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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 -
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 -
Journal of Gynecology Obstetrics and... Jun 2023The exposure to adverse childhood experiences has been associated with the subsequent development of several chronic health conditions, including pelvic pain.... (Review)
Review
The exposure to adverse childhood experiences has been associated with the subsequent development of several chronic health conditions, including pelvic pain. Endometriosis is a chronic disease characterized by the growth of endometrial-like tissue outside of the uterus, and is considered a common cause of chronic pelvic pain and infertility in reproductive-age women. However, the topic of pelvic pain and endometriosis is fraught with many challenges. This applies not just to clinical practice but also to research where many inconsistencies relating to pelvic pain and endometriosis definitions are encountered. A review was carried out for articles exploring the association of adverse childhood experiences and endometriosis. Studies addressing self-reported endometriosis suggested a relationship with childhood adversity, whilst papers relying on surgically diagnosed lesions of endometriosis irrespective of clinical presentation did not. This highlights the potential bias associated with the inconsistent use of the expression "endometriosis" in research.
Topics: Female; Humans; Adverse Childhood Experiences; Endometriosis; Pelvic Pain; Infertility; Uterus; Chronic Disease
PubMed: 37196919
DOI: 10.1016/j.jogoh.2023.102603 -
Pain Physician Mar 2018Chronic pelvic pain (CPP) represents a group of poorly understood disorders that are often refractory to conventional treatment. Referral to pain management typically... (Review)
Review
BACKGROUND
Chronic pelvic pain (CPP) represents a group of poorly understood disorders that are often refractory to conventional treatment. Referral to pain management typically occurs later in the continuum of care; as such, many of the injections and nerve blocks commonly prescribed for such patients are potentially limited in efficacy. While neuromodulation is conventionally considered the next algorithmic step in the treatment of chronic pain after injections fail, there is a common perception that neuromodulation is largely ineffective for CPP conditions. However, there is evidence that suggests neuromodulation may in fact be a viable treatment option for this particular patient population when utilized properly.
OBJECTIVES
To provide a basic overview of the pathophysiology of CPP and the relevant neuroanatomy as it pertains to various available treatment options, as well as the techniques and potential targets for neuromodulation.
STUDY DESIGN
Literature review.
SETTING
Private practice, academic and hospital setting.
METHODS
A comprehensive review of the available literature was performed targeting publications focused on CPP and various techniques for utilizing neuromodulation to treat it.
RESULTS
Neuromodulation is an established treatment modalities, however its usefulness as it relates to treating CPP has typically been drawn into question. In this literature review, we discuss the efficacy of various techniques for treating CPP with neuromodulation.
LIMITATIONS
Evidence to support the various treatments, while encouraging, is based on small studies and case series. Large-scale randomized, placebo-controlled clinical trials are warranted to evaluate the clinical efficacy and safety of the different treatments described, particularly neuromodulation.
CONCLUSIONS
In addition to the percutaneous, injection-based treatments described herein, neuromodulation remains a plausible option for recalcitrant cases that fail to respond to more conventional means.
KEY WORDS
Chronic pelvic pain, neuromodulation, spinal cord stimulation, CRPS, complex regional pain syndrome, neuropathic pain.
Topics: Chronic Pain; Humans; Male; Pain Management; Pelvic Pain; Spinal Cord Stimulation
PubMed: 29565946
DOI: No ID Found -
International Journal of Molecular... Sep 2023Endometriosis is a chronic and inflammatory disease associated with pelvic pain. Dietary changes may be therapeutic for chronic inflammatory processes, reducing visceral...
BACKGROUND
Endometriosis is a chronic and inflammatory disease associated with pelvic pain. Dietary changes may be therapeutic for chronic inflammatory processes, reducing visceral input. The aim was to evaluate the role of dietary changes according to the Mediterranean Diet (MD) on pain perception in endometriosis and their relationship with oxidative stress.
METHODS
in this prospective study, we included 35 endometriosis women. At baseline (T0) and after 3 (T1) and 6 (T2) months from the start of the diet, we investigated pain intensity with VAS (Visual Analogue Scale, from 0 to 10), vitamin profile, and oxidative stress.
