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European Urology Focus May 2020Patients with chronic pelvic pain (CPP) may have pain refractory to conventional pain management strategies. Neuromodulation could provide relief of pain.
CONTEXT
Patients with chronic pelvic pain (CPP) may have pain refractory to conventional pain management strategies. Neuromodulation could provide relief of pain.
OBJECTIVE
To evaluate the benefits and harms of neuromodulation for CPP.
EVIDENCE ACQUISITION
A comprehensive search of EMBASE, PUBMED, and SCOPUS was performed for the entire database to January 2018. Studies were selected, data were extracted, and quality was assessed by two independent reviewers. A meta-analysis was used to combine randomized controlled trials (RCTs); otherwise, a narrative analysis was used.
EVIDENCE SYNTHESIS
After screening 1311 abstracts, 36 studies including eight RCTs were identified, enrolling 1099 patients. Studies covered a broad range in terms of phenotypes of CPP and methods of neuromodulation. A meta-analysis was possible for percutaneous tibial nerve stimulation and transcutaneous electrical nerve stimulation, which showed improvement in pain. Only narrative synthesis was possible for other modalities (sacral nerve stimulation, spinal cord stimulation, intravaginal electrical stimulation, and pudendal nerve stimulation) which appeared to reduce pain in patients with CPP. Treatments generally improved quality of life but with variable reporting of adverse events. Many studies showed high risks of bias and confounding.
CONCLUSIONS
While electrical neuromodulation may improve symptoms in CPP, further work is needed with high-quality studies to confirm it.
PATIENT SUMMARY
Neuromodulation may be useful in reducing pain and improving quality of life in patients with chronic pelvic pain, but more research is needed.
Topics: Chronic Pain; Humans; Pelvic Pain; Randomized Controlled Trials as Topic; Transcutaneous Electric Nerve Stimulation
PubMed: 31636030
DOI: 10.1016/j.euf.2019.09.011 -
Pain Practice : the Official Journal of... Feb 2024Chronic pelvic pain is a burdensome condition that involves multiple medical sub-specialties and is often difficult to treat. Sacral stimulation for functional bladder... (Review)
Review
BACKGROUND
Chronic pelvic pain is a burdensome condition that involves multiple medical sub-specialties and is often difficult to treat. Sacral stimulation for functional bladder disease has been well established, but little large-scale evidence exists regarding utilization of other neuromodulation techniques to treat chronic pelvic pain. Emerging evidence does suggest that neuromodulation is a promising treatment, and we aim to characterize the use and efficacy of such techniques for treating chronic pelvic pain syndromes.
MATERIALS AND METHODS
A systematic review of the literature demonstrating the treatment of chronic pelvic pain syndromes with neuromodulation. Abstracts were reviewed and selected for inclusion, including case series, prospective studies, and randomized controlled trials (RCTs). Case studies and publications in abstract only were not included. The reporting for this systematic review follows Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The literature search was performed using MEDLINE, Embase, Cochrane Library, PubMed, CINAHL, and Scopus.
RESULTS
A total of 50 studies were included in this review, three of which were randomized controlled trials, and the remaining were prospective and retrospective case series. The range of pelvic pain conditions treated included interstitial cystitis, peripheral neuralgia, pudendal neuralgia, gastrointestinal pain, urogenital pain, sacroiliac joint pain, and visceral chronic pelvic pain. We reported on outcomes involving pain, functionality, psychosocial improvement, and medication reduction.
CONCLUSIONS
Neuromodulation is a growing treatment for various chronic pain syndromes. Peripheral nerve stimulation was the least studied form of stimulation. Posterior tibial nerve stimulation appears to offer short-term benefit, but long-term results are challenging. Sacral nerve stimulation is established for use in functional bladder syndromes and appears to offer pain improvement in these patients as well. Dorsal root ganglion stimulation and spinal cord stimulation have been used for a variety of conditions with promising results. Further studies of homogeneous patient populations are necessary before strong recommendations can be made at this time, although pooled analysis may also be impactful.
Topics: Humans; Transcutaneous Electric Nerve Stimulation; Pelvic Pain; Spinal Cord Stimulation; Chronic Pain; Neuralgia
PubMed: 37726930
DOI: 10.1111/papr.13295 -
Pain Physician 2016Chronic pain is one of the most frequent disease symptoms and represents a global health problem with a considerable economic burden. The role of polyunsaturated fatty... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Chronic pain is one of the most frequent disease symptoms and represents a global health problem with a considerable economic burden. The role of polyunsaturated fatty acids (PUFA) in chronic pain conditions was debated during the last decade with conflicting results.
