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Women's Health (London, England) 2023Dysmenorrhea (painful menstrual cramps) is one of the most common gynecological complaints in women and girls. Dysmenorrhea may be a condition itself or a result of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Dysmenorrhea (painful menstrual cramps) is one of the most common gynecological complaints in women and girls. Dysmenorrhea may be a condition itself or a result of another medical condition, including endometriosis and chronic pelvic pain. Research examining the relationship between menstrual pain ratings and catastrophizing has produced mixed results.
OBJECTIVE
To review and meta-analyze the relationship between catastrophizing and pain ratings of chronic cyclical pelvic pain.
DESIGN
Cross-sectional, longitudinal, and intervention studies that reported the relationship between menstrual/pelvic pain and catastrophizing were included. Study populations had to include healthy menstruating persons or persons with a condition associated with cyclical pelvic pain including primary dysmenorrhea, endometriosis, and/or chronic pelvic pain.
DATA SOURCES AND METHODS
A systematic search of articles published since 2012 on PubMed, PsychInfo, CINHAL, and Medline was conducted in January and rerun in November of 2022. Search terms included cyclical pelvic pain, dysmenorrhea, endometriosis, pelvic pain, and catastrophizing. Data extraction was completed independently by two extractors and cross-checked for errors. A random-effects meta-regression was used to synthesize the data using restricted maximum likelihood.
RESULTS
Twenty-five studies examining 4,540 participants were included. A random effects model found a meta-correlation between catastrophizing and pain of = .31 (95% confidence interval: .23-.40) < .001. Heterogeneity was large and significant ( = 84.5%, (24) = 155.16, < .001). Studies that measured general pelvic pain rather than cyclical pelvic pain specifically and those that used multi-item rather than single-item measures of pain had significantly higher correlations. Age and depression did not moderate the relationship between catastrophizing and pain.
CONCLUSION
A systematic review and meta-analysis found that catastrophizing had a small but significant positive association with pain ratings. Patients experiencing cyclical pelvic pain may benefit from interventions targeting the psychological management of pain.
REGISTRATION
This meta-analysis was registered in PROSPERO on 14 January 2022. Registration number: CRD42022295328.
Topics: Female; Humans; Dysmenorrhea; Endometriosis; Cross-Sectional Studies; Pelvic Pain; Chronic Pain; Catastrophization
PubMed: 37752879
DOI: 10.1177/17455057231199949 -
BMJ Clinical Evidence Mar 2007Ectopic endometrial tissue is found in up to 20% of asymptomatic women, up to 60% of those with dysmenorrhoea, and up to 30% of women with subfertility, with a peak... (Review)
Review
INTRODUCTION
Ectopic endometrial tissue is found in up to 20% of asymptomatic women, up to 60% of those with dysmenorrhoea, and up to 30% of women with subfertility, with a peak incidence at around 40 years of age. However, symptoms may not correlate with laparoscopic findings.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of hormonal treatments given at diagnosis of endometriosis? What are the effects of hormonal treatments before surgery for endometriosis? What are the effects of non-hormonal medical treatments for endometriosis? What are the effects of surgical treatments for endometriosis? What are the effects of hormonal treatment after conservative surgery for endometriosis? What are the effects of hormonal treatment after oophorectomy (with or without hysterectomy) for endometriosis? What are the effects of treatments for ovarian endometrioma? We searched: Medline, Embase, The Cochrane Library and other important databases up to April 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 32 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: combined oral contraceptives; danazol; dydrogesterone; gestrinone; gonadorelin analogues; hormonal treatment before surgery; hormonal treatment; laparoscopic cystectomy; laparoscopic removal of endometriotic deposits (alone or with uterine nerve ablation); laparoscopic removal plus presacral neurectomy; laparoscopic uterine nerve ablation; non-steroidal anti-inflammatory drugs; presacral neurectomy alone; and progestogens other than dydrogesterone.
Topics: Administration, Oral; Anti-Inflammatory Agents, Non-Steroidal; Contraceptives, Oral; Danazol; Dysmenorrhea; Endometriosis; Female; Humans; Laparoscopy; Progestins
PubMed: 19454060
DOI: No ID Found -
AJOG Global Reports Feb 2022While widely used for the treatment of chronic pelvic pain, limited data exists on efficacy of gabapentin, especially in the subgroup of women suffering from chronic...
BACKGROUND
While widely used for the treatment of chronic pelvic pain, limited data exists on efficacy of gabapentin, especially in the subgroup of women suffering from chronic pelvic pain without a known diagnosis, such as endometriosis.
OBJECTIVE
This study aimed to assess the efficacy of gabapentin when administered to women with chronic pelvic pain without another diagnosis.