RESULTS
we found a significant increase in the diet score ( < 0.001). At T1, patients reduced pain in terms of dyspareunia ( = 0.04), non-menstrual pelvic pain ( = 0.06), dysuria ( = 0.04), and dyschezia ( < 0.001). Dyspareunia ( = 0.002) and dyschezia ( < 0.001) were further significantly reduced also at T2. We observed a significant positive correlation between lipid peroxidation and VAS non-menstrual pelvic pain and dysuria and a significant negative correlation between Oxygen radical absorbance capacity and VAS non-menstrual pain and dyschezia.
CONCLUSIONS
our findings show a clear tendency toward a relationship between pain relief in endometriosis and MD. This appears promising to treat endometriosis-related symptoms and could be considered a new effective strategy for chronic pain management in the long term.
Topics: Humans; Female; Endometriosis; Prospective Studies; Diet, Mediterranean; Dyspareunia; Dysuria; Pelvic Pain; Pain Perception; Constipation; Dysmenorrhea
PubMed: 37834048
DOI: 10.3390/ijms241914601 -
American Journal of Physiology.... Mar 2018Chronic abdominal and pelvic pain are common debilitating clinical conditions experienced by millions of patients around the globe. The origin of such pain commonly... (Review)
Review
Chronic abdominal and pelvic pain are common debilitating clinical conditions experienced by millions of patients around the globe. The origin of such pain commonly arises from the intestine and bladder, which share common primary roles (the collection, storage, and expulsion of waste). These visceral organs are located in close proximity to one another and also share common innervation from spinal afferent pathways. Chronic abdominal pain, constipation, or diarrhea are primary symptoms for patients with irritable bowel syndrome or inflammatory bowel disease. Chronic pelvic pain and urinary urgency and frequency are primary symptoms experienced by patients with lower urinary tract disorders such as interstitial cystitis/painful bladder syndrome. It is becoming clear that these symptoms and clinical entities do not occur in isolation, with considerable overlap in symptom profiles across patient cohorts. Here we review recent clinical and experimental evidence documenting the existence of "cross-organ sensitization" between the colon and bladder. In such circumstances, colonic inflammation may result in profound changes to the sensory pathways innervating the bladder, resulting in severe bladder dysfunction.
Topics: Abdominal Pain; Animals; Chronic Pain; Colitis; Colon; Ganglia, Spinal; Humans; Nociceptors; Pelvic Pain; Prognosis; Risk Factors; Urinary Bladder; Urinary Bladder Diseases; Urination; Urodynamics
PubMed: 29146678
DOI: 10.1152/ajpgi.00272.2017 -
Acta Obstetricia Et Gynecologica... Oct 2023There has been increased interest in addressing chronic pelvic pain and its complexity in women. The often multifactorial etiology of chronic pelvic pain and its...
INTRODUCTION
There has been increased interest in addressing chronic pelvic pain and its complexity in women. The often multifactorial etiology of chronic pelvic pain and its heterogeneous presentation, however, make the condition challenging to manage. Overlap with other pain-related conditions is frequently reported, and chronic pelvic pain may impact sexual function. Nevertheless, little is known about the symptom burden of chronic pelvic pain and more complex pelvic pain in different groups of women. Thus, the aim of our study was to use a newly validated Norwegian version of the Amsterdam Complex Pelvic Pain Symptom Scale (ACPPS) to describe and compare the symptom severity of complex pelvic pain in three cohorts of women and to assess associations between demographic and gynecological characteristics and the severity of the condition.
MATERIAL AND METHODS
In our cross-sectional study, we collected self-reported data from patients referred to gynecological outpatient clinics, members of vulvodynia or endometriosis patient associations, and healthy volunteers. The 397 participants (47% response rate) completed an online survey about their demographic and gynecological characteristics and symptoms related to complex pelvic pain, including the Norwegian ACPPS. Score means on questionnaires, with standard deviations and 95% confidence intervals, were recorded. We used Pearson's chi-square test, Analysis of variance and multivariable linear regression were used to assess associations of demographic and gynecological characteristics with ACPPS scores.
