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Journal of Clinical Medicine Aug 2023Endometriosis affects approximately 10% of premenopausal women worldwide. Despite its impact on quality of life, the delay in diagnosing this chronic disease is well... (Review)
Review
Endometriosis affects approximately 10% of premenopausal women worldwide. Despite its impact on quality of life, the delay in diagnosing this chronic disease is well known. Many patients with endometriosis report having suffered from dysmenorrhea and chronic pelvic pain in adolescence or at a young age. However, this painful symptom is often highly underestimated and considered a normal and transient symptom in young women. The real prevalence of endometriosis in adolescence remains uncertain. Some authors recently described at least one ultrasound feature of endometriosis in 13.3% of a general population of adolescent girls, which increased to 35.3% in young girls with severe dysmenorrhea. Dysmenorrhea is classified as primary dysmenorrhea or secondary dysmenorrhea. Primary dysmenorrhea is defined as a menstrual pain without organic disease, while secondary dysmenorrhea is defined as a menstrual pain associated with organic pelvic pathology. Since endometriosis represents the main cause of secondary dysmenorrhea in adolescents and young women, it is important to determine whether the patient has primary dysmenorrhea or additional suggestive symptoms related to endometriosis. Endometriosis in adolescent patients is a challenging problem with clinical and pathological differences compared with its presentation in premenopausal women. Adolescents and young women with dysmenorrhea and painful symptoms that suggest endometriosis should be referred to dedicated endometriosis centers for an early diagnosis and appropriate medical and surgical management. This paper aims to describe the role of dysmenorrhea in adolescents and the management of these young patients to confirm or exclude endometriosis.
PubMed: 37685691
DOI: 10.3390/jcm12175624 -
Complementary Therapies in Medicine Sep 2023This study aimed to examine the effect of acupuncture on symptoms and health-related quality of life in patients with endometriosis.
OBJECTIVES
This study aimed to examine the effect of acupuncture on symptoms and health-related quality of life in patients with endometriosis.
METHODS
Nine biomedical databases were searched to April 2022 to identify randomized controlled trials of acupuncture and/or moxibustion used alone or as adjunct to guideline-recommended pharmacotherapy for the treatment of endometriosis. One reviewer extracted data and another verified the data. A random effects model was used to calculate mean differences.
RESULTS
Fifteen trials involving 1018 patients met the inclusion criteria, but diversity in comparisons and outcome measures prevented meta-analysis. Compared to sham acupuncture, manual acupuncture was more effective at reducing dysmenorrhea VAS pain score (mean difference [MD] - 2.40, 95 % CI [- 2.80, - 2.00]; moderate certainty evidence), pelvic pain VAS score (MD - 2.65, 95 % CI [- 3.40, - 1.90]; high certainty evidence) and dyspareunia VAS scores (MD - 2.88, [- 3.83, - 1.93]), lessened the size of ovarian cyst (MD - 3.88, 95 % CI [- 7.06, - 0.70]), and improved quality of life. Compared to conventional therapy, manual acupuncture plus conventional therapy and warm needle alone resulted in greater improvements in quality of life than conventional therapy. Among the six studies that reported safety, fewer adverse events were reported in participants who received acupuncture or moxibustion.
CONCLUSIONS
Low to moderate certainty evidence from single studies showed that manual acupuncture may improve pain-related symptoms and quality of life; however, there is insufficient evidence on the overall effectiveness of acupuncture and moxibustion for endometriosis.
Topics: Female; Humans; Moxibustion; Quality of Life; Endometriosis; Acupuncture Therapy; Dysmenorrhea
PubMed: 37453585
DOI: 10.1016/j.ctim.2023.102963 -
Cureus Sep 2023Despite its prevalence, there is no clear-cut diagnostic path or treatment paradigm for fibromyalgia; this can lead to a multiplicity of symptoms and comorbid conditions... (Review)
Review
Despite its prevalence, there is no clear-cut diagnostic path or treatment paradigm for fibromyalgia; this can lead to a multiplicity of symptoms and comorbid conditions that complicate care. "Overlapping symptoms" describe conditions that can occur concomitantly with fibromyalgia and include migraine, irritable bowel syndrome, obesity, and pelvic pain syndromes. A variety of pharmacologic and nonpharmacologic treatments are available for fibromyalgia, but treatment is best personalized for an individual and recognizes potential comorbidities. Opioids are not the recommended front-line treatment, cannabinoids hold promise but with limitations and nonpharmacologic options, such as aerobic or resistance exercise and cognitive behavior therapy, can play a very important but often underestimated role. Amitriptyline appears to be safe and effective in treating six of the main fibromyalgia domains: pain, disturbed sleep, fatigue, affective symptoms, functional limitations, and impaired cognition ("fibro fog"). Very low-dose naltrexone (2.5-4.5 mg) may offer analgesic and anti-inflammatory benefits to fibromyalgia patients, but further studies are needed. Fibromyalgia can be a devastating and debilitating condition for patients, and clinicians are challenged with its diagnosis and treatment as well. Further research as well as compassionate approaches to offering personalized care to those with fibromyalgia are required.
