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Journal of Manipulative and... 2023The aims of this study were to (1) examine if the location of pregnancy-related back pain impacts activities of daily living and absence from work and (2) determine... (Observational Study)
Observational Study
OBJECTIVE
The aims of this study were to (1) examine if the location of pregnancy-related back pain impacts activities of daily living and absence from work and (2) determine which types of pain were more likely to persist postpartum.
METHODS
This was a secondary analysis of data from an observational cohort study. Data were collected in Ontario between 2013 and 2014. Four pain location groups were identified, including low back pain (LBP), pelvic girdle pain (PGP), combined pain, and mixed pain. Logistic regression models were used to examine the impact of pain location on activity and absence from work. Descriptive analyses explored the association between pregnancy pain location and postpartum pain patterns.
RESULTS
We surveyed 305 pregnant participants and followed up with 80 of these participants up to 6 months postpartum. Data analysis showed approximately a 2-fold increase in interference with employment (outside the home) and self-grooming for those with combined pain compared to those only experiencing LBP. Respondents with PGP and combined PGP and LBP had approximately a 5-fold increased likelihood of absence from work compared to respondents with only LBP; those with a mixture of LBP and PGP had a 13-fold increase in likelihood. Approximately 50% of respondents reported being pain-free, 16% experienced lingering pain, and 38% experienced persistent pain within 6 months postpartum. Those with combined pain during pregnancy continued to have persistent pain up to 6 months postpartum.
CONCLUSION
The results suggest that the location of pregnancy-related back pain is associated with interference in daily activities, an increase in absence from work, and the persistence of postpartum pain. For this cohort, back pain did not always resolve after delivery, and those experiencing pregnancy-related combined pain continued to experience symptoms postpartum.
Topics: Pregnancy; Female; Humans; Activities of Daily Living; Pregnancy Complications; Postpartum Period; Back Pain; Low Back Pain
PubMed: 38530696
DOI: 10.1016/j.jmpt.2024.02.001 -
Fertility and Sterility Mar 2024The World Endometriosis Research Foundation established the Endometriosis Phenome and Biobanking Harmonisation Project (EPHect) to create standardized documentation...
OBJECTIVE
The World Endometriosis Research Foundation established the Endometriosis Phenome and Biobanking Harmonisation Project (EPHect) to create standardized documentation tools (with common data elements) to facilitate the comparison and combination of data across different research sites and studies. In 2014, 4 data research standards were published: clinician-reported surgical data, patient-reported clinical data, and fluid and tissue biospecimen collection. Our current objective is to create an EPHect standard for the clinician-reported physical examination (EPHect-PE) for research studies.
DESIGN
An international consortium involving 26 clinical and academic experts and patient partners from 11 countries representing 25 institutions and organizations. Two virtual workshops, followed by the development of the physical examination standards underwent multiple rounds of iterations and revisions.
SUBJECTS
N/A MAIN OUTCOME MEASURE(S): N/A RESULT(S): The EPHect-PE tool provides standardized assessment of physical examination characteristics and pain phenotyping. Data elements involve examination of back and pelvic girdle; abdomen including allodynia and trigger points; vulva including provoked vestibulodynia; pelvic floor muscle tone and tenderness; tenderness on unidigital pelvic examination; presence of pelvic nodularity; uterine size and mobility; presence of adnexal masses; presence of incisional masses; speculum examination; tenderness and allodynia at an extra-pelvic site (e.g., forearm); and recording of anthropometrics.
CONCLUSION(S)
The EPHect-PE standards will facilitate the standardized documentation of the physical examination, including the assessment and documentation of examination phenotyping of endometriosis-associated pelvic pain.
PubMed: 38508508
DOI: 10.1016/j.fertnstert.2024.03.007 -
Reproduction in Domestic Animals =... Mar 2024Urovagina (UV) is less studied in cows. The vaginal contents, constrictor vestibule muscle activity, circulating progesterone, pelvic girdle, vagina and vulva angles...