STUDY DESIGN
We performed a Systematic Review and Meta Analysis including all controlled clinical trials addressing the use of gabapentin for the treatment of chronic pelvic pain without another diagnosis. We searched PubMed, Scopus, Web of Science, ClinicalTrials.Gov, MEDLINE, and The Cochrane Library from inception of each database to April 30, 2021. We included all the studies that fulfilled the following criteria: (1) population: women suffering from chronic pelvic pain without another identified diagnosis (such as endometriosis); (2) intervention: gabapentin (regardless of the dosage); (3) comparator:placebo; (4) outcomes: pain score (visual analog scale) after 3 months and pain score (visual analog scale) after 6 months as primary outcomes; and (5) study design: we only included randomized or controlled clinical trials. Our exclusion criteria included (1) uncontrolled clinical trials, (2) studies that did not report data or measures for any of our selected outcomes, (3) studies that included patients with surgically or clinically diagnosed endometriosis, or (4) studies with no full-text manuscript available. Risk of bias assessment was performed using the Cochrane risk of bias tool. We analyzed dichotomous outcomes as percentages and totals, whereas continuous outcomes were analyzed using mean difference, standard deviations, and relative 95% confidence intervals using the inverse variance method.
RESULTS
We included 4 placebo-controlled randomized controlled trials. Analysis was hindered because half of the studies (n=2) used the visual analog scale pain score and the other half (n=2) used the numerical rating scale. The analysis showed that when compared with the placebo, gabapentin significantly lowered the visual analog scale pain score at 3 months (mean difference, 0.79; 1.23 to 0.35; =.005) and 6 months (mean difference, 1.68; 2.30 to 1.05; =.001) and the numerical rating scale pain score at 3 months (mean difference, 0.20; 0.25 to 0.15; =.001). However, in terms of the numerical rating scale pain score after 6 months, the 2 groups showed no significant difference (mean difference, 0.27; 0.80 to 0.26; =.32).
CONCLUSION
Gabapentin may hold benefit for the management of chronic pelvic pain, with significant improvement in pain seen in both scales at 3 months when compared with the placebo, but only in the visual analog scale group at 6 months of usage. Secondary to the differences in the nature of the 2 scales, a further weighted combined analysis was not possible.
PubMed: 36274967
DOI: 10.1016/j.xagr.2021.100042 -
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 -
Maturitas May 2023Endometriosis is a benign, estrogen-dependent, chronic inflammatory disease and is the commonest cause of chronic pelvic pain in younger women. Cardiovascular disease is... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Endometriosis is a benign, estrogen-dependent, chronic inflammatory disease and is the commonest cause of chronic pelvic pain in younger women. Cardiovascular disease is the main cause of death worldwide. Because the relationship between endometriosis and CV disease is not well established, we performed a systematic review of longitudinal studies that assessed the occurrence of cardiovascular events in women with endometriosis compared to those without endometriosis.
STUDY DESIGN
Systematic review with meta-analysis of longitudinal cohort/nested case-control studies with endometriosis patients and controls. A search was conducted of the MEDLINE, CENTRAL, and Embase databases from inception to November 2022. Random-effects meta-analysis was performed to estimate pooled hazard ratios (HR) and 95 % confidence intervals (95%CI).
MAIN OUTCOME MEASURE
Cardiovascular outcomes such as ischemic heart disease and cerebrovascular disease.
RESULTS
Six cohort studies were included, with a total of 254,929 participants. Meta-analysis showed that endometriosis was associated with a significantly increased risk of ischemic heart disease (HR 1.50, 95%CI 1.37-1.65; I = 0 %) and cerebrovascular disease (HR 1.17, 95%CI 1.07-1.29; I = 0 %). The one study that examined the relationship between cardiovascular mortality and endometriosis found a decreased risk in women with endometriosis relative to women without endometriosis (HR 0.55 (95%CI 0.47-0.65)).
CONCLUSIONS
Endometriosis is associated with a significantly increased risk of cardiovascular disease, namely ischemic heart disease and cerebrovascular disease. Further studies are required to determine if endometriosis and/or its treatments are risk factors (particularly for cardiovascular mortality), and whether preventive measures could reduce the burden of cardiovascular disease in women with endometriosis. Study protocol registered at PROSPERO: CRD42022298830.
Topics: Humans; Female; Cardiovascular Diseases; Endometriosis; Cerebrovascular Disorders; Myocardial Ischemia; Cohort Studies
PubMed: 37075537
DOI: 10.1016/j.maturitas.2023.04.001 -
International Journal of Molecular... Oct 2022Endometriosis is defined as ectopic endometrial tissues dispersed outside the endometrium. This can cause disruption in hormonal and immunological processes, which may... (Meta-Analysis)
Meta-Analysis Review
Endometriosis is defined as ectopic endometrial tissues dispersed outside the endometrium. This can cause disruption in hormonal and immunological processes, which may increase susceptibility to SARS-CoV-2 infection. Worsening of endometriosis symptoms may occur as a result of this infection. The aim of our review was to estimate the pooled prevalence of SARS-CoV-2 infection and the health impacts of the COVID-19 pandemic in endometriosis patients. We conducted a systematic review and meta-analysis. MEDLINE, Science Direct, Scopus, and Google Scholar databases were searched, using the keywords: (endometriosis) AND (COVID-19 OR SARS-CoV-2). Forest plots and pooled estimates were created using the Open Meta Analyst software. After screening 474 articles, 19 studies met the eligibility criteria for the systematic review, and 15 studies were included in the meta-analyses. A total of 17,799 patients were analyzed. The pooled prevalence of SARS-CoV-2 infection in endometriosis patients was 7.5%. Pooled estimates for the health impacts were 47.2% for decreased access to medical care, 49.3% increase in dysmenorrhea, 75% increase in anxiety, 59.4% increase in depression, and 68.9% increase in fatigue. Endometriosis patients were undeniably impacted by the COVID-19 pandemic, which caused the worsening of symptoms such as dysmenorrhea, pelvic pain, anxiety, depression, and fatigue.