PubMed: 37809234
DOI: 10.7759/cureus.44852 -
Acta Obstetricia Et Gynecologica... Oct 2023
Topics: Humans; Female; Pelvic Pain; Chronic Pain
PubMed: 37773602
DOI: 10.1111/aogs.14682 -
Heliyon Sep 2023Dysmenorrhea is a condition that manifests itself in women before, during, and after menstruation, and it is accompanied by very intense pelvic pain. Moreover, women... (Review)
Review
Dysmenorrhea is a condition that manifests itself in women before, during, and after menstruation, and it is accompanied by very intense pelvic pain. Moreover, women experience moderate to intense menstrual cramps year after year, decreasing their quality of life. The purpose of the study was to establish semiological differences associated with primary dysmenorrhea. Women who start their menstrual cycles with this symptomatology assume that it is normal and that they do not need specialized medical assistance. Medical professionals have established general practice guidelines on clinical disorders. However, there are no specific recommendations for the menstrual cycle that can effectively support the prompt diagnosis and treatment of primary dysmenorrhea, particularly at 3870 msnm. The uniqueness of our research is that semiological distinctions can change depending on height.
PubMed: 37810005
DOI: 10.1016/j.heliyon.2023.e19489 -
Pain Physician Sep 2023Endometriosis is a chronic common condition affecting 10% of reproductive-aged women globally. It is caused by the growth of endometrial-like tissue outside the uterine... (Review)
Review
BACKGROUND
Endometriosis is a chronic common condition affecting 10% of reproductive-aged women globally. It is caused by the growth of endometrial-like tissue outside the uterine cavity and leads to chronic pelvic pain, affecting various aspects of a woman's physical, mental, emotional, and social well-being. This highlights the importance of an understanding of the potential involvement of the nervous system and involved nerves as well as an effective multidisciplinary pain management.
OBJECTIVES
Our aim was to assess the current understanding of pain mechanisms in endometriosis and the effectiveness of different interventional pain management strategies.
STUDY DESIGN
Literature review.
METHODS
A search was conducted using multiple databases, including Google Scholar, MEDLINE (Ovid), PubMed, and Embase. We used keywords such as "endometriosis," "pain," pelvic pain, "management," and "anaesthesia" along with Boolean operators and MeSH terms. The search was limited to English language articles published in the last 15 years.
RESULTS
Nerve involvement is a well-established mechanism for pain generation in patients with endometriosis, through direct invasion, irritation, neuroangiogenesis, peripheral and central sensitization, and scar tissue formation. Endometriosis may also affect nerve fibers in the pelvic region, causing chronic pelvic pain, including sciatic neuropathy and compression of other pelvic nerves. Endometriosis can cause sciatica, often misdiagnosed due to atypical symptoms. Interventional pain management techniques such as superior hypogastric plexus block, impar ganglion block, S3 pulsed radiofrequency, myofascial pain trigger point release, peripheral nerve hydrodissection, and neuromodulation have been used to manage persistent and intractable pain with positive patient outcomes and improved quality of life.
LIMITATIONS
The complex and diverse clinical presentations of endometriosis make it challenging to compare the effectiveness of different pain management techniques.
CONCLUSION
Endometriosis is a complex condition causing various forms of pain including nerve involvement, scar tissue formation, and bowel/bladder symptoms. Interventional pain management techniques are effective for managing endometriosis-related pain.
KEY WORDS
Endometriosis, chronic pain, therapeutic interventions, interventional techniques, pain injections, visceral pain, peripheral pain.
Topics: Adult; Female; Humans; Chronic Disease; Cicatrix; Endometriosis; Pain Management; Pelvic Pain; Pelvis; Quality of Life
PubMed: 37774202
DOI: No ID Found -
Deutsches Arzteblatt International Jul 2023Chronic primary pelvic pain syndrome in men (CPPPSm) can be associated with urogenital pain, urinary symptoms, sexual dysfunction, and emotional disturbance. Its... (Review)
Review
BACKGROUND
Chronic primary pelvic pain syndrome in men (CPPPSm) can be associated with urogenital pain, urinary symptoms, sexual dysfunction, and emotional disturbance. Its clinical heterogeneity and incompletely understood pathogenesis make it more difficult to treat. This article is intended to familiarize the reader with basic aspects of the manifestations, pathophysiology, diagnostic evaluation, differential diagnosis, and treatment of this condition.