Urovagina (UV) is less studied in cows. The vaginal contents, constrictor vestibule muscle activity, circulating progesterone, pelvic girdle, vagina and vulva angles were compared on Days 0 and 14 within and between UV (UV group; n = 36) and normal (N group; n = 36) cows. The oestrous duration was compared among the groups. Parameters for various UV severities were also compared. Another set of pregnant-postpartum cows (P-PP group; n = 31) underwent monthly evaluations for UV and the angles from the third month of pregnancy until the second month postpartum. The effect of age, parity and body condition score on UV severities on Day 0, and parity on angles in the P-PP group was evaluated. Different variables were correlated in different groups. The UV group was repeat breeder, exhibited prolonged oestrus and reduced progesterone on Day 14. The latter increased with UV severity on Day 0. On Day 14, severe form of UV was more prevalent. The UV severity increased with parity. In the UV group, a cranioventral pelvic girdle on Day 0 became more cranioventral on Day 14 and was correlated with the vagina moving from a caudodorsal position on Day 0 to a cranioventral position on Day 14. In the P-PP group, the pelvic girdle and vagina remained caudodorsal and UV was undetectable throughout the study. Vagina and vulva displayed a parity-by-month interaction in the P-PP group. To summarize, the UV characteristics were influenced by the oestrous cycle stage, pelvic girdle angles, and parity.
Topics: Pregnancy; Female; Cattle; Animals; Progesterone; Postpartum Period; Vagina; Estrus; Vulva; Parity
PubMed: 38501571
DOI: 10.1111/rda.14552 -
Scientific Reports Mar 2024Multisystem Proteinopathy 1 (MSP1) disease is a rare genetic disorder caused by mutations in the Valosin-Containing Protein (VCP) gene with clinical features of...
Multisystem Proteinopathy 1 (MSP1) disease is a rare genetic disorder caused by mutations in the Valosin-Containing Protein (VCP) gene with clinical features of inclusion body myopathy (IBM), frontotemporal dementia (FTD), and Paget's disease of bone (PDB). We performed bone scan imaging in twelve patients (6 females, 6 males) with confirmed VCP gene mutation six (50%) of which has myopathy alone, four (33%) with both PDB and myopathy, and two (15%) were presymptomatic carriers. We aim to characterize the PDB in diagnosed individuals, and potentially identify PDB in the myopathy and presymptomatic groups. Interestingly, two patients with previously undiagnosed PDB had positive diagnostic findings on the bone scan and subsequent radiograph imaging. Among the individuals with PDB, increased radiotracer uptake of the affected bones were of typical distribution as seen in conventional PDB and those reported in other MSP1 cohorts which are the thoracic spine and ribs (75%), pelvis (75%), shoulder (75%) and calvarium (15%). Overall, we show that technetium-99m bone scans done at regular intervals are a sensitive screening tool in patients with MSP1 associated VCP variants at risk for PDB. However, diagnostic confirmation should be coupled with clinical history, biochemical analysis, and skeletal radiographs to facilitate early treatment and prevention complications, acknowledging its limited specificity.
Topics: Male; Female; Humans; Frontotemporal Dementia; Valosin Containing Protein; Cell Cycle Proteins; Osteitis Deformans; Merozoite Surface Protein 1; Tomography, X-Ray Computed; Mutation; Myositis, Inclusion Body; Muscular Dystrophies, Limb-Girdle
PubMed: 38467645
DOI: 10.1038/s41598-024-54526-7 -
American Journal of Obstetrics and... Mar 2024It seems puzzling why humans have evolved such a small and rigid birth canal that entails a relatively complex process of labor compared with the birth canal of our... (Review)
Review
It seems puzzling why humans have evolved such a small and rigid birth canal that entails a relatively complex process of labor compared with the birth canal of our closest relatives, the great apes. This study reviewed insights into the evolution of the human birth canal from recent theoretical and empirical studies and discussed connections to obstetrics, gynecology, and orthopedics. Originating from the evolution of bipedality and the large human brain million years ago, the evolution of the human birth canal has been characterized by complex trade-off dynamics among multiple biological, environmental, and sociocultural factors. The long-held notion that a wider pelvis has not evolved because it would be disadvantageous for bipedal locomotion has not yet been empirically verified. However, recent clinical and biomechanical studies suggest that a larger birth canal would compromise pelvic floor stability and increase the risk of incontinence and pelvic organ prolapse. Several mammals have neonates that are equally large or even larger than human neonates compared to the size of the maternal birth canal. In these species, the pubic symphysis opens widely to allow successful delivery. Biomechanical and developmental constraints imposed by bipedality have hindered this evolutionary solution in humans and led to the comparatively rigid pelvic girdle in pregnant women. Mathematical models have shown why the evolutionary compromise to these antagonistic selective factors inevitably involves a certain rate of fetopelvic disproportion. In addition, these models predict that cesarean deliveries have disrupted the evolutionary equilibrium and led to new and ongoing evolutionary changes. Different forms of assisted birth have existed since the stone age and have become an integral part of human reproduction. Paradoxically, by buffering selection, they may also have hindered the evolution of a larger birth canal. Many of the biological, environmental, and sociocultural factors that have influenced the evolution of the human birth canal vary globally and are subject to ongoing transitions. These differences may have contributed to the global variation in the form of the birth canal and the difficulty of labor, and they likely continue to change human reproductive anatomy.
