta-analysis showed that compared to sham acupuncture (SAT) and western medicine (WM), acupuncture (AT) played superior roles for CP/CPPS patients in pain score, NIH-CPSI score, quality of life score, urinary symptom, and efficacy rate. As for the adverse effects, 4 RCTs described mild hematoma and pain in AT and SAT groups, while specific symptoms including nausea, abdominal pain, dizziness, and low blood pressure were reported in WM groups.
CONCLUSION
This meta-analysis indicated that acupuncture has measurable benefits on CP/CPPS, and security has also been ensured. However, this meta-analysis only included 10 RCTs; thus, RCTs with a larger sample size and longer-term observation are required to verify the effectiveness of acupuncture further in the future.
Topics: Male; Middle Aged; Humans; Chronic Pain; Prostatitis; Chronic Disease; Acupuncture Therapy; Pelvic Pain
PubMed: 36960418
DOI: 10.1155/2023/7754876 -
Seminars in Ultrasound, CT, and MR Dec 2023Chronic pelvic pain (CPP) in women is not uncommon, and it may be difficult to identify the exact cause difficult to manage. It is major health problem for women that... (Review)
Review
Chronic pelvic pain (CPP) in women is not uncommon, and it may be difficult to identify the exact cause difficult to manage. It is major health problem for women that affects the quality of their daily lives. The etiology of chronic pelvic pain may be of gynecological or non-gynecological origin and associated with several predisposing and precipitating factors. Psychological and social factors also contribute to the syndrome of CPP and must be evaluated before managing these patients. Due to multifactorial etiology, CPP needs a multidisciplinary approach for diagnosis and management. A detailed history and physical examination supported by appropriate laboratory tests and imaging are the keys to diagnosis. In this paper, the role of imaging in diagnosis and management of CPP is reviewed. Imaging findings should be correlated with detailed clinical examination findings as there are imaging findings that may be unrelated and not the cause of CPP in a particular patient, imaging findings should be correlated with the clinical circumstances.
Topics: Female; Humans; Pelvic Pain; Gynecology; Diagnostic Imaging
PubMed: 37879545
DOI: 10.1053/j.sult.2023.10.006 -
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