OBJECTIVE
To assess whether polyunsaturated fatty acids intake is useful as a preventive or curative tool in chronic pain.
STUDY DESIGN
Systematic review and meta-analysis.
SETTING
This study examined all published studies, either preventive or curative, on PUFA supplementation and chronic pain.
METHODS
We retrieved studies published in any language by searching systematically Medline, Embase, Conference Proceedings Citation Index, dissertations databases, and the 5 regional bibliographic databases of the World Health Organization until May 2015. We included both observational and intervention studies reporting effect measures and their confidence intervals of polyunsaturated fatty acids intake in the regular diet or supplementation and pain. Two investigators selected studies; extracted data independently on baseline characteristics, exposure, and outcomes; and rated the quality of interventional studies using Jadad score. We calculated pooled standardized mean differences (SMDs) of pain indexes such as the Visual Analogue Score. We further carried out subgroup analyses by disease, type of PUFA, outcome scale, quality index, dose, and time of supplementation.
RESULTS
We retrieved 5 observational and 46 intervention studies. Only one observational study showed a protective effect of PUFA. On the contrary, the interventional studies yielded a pooled random effects SMD of -0.40 (95% CI -0.58, -0.22), which indicates improvement, as 0 is the value that indicates absence of effect. The largest effect was found for dysmenorrhea (SMD -0.82, 95% CI -1.21, -0.43), Ω-3 supplementation (-0.47, 95% CI -0.68, -0.26) and composite scores (-0.58, 95% CI -1.07, -0.09). Mitigation of pain was stronger for low doses (-0.55, 95% CI -0.79, -0.30) and short supplementation periods (-0.56, 95% CI -0.86, -0.25).
LIMITATIONS
While the number of curative studies was large, that of preventive studies available was limited.
CONCLUSION
Our results suggest that Ω-3 PUFA supplementation moderately improves chronic pain, mainly that due to dysmenorrhea. Further investigation on the preventive potential of PUFA supplementation is needed, as the amount of evidence is scarce. Key words: Meta-analysis, systematic review, chronic pain, PUFA, supplementation, Ω-3, dysmenorrhea.
Topics: Chronic Pain; Dietary Supplements; Dysmenorrhea; Fatty Acids, Omega-3; Fatty Acids, Unsaturated; Female; Humans
PubMed: 27906932
DOI: No ID Found -
Sexual Medicine Reviews Jan 2019Many conditions of pelvic and sexual dysfunction can be addressed successfully through pelvic floor physical therapy (PFPT) through various manual therapy techniques,...
INTRODUCTION
Many conditions of pelvic and sexual dysfunction can be addressed successfully through pelvic floor physical therapy (PFPT) through various manual therapy techniques, neuromuscular reeducation, and behavioral modifications. The field of pelvic rehabilitation, including sexual health, continues to advance to modify these techniques according to a biopsychosocial model.
AIM
To provide an update on peer-reviewed literature on the role of PFPT in the evaluation and treatment of pelvic and sexual dysfunctions in men and women owing to the overactive and the underactive pelvic floor.
METHODS
A literature review to provide an update on the advances of a neuromusculoskeletal approach to PFPT evaluation and treatment.
MAIN OUTCOME MEASURE
The use and advancement of PFPT methods can help in successfully treating pelvic and sexual disorders.
RESULTS
PFPT for pelvic muscle overactivity and underactivity has been proven to be a successful option for pelvic and sexual dysfunction. Understanding the role of the organs, nerves, fascia, and musculoskeletal system in the abdomino-pelvic and lumbo-sacro-hip region and how pelvic floor physical therapists can effectively evaluate and treat pelvic and sexual health. It is important for the treating practitioner to know when to refer to PFPT.
CONCLUSION
Neuromusculoskeletal causes of pelvic floor disorders affect a substantial proportion of men, women, and children and PFPT is a successful and non-invasive option. Pelvic floor examination by healthcare practitioners is essential in identifying when to refer to PFPT. Use of a biopsychosocial model is important for the overall well-being of each patient. Further research is needed. Stein A, Sauder SK, Reale J. The role of physical therapy in sexual health in men and women: Evaluation and treatment. Sex Med Rev 2019;7:46-56.