Topics: Animals; Infant, Newborn; Humans; Pregnancy; Female; Biological Evolution; Hominidae; Pelvis; Cesarean Section; Labor, Obstetric; Pelvic Floor; Mammals
PubMed: 38462258
DOI: 10.1016/j.ajog.2022.09.010 -
PloS One 2024During pregnancy, many changes in the musculoskeletal system and pregnancy-related disorders affect posture and postural stability. Pregnancy-related pelvic girdle pain...
INTRODUCTION
During pregnancy, many changes in the musculoskeletal system and pregnancy-related disorders affect posture and postural stability. Pregnancy-related pelvic girdle pain (PPGP) is a common disorder in pregnancy; the cause remains unknown. The purpose of the present study was to determine if PPGP affects static postural stability and its relation to the stage of pregnancy.
METHODS
Sixty-three pregnant women between the ages of 18 and 45 and between the 12th and 38th weeks of gestation were included in the study. They were divided into four groups according on the trimester and the presence of PPGP. Static balance was assessed using a force plate on firm and compliant surfaces with eyes open and closed.
RESULTS
Pregnant women with PPGP had significantly (p < 0.05) greater centre-of-pressure velocity and sway area compared to pregnant women without PPGP, especially in the third trimester of pregnancy. In the second trimester, only two significant differences in COP parameters were observed between pregnant women with and without PPGP. Pregnant women in the third trimester of pregnancy had significantly (p < 0.05) greater centre-of-pressure velocity and larger postural sway area compared to pregnant women in the second trimester of pregnancy, regardless of PPGP.
DISCUSSION AND CONCLUSION
Pregnant women with PPGP had poorer static stability when compared to pregnant women without pain, especially in the third trimester of pregnancy. The cause could be found in the poorer ability to stabilise the trunk and pelvis, poorer proprioception, and issues with automatic movement patterns.
Topics: Pregnancy; Humans; Female; Infant; Pregnancy Trimester, Third; Pelvic Girdle Pain; Pregnancy Trimester, Second; Pregnancy Trimesters; Postural Balance; Pregnancy Complications
PubMed: 38457422
DOI: 10.1371/journal.pone.0287221 -
An Approach to the Examination of the Lumbar Plexus for Neurosurgical Residents: A Video Manuscript.The Malaysian Journal of Medical... Feb 2024The lumbar plexus provides innervation to the lower limbs and is essential in enabling motor movement and sensation in the lower limbs. Some of its branches also...
The lumbar plexus provides innervation to the lower limbs and is essential in enabling motor movement and sensation in the lower limbs. Some of its branches also innervate the muscles in the pelvic girdle. Compared to the brachial plexus in the upper limbs, the lumbar plexus appears to garner less recognition among physicians and surgeons. However, it is important to understand the anatomy of the lumbar plexus and its branches along with the innervation they enable, as injury to them can cause plexopathies and pathologies that should be recognised by any treating clinician. Lumbar disc herniation, trauma and entrapment by muscles or hypertrophic ligaments are common causes of lumbar plexus or nerve injuries. A video was produced to demonstrate the examination techniques explained in this article. To provide comprehensive examination of the lower limbs, the sciatic nerve and its branches are also included in the examination video.