RESULTS
Members of the patient associations had significantly higher self-reported symptom burden than patients and volunteers. Symptom burden was lower among older and postmenopausal women, and unemployed women scored higher than employed ones. Especially high scores on the ACPPS were found among women with complaints of chronic pelvic pain, at least moderate pelvic pain intensity, and/or chronic vulvar pain. Women who had experienced sexual assault and/or reported low sexual function also reported high scores. In multivariable regression, fibromyalgia, low mental health and past sexual assault were found to be associated with high scores on the ACPPS.
CONCLUSION
Many women in our study reported complex pelvic pain, and overlap with other pain-related conditions, low mental health and past sexual assault was associated with high symptom burden. Those findings support taking a biopsychosocial approach to treating women who present with such complaints.
Topics: Female; Humans; Cross-Sectional Studies; Pelvic Pain; Surveys and Questionnaires; Chronic Pain; Sex Offenses
PubMed: 37698177
DOI: 10.1111/aogs.14678 -
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 -
Neurourology and Urodynamics Apr 2023Sacral neuromodulation (SNM) is a treatment approved for use in several conditions including refractory overactive bladder (OAB) and voiding dysfunction. Chronic pelvic... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Sacral neuromodulation (SNM) is a treatment approved for use in several conditions including refractory overactive bladder (OAB) and voiding dysfunction. Chronic pelvic pain (CPP) is a debilitating condition for which treatment is often challenging. SNM shows promising effect in patients with refractory CPP. However, there is a lack of clear evidence, especially in long-term outcomes. This systematic review will assess outcomes of SNM for treating CPP.
METHODS
A systematic search of MEDLINE, Embase, Cochrane Central and clinical trial databases was completed from database inception until January 14, 2022. Studies using original data investigating SNM in an adult population with CPP which recorded pre and posttreatment pain scores were selected. Primary outcome was numerical change in pain score. Secondary outcomes were quality of life assessment and change in medication use and all-time complications of SNM. Risk of bias was assessed using the Newcastle Ottawa Tool for cohort studies.
RESULTS
Twenty-six of 1026 identified articles were selected evaluating 853 patients with CPP. The implantation rate after test-phase success was 64.3%. Significant improvement of pain scores was reported in 13 studies; three studies reported no significant change. WMD in pain scores on a 10-point scale was -4.64 (95% confidence interval [CI] = -5.32 to -3.95, p < 0.00001) across 20 studies which were quantitatively synthesized: effects were maintained at long-term follow-up. Mean follow-up was 42.5 months (0-59). Quality of life was measured by RAND SF-36 and EQ-5D questionnaires and all studies reported improvement in quality of life. One hundred and eighty-nine complications were reported in 1555 patients (Clavien-Dindo Grade I-IIIb). Risk of bias ranged from low to high risk. Studies were case series and bias stemmed from selection bias and loss to follow-up.
CONCLUSION
Sacral Neuromodulation is a reasonably effective treatment of Chronic Pelvic Pain and significantly reduces pain and increases patients' quality of life with immediate to long-term effects.
Topics: Adult; Humans; Electric Stimulation Therapy; Quality of Life; Urinary Bladder, Overactive; Treatment Outcome; Pelvic Pain
PubMed: 36877182
DOI: 10.1002/nau.25167 -
Ginekologia Polska 2020Chronic pelvic pain is a common health problem that afflicts 39% of women at some time in their life. It is a common challenge for gynecologists, internists, surgeons,... (Review)
Review
Chronic pelvic pain is a common health problem that afflicts 39% of women at some time in their life. It is a common challenge for gynecologists, internists, surgeons, gastroenterologists, and pain management physicians. Pelvic venous insufficiency (PVI) accounts for 16-31% of cases of chronic pain but it seems to be often overlooked in differential diagnosis. The aim of this article was to summarize current data concerning PVI. The embolization of insufficient ovarian veins remains the gold standard of therapy but the optimal procedure is yet to be determined. Well-designed randomized trials are required to establish the best treatment modalities.
Topics: Embolization, Therapeutic; Female; Humans; Leg; Ovary; Pelvic Pain; Venous Insufficiency
PubMed: 33301167
DOI: 10.5603/GP.a2020.0093