METHODS
This article is based on relevant publications retrieved by a selective search of the literature, including the current guidelines of the European Association of Urology. The features of this disease pertaining to urology, psychosomatic medicine, and pain medicine are illuminated from an interdisciplinary perspective.
RESULTS
Chronic pelvic pain appears to arise through a complex interaction of inflammatory, infectious, neurological, musculoskeletal, and psychosomatic factors. A comprehensive diagnostic work-up should be carried out to evaluate and exclude the numerous differential diagnoses. Treatment strategies are based on the clinical phenotype. Randomized controlled trials have shown that significant relief can be achieved with a variety of drugs and non-pharmacological treatments, selected according to the manifestations of the condition in the individual case. Attention must be paid to treatment-specific adverse effects.
CONCLUSION
The management of patients with CPPPSm should consist of a comprehensive differential diagnostic evaluation and an individually oriented treatment strategy.
Topics: Humans; Male; Chronic Pain; Diagnosis, Differential; Drug-Related Side Effects and Adverse Reactions; Pelvic Pain; Phenotype
PubMed: 36922749
DOI: 10.3238/arztebl.m2023.0036 -
Revista Brasileira de Ginecologia E... Dec 2023To correlate the morphological aspects with pelvic pain in women with deep infiltrating endometriosis.
OBJECTIVE
To correlate the morphological aspects with pelvic pain in women with deep infiltrating endometriosis.
METHODS
A retrospective study with 67 women with deep endometriosis who underwent surgical treatment in a tertiary hospital from 2007 to 2017. The following variables were considered: age, parity, body mass index, site of involvement, hormonal treatment before surgery, pelvic pain, and morphometric analysis. The histological slides of the surgical specimens were revised and, using the ImageJ software for morphometric study, the percentages of stromal/glandular tissues were calculated in the histological sections.
RESULTS
The mean age of the women was 38.9 ± 6.5 years. The mean pain score was 8.8 ± 1.9 and the mean time of symptomatology was 4.7 ± 3.5 years, with 87% of the patients undergoing hormone treatment prior to surgery. The average expression of CD10, CK7, and S100 markers was 19.5 ± 11.8%, 9.4 ± 5.9%, and 7.9 ± 5.8% respectively. It was found that the greater the expression of CD10, the greater the level of pain ( = 0.02). No correlation was observed between the expression of CD10, CK7, and S100 markers and age and duration of symptoms.
CONCLUSION
Women with deep infiltrating endometriosis have a positive association between the level of pain and the fibrosis component in the endometrial tissue's histological composition.
Topics: Humans; Female; Adult; Middle Aged; Endometriosis; Retrospective Studies; Pelvic Pain; Tertiary Care Centers; Endometrium
PubMed: 38141597
DOI: 10.1055/s-0043-1772473 -
Life (Basel, Switzerland) Oct 2023In female patients, acute pelvic pain can be caused by gynaecological, gastrointestinal, and urinary tract pathologies. Due to the variety of diagnostic possibilities,... (Review)
Review
In female patients, acute pelvic pain can be caused by gynaecological, gastrointestinal, and urinary tract pathologies. Due to the variety of diagnostic possibilities, the correct assessment of these patients may be challenging. The most frequent gynaecological causes of acute pelvic pain in non-pregnant women are pelvic inflammatory disease, ruptured ovarian cysts, ovarian torsion, and degeneration or torsion of uterine leiomyomas. On the other hand, spontaneous abortion, ectopic pregnancy, and placental disorders are the most frequent gynaecological entities to cause acute pelvic pain in pregnant patients. Ultrasound (US) is usually the first-line diagnostic technique because of its sensitivity across most common aetiologies and its lack of radiation exposure. Computed tomography (CT) may be performed if ultrasound findings are equivocal or if a gynaecologic disease is not initially suspected. Magnetic resonance imaging (MRI) is an extremely useful second-line technique for further characterisation after US or CT. This pictorial review aims to review the spectrum of gynaecological entities that may manifest as acute pelvic pain in the emergency department and to describe the imaging findings of these gynaecological conditions obtained with different imaging techniques.
PubMed: 37895407
DOI: 10.3390/life13102025