PubMed: 38456113
DOI: 10.21315/mjms2024.31.1.19 -
Scandinavian Journal of Pain Jan 2024The aim of this study is to investigate the criterion validity, specifically the concurrent validity of the measure of days with bothersome pain, by investigating its...
OBJECTIVES
The aim of this study is to investigate the criterion validity, specifically the concurrent validity of the measure of days with bothersome pain, by investigating its association with measures of pain intensity, disability, and quality of life.
METHODS
We used two separate cohorts to study the concurrent validity of "days with bothersome pain," by investigating its association with pain intensity, disability, and quality of life: (1) 321 patients with low back pain (LBP), using follow-up data at 1 year, and (2) 170 pregnant women with pelvic girdle pain (PGP), using data at 12 and 30 weeks of their pregnancy. In both studies, weekly text messages asked for the number of days with bothersome pain the previous week. Pearson's correlation, univariable, and multivariable linear regression were used to assess the association between days with bothersome pain per week and pain intensity, disability, and quality of life. Non-linear associations were explored.
RESULTS
Days with bothersome pain were moderately and inversely correlated with quality of life ( = -0.45, < 0.001), and moderately correlated with pain intensity ( = 0.70, < 0.001) and disability ( = 0.51, < 0.001), among patients with LBP, and to a lesser degree among pregnant women with PGP (corresponding values at 18 weeks of pregnancy for quality of life; = -0.27, = 0.005, for pain intensity = 0.41, < 0.001, and for disability = 0.41, < 0.001). Furthermore, it was best explained by pain intensity for LBP patients, and by pain intensity and disability for pregnant women with pelvic pain. For the latter cohort, non-linear analyses suggested that days with bothersome pain could not distinguish between individuals with different high pain intensities and disabilities and low quality of life.
CONCLUSIONS
We consider the concurrent validity of "days with bothersome pain" to be moderate in the correlations with pain intensity, disability, and quality of life in patients with LBP and in pregnant women with PGP. Ceiling effects may be an issue in populations with high pain severity. The differences between the cohorts suggested that also other constructs are involved in the concept of days with bothersome pain.
Topics: Pregnancy; Humans; Female; Pain Measurement; Quality of Life; Low Back Pain; Pelvic Pain; Linear Models
PubMed: 38447020
DOI: 10.1515/sjpain-2023-0049 -
Journal of Pain Research 2024[This corrects the article DOI: 10.2147/JPR.S431438.].
[This corrects the article DOI: 10.2147/JPR.S431438.].
PubMed: 38444879
DOI: 10.2147/JPR.S466139 -
European Spine Journal : Official... Apr 2024Many women experience pain around the low back and pelvic girdle during/after pregnancy. These pains have different risk factors and require independent management...
PURPOSE
Many women experience pain around the low back and pelvic girdle during/after pregnancy. These pains have different risk factors and require independent management strategies. Therefore, an epidemiological database is required to understand when each type of pain occurs, and how serious it could be. Thus, the history of pain in the lumbopelvic region throughout the perinatal period was investigated.
METHODS
The information of 170 women recruited at the obstetrics and gynecology clinics in Japan was collected at 12, 24, 30, and 36 weeks of pregnancy, in the early days after childbirth, and one month after childbirth. The presence and severity of sacroiliac joint pain, pubic pain, groin pain, and low back pain were assessed using a numerical rating scale. Descriptive statistics were used to determine changes in the prevalence of pain. In addition, the change in the severity of each type of pain was observed through descriptive statistics, by including only those who had pain.
RESULTS
The sacroiliac joint pain showed a twofold increase from 12 to 24 weeks, while the pubic pain suddenly increased after 24 weeks. The severity of pubic and groin pain increased sharply during pregnancy. Regarding low back pain, the change in the severity was lesser than the other pains. The sacroiliac joint pain was the highest among the four pains during pregnancy.
CONCLUSION
Each type of pain had a different incidence rate and a different time of onset and aggravation. These results help women and health professionals to manage, and prevent these harmful symptoms.
Topics: Pregnancy; Female; Humans; Low Back Pain; Prospective Studies; Pregnancy Complications; Pelvic Pain; Arthralgia
PubMed: 38427055
DOI: 10.1007/s00586-024-08193-x