Topics: Female; Humans; Male; Pain Management; Pelvic Floor; Pelvic Floor Disorders; Pelvic Pain; Physical Therapy Modalities; Sexual Dysfunction, Physiological; Sexual Health; Treatment Outcome
PubMed: 30503726
DOI: 10.1016/j.sxmr.2018.09.003 -
International Urogynecology Journal Jul 2019Sacral neuromodulation (SNM) is gaining popularity as a treatment option for chronic pelvic pain (CPP). Our hypothesis is that SNM is effective in improving CPP. (Meta-Analysis)
Meta-Analysis
INTRODUCTION AND HYPOTHESIS
Sacral neuromodulation (SNM) is gaining popularity as a treatment option for chronic pelvic pain (CPP). Our hypothesis is that SNM is effective in improving CPP.
METHODS
A systematic search was conducted through September 2018. Peer-reviewed studies using pre- and postpain intensity scores were selected. The primary outcome was pain improvement on a 10-point visual analog scale (VAS) (adjusted or de novo) in patients with CPP. Secondary outcomes included comparing SNM approaches and etiologies and evaluating lower urinary tract symptoms (LUTS).
RESULTS
Fourteen of 2175 studies, evaluating 210 patients, were eligible for further analysis. The overall VAS pain score improvement was significant [weighted mean difference (WMD) -4.34, 95% confidence interval (CI) = -5.22, to-3.64, p < 0.0001)]. Regarding SNM approach, both standard and caudal approaches had significant reduction in pain scores: WMD -4.32, CI 95% = -5.32, to -3.31 (p < 0.001) for the standard approach, compared with WMD -4.63, 95% CI = -6.57 to -2.69 (P < 0.001), for the caudal approach (p = 0.75). While significant improvement in pain was observed both in patients with and without interstitial cystitis/bladder pain syndrome (IC/BPS), the observed improvement was lower in patients with (WMD -4.13, CI 95% -5.36 to -2.90 versus without (WMD -5.72, CI 95% = -6.18, to-5.27) IC/BPS (p = 0.02). SNM was effective in treating voiding symptoms (frequency, urgency, nocturia) associated with IC/BPS (all p < 0.01).
CONCLUSIONS
SNM is an effective therapy for CPP in both IC/BSP and non-IC/BSP patients, with better results in non-IC/BSP patients. Outcomes of the antegrade caudal approach were comparable with the standard retrograde approach.
Topics: Animals; Chronic Pain; Cystitis, Interstitial; Electrodes, Implanted; Female; Humans; Lumbosacral Plexus; Pain Measurement; Pelvic Pain; Prospective Studies; Retrospective Studies; Transcutaneous Electric Nerve Stimulation; Treatment Outcome
PubMed: 30874835
DOI: 10.1007/s00192-019-03898-w -
International Urogynecology Journal Nov 2022Chronic pelvic pain (CPP) is a common multifactorial condition affecting 6 to 27% of women aged 18-50 years worldwide. This study was conducted to review and... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION AND HYPOTHESIS
Chronic pelvic pain (CPP) is a common multifactorial condition affecting 6 to 27% of women aged 18-50 years worldwide. This study was conducted to review and meta-analyse the current literature on the reduction of chronic pelvic pain after botulinum toxin A (BTA) injection.
METHOD
In July 2021 we performed a systematic search in PubMed and EMBASE to assess the benefits of BTA injection in pelvic floor muscles in women with chronic pelvic pain. Primary outcome was reduction in visual analogue scale (VAS) after treatment. Secondary outcomes evaluated were: reduction of dyspareunia, pelvic floor resting pressure and quality of life. Identified reports were assessed on quality of reporting and risk of bias. Standardized mean difference (SMD) was used to combine and analyse outcomes of the included studies.
RESULTS
Eight studies with 289 participants were considered eligible to be included in this systematic review and meta-analysis. After recalculating SMD into VAS scores (0-100), long-term follow-up (24-26 weeks) showed a significant 15-point improvement in VAS scores (95% CI: 8.8-21.5) for non-menstrual pelvic pain and a 13-point improvement (95% CI: 2.1-24.0) for dyspareunia. BTA injection had a significant effect on pelvic floor resting pressure and quality of life.
CONCLUSION
There is limited scientific evidence on the effectiveness of BTA injections in pelvic floor muscles in women with chronic pelvic pain. The available studies show that BTA injections significantly reduce pain levels and improve quality of life at 6 months follow-up.
PROSPERO ID
CRD42018105204.