Topics: Female; Humans; COVID-19; Endometriosis; SARS-CoV-2; Pandemics; Dysmenorrhea; Prevalence; Fatigue
PubMed: 36361745
DOI: 10.3390/ijms232112951 -
Journal of Orthopaedics and... Sep 2017Pelvic posture and kinematics influence acetabular orientation and are therefore expected to be involved in the pathomechanics of femoroacetabular impingement (FAI).... (Review)
Review
BACKGROUND
Pelvic posture and kinematics influence acetabular orientation and are therefore expected to be involved in the pathomechanics of femoroacetabular impingement (FAI). This systematic review aims to determine whether FAI patients show pelvic postures or patterns of motion contributing to impingement or, conversely, develop compensatory postures and patterns of motion preventing it.
MATERIALS AND METHODS
PubMed/MEDLINE, Embase, Google Scholar and the Cochrane Library were systematically searched to find all the studies that measured pelvic positional and/or kinematic data in humans (patients or cadaveric specimens) affected by FAI.
RESULTS
Twelve items were selected and grouped according to the main field of investigation. No quantitative data synthesis was allowed due to methodological heterogeneity. Pelvic posture and kinematics seem to play a relevant role in FAI. The patients, especially if symptomatic, show a paradoxical lack of pelvic back tilt in standing hip flexions, i.e., in squatting, that enhances femoroacetabular engagement. Such an aberrant pattern might depend on a lower pelvic incidence. On the contrary, active hip flexion in decubitus elicits a compensatory, more pronounced back tilt to facilitate hip flexion without impingement. Stair climbing shows a compensatory pattern of augmented pelvic axial rotation and augmented peak forward tilt to reduce painful hip motions, namely internal rotation and extension.
CONCLUSION
In FAI patients, pelvic posture and kinematics are sometimes an expression of compensatory mechanisms developed to reduce pain and discomfort, and sometimes an expression of paradoxical responses that further enhance the impingement pathomechanism.
LEVEL OF EVIDENCE
IV.
Topics: Acetabulum; Biomechanical Phenomena; Femoracetabular Impingement; Femur Head; Femur Neck; Hip Joint; Humans; Pelvic Bones; Posture; Spine
PubMed: 28150180
DOI: 10.1007/s10195-016-0439-2 -
World Journal of Gastroenterology Oct 2011This systematic review addresses the pathophysiology, diagnostic evaluation, and treatment of several chronic pain syndromes affecting the pelvic organs: chronic... (Review)
Review
This systematic review addresses the pathophysiology, diagnostic evaluation, and treatment of several chronic pain syndromes affecting the pelvic organs: chronic proctalgia, coccygodynia, pudendal neuralgia, and chronic pelvic pain. Chronic or recurrent pain in the anal canal, rectum, or other pelvic organs occurs in 7% to 24% of the population and is associated with impaired quality of life and high health care costs. However, these pain syndromes are poorly understood, with little research evidence available to guide their diagnosis and treatment. This situation appears to be changing: a recently published large randomized, controlled trial by our group comparing biofeedback, electrogalvanic stimulation, and massage for the treatment of chronic proctalgia has shown success rates of 85% for biofeedback when patients are selected based on physical examination evidence of tenderness in response to traction on the levator ani muscle--a physical sign suggestive of striated muscle tension. Excessive tension (spasm) in the striated muscles of the pelvic floor appears to be common to most of the pelvic pain syndromes. This suggests the possibility that similar approaches to diagnostic assessment and treatment may improve outcomes in other pelvic pain disorders.
Topics: Anal Canal; Chronic Pain; Diagnosis, Differential; Humans; Pelvic Pain; Pudendal Neuralgia; Rectum; Sacrococcygeal Region
PubMed: 22110274
DOI: 10.3748/wjg.v17.i40.4447 -
Toxins Jan 2022Pain management of patients with chronic pelvic pain syndrome (CPPS) is challenging, because pain is often refractory to conventional treatments. Botulinum toxin A... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Pain management of patients with chronic pelvic pain syndrome (CPPS) is challenging, because pain is often refractory to conventional treatments. Botulinum toxin A (BTX-A) may represent a promising therapeutic strategy for these patients. The aim of this systematic review was to investigate the role of BTX-A in CPPS treatment.
METHODS
We reviewed the literature for prospective studies evaluating the use of BTX-A in the treatment of CPPS. A comprehensive search in the PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases was performed from English language articles published between January 2000 and October 2021. The primary outcome was to evaluate pain improvement in CPPS after BTX-A treatment. Pooled meta-analysis of the included studies, considering the effect of BTX-A on pain evaluated