Topics: Botulinum Toxins, Type A; Chronic Pain; Dyspareunia; Female; Humans; Neuromuscular Agents; Pelvic Floor; Pelvic Pain; Quality of Life
PubMed: 35362767
DOI: 10.1007/s00192-022-05115-7 -
Medicina (Kaunas, Lithuania) Dec 2023: To identify the most frequently reported predictive factors for the persistency of pregnancy-related pelvic girdle pain (PPGP) at 3-6 months after childbirth in women... (Meta-Analysis)
Meta-Analysis Review
: To identify the most frequently reported predictive factors for the persistency of pregnancy-related pelvic girdle pain (PPGP) at 3-6 months after childbirth in women with PPGP alone or PPGP in association with pregnancy-related lower back pain (PLBP). : Eligibility criteria: Two authors independently selected studies excluding PPGP determined by a specific, traumatic, gynecological/urological cause or isolated PLBP and studies that did not include the presence/absence of PPGP as the the primary outcome. We, instead, included studies with an initial assessment in pregnancy (within 1 month of delivery) and with a follow-up of at least 3 months after delivery. : The research was performed using the databases of Medline, Cochrane, Pedro, Scopus, Web of Science and Cinahl from December 2018 to January 2022, following the indications of the PRISMA statement 2021 and the MOOSE checklist. It includes observational cohort studies in which data were often collected through prospective questionnaires (all in English). : Two independent authors performed evaluations of the risk of bias (ROB) using the quality in prognostic studies (QUIPS) tool. : An in-depth qualitative analysis was conducted because, due to a high degree of heterogeneity in the data collection of the included studies and a lack of raw data suitable for quantitative analysis, it was not possible to carry out the originally planned meta-analyses for the subgroups. : The research process led to the inclusion of 10 articles which were evaluated using the QUIPS tool: 5 studies were evaluated as low ROB and 5 were evaluated as moderate ROB. High levels of pain in pregnancy, a large number of positive provocation tests, a history of lower back pain and lumbo-pelvic pain, high levels of disability in pregnancy, neurotic behavior and high levels of fear-avoidance belief were identified as strong predictors of long-term PPGP, while there was weak or contradictory evidence regarding predictions of emotional distress, catastrophizing and sleep disturbances. : The impossibility of carrying out the meta-analysis by subgroups suggests the need for further research with greater methodological rigor in the acquisition of measures based on an already existing PPGP core predictors/outcome sets.
Topics: Pregnancy; Humans; Female; Pelvic Girdle Pain; Low Back Pain; Prospective Studies; Pregnancy Complications; Surveys and Questionnaires
PubMed: 38138226
DOI: 10.3390/medicina59122123 -
European Urology Focus Jan 2022Patients with chronic pelvic pain syndrome (CPPS) may have pain refractory to conventional management strategies. Botulinum toxin A (BTX-A) is a potential therapeutic... (Review)
Review
The Benefits and Harms of Botulinum Toxin-A in the Treatment of Chronic Pelvic Pain Syndromes: A Systematic Review by the European Association of Urology Chronic Pelvic Pain Panel.
CONTEXT
Patients with chronic pelvic pain syndrome (CPPS) may have pain refractory to conventional management strategies. Botulinum toxin A (BTX-A) is a potential therapeutic option.
OBJECTIVE
To evaluate the benefits and harms of BTX-A injections in the treatment of CPPS.
EVIDENCE ACQUISITION
A systematic review of the use of BTX-A in the treatment of CPPS was conducted (PROSPERO-ID: 162416). Comprehensive searches of EMBASE, PUBMED, Medline, and SCOPUS were performed for publications between January 1996 and May 2020. Identified studies were screened and selected studies assessed for quality prior to data extraction. The primary outcomes were improvement in pain and adverse events following treatment. Secondary outcomes included quality of life, global response assessment, sexual function, bowel function, and bladder function.
EVIDENCE SYNTHESIS
After screening 1001 abstracts, 16 studies including 11 randomised controlled trials were identified, enrolling 858 patients and covering a range of CPPS subtypes. Most studies showed high risks of bias and confounding across all domains. A narrative synthesis was performed as heterogeneity of included studies precluded a meta-analysis and calculation of pooled effect estimates of measured outcomes. BTX-A reduced pain significantly in patients with bladder pain syndrome in two studies and in patients with prostate pain syndrome in one study, but no included studies showed benefit for patients with gynaecological pelvic pain. Adverse event reporting was variable and generally poor, but no serious adverse events were described.
CONCLUSIONS
Beneficial effects of BTX-A on pain, quality of life, and functional symptoms were seen in patients with certain CPPS subtypes, but the current evidence level is too weak to allow recommendations about BTX-A use for treating CPPS.
PATIENT SUMMARY
Botulinum toxin A is used to treat different pain disorders, but current studies are of insufficient quality to determine whether it reduces pain and improves quality of life in patients with chronic pelvic pain. Further research is needed.
Topics: Botulinum Toxins, Type A; Humans; Male; Pelvic Pain; Quality of Life; Syndrome; Urology
PubMed: 33526405
DOI: 10.1016/j.euf.2021.01.005 -
Wiener Klinische Wochenschrift Jan 2022Biofeedback is recognized as an effective additive method for treating certain phenotypes of chronic pelvic pain syndrome and is a therapeutic option in other pelvic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Biofeedback is recognized as an effective additive method for treating certain phenotypes of chronic pelvic pain syndrome and is a therapeutic option in other pelvic pain conditions. This review aims to evaluate evidence from the literature with a focus on the effect of biofeedback on pain reduction, overall symptom relief, physiological parameters and quality of life.
METHODS
A systematic literature search was conducted using the databases PubMed, MEDLINE, Embase, Cochrane Library and PEDro from inception to July 2020. Data were tabulated and a narrative synthesis was carried out, since data heterogeneity did not allow a meta-analysis. The PEDro scale and the McMaster Critical Review Form-Quantitative Studies were applied to assess risk of bias.
RESULTS
Out of 651 studies, 37 quantitative studies of primary research evaluating pelvic pain conditions in male and female adults and children were included. They covered biofeedback interventions on anorectal disorders, chronic prostatitis, female chronic pelvic pain conditions, urologic phenotypes in children and adults and a single study on low back pain. For anorectal disorders, several landmark studies demonstrate the efficacy of biofeedback. For other subtypes of chronic pelvic pain conditions there is tentative evidence that biofeedback-assisted training has a positive effect on pain reduction, overall symptoms relief and quality of life. Certain factors have been identified that might be relevant in improving treatment success.
CONCLUSIONS
For certain indications, biofeedback has been confirmed to be an effective treatment. For other phenotypes, promising findings should be further investigated in robust and well-designed randomized controlled trials.
Topics: Biofeedback, Psychology; Female; Humans; Male; Pelvic Floor; Pelvic Pain; Quality of Life; Treatment Outcome
PubMed: 33751183
DOI: 10.1007/s00508-021-01827-w -
The Journal of Pain Dec 2022This study provides evidence- and consensus-based recommendations for the instruments to measure the five Pelvic Girdle Pain Core Outcome Set (PGP-COS): pain frequency,... (Review)
Review
Outcome Measurement Instruments and Evidence-based Recommendations for Measurement of the Pelvic Girdle Pain Core Outcome Set (PGP-COS): A Systematic Review and Consensus Process.
This study provides evidence- and consensus-based recommendations for the instruments to measure the five Pelvic Girdle Pain Core Outcome Set (PGP-COS): pain frequency, pain intensity/severity, function/disability/activity limitation, health-related quality of life and fear avoidance. Studies evaluating measurement properties of instruments measuring any PGP-COS outcome in women with PGP were identified through a systematic search of MEDLINE, EMBASE and PEDro databases (inception-July 2021). The methodological quality of studies and quality of measurement properties were evaluated using the COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN) checklist. Quality criteria and the synthesized evidence were graded using the modified grading of recommendations, assessment, development, and evaluation (GRADE) approach. A consensus meeting with PGP stakeholders was then held to establish recommendations, based on the evidence, for the instruments that should be used to measure the PGP-COS. Ten instruments were identified from 17 studies. No instrument showed high quality evidence for all measurement properties and/or measured all PGP-COS outcomes. Based on current evidence and consensus, the Pelvic Girdle Questionnaire (PGQ), the Short Form-8 (SF-8) and the Fear Avoidance Beliefs Questionnaire (FABQ) are recommended for measuring the PGP-COS. Future research should establish additional measurement properties of instruments and to substantiate these recommendations.
Topics: Female; Humans; Pelvic Girdle Pain; Consensus; Quality of Life; Surveys and Questionnaires; Outcome Assessment, Health Care
PubMed: 36115519
DOI: 10.1016/j.jpain.2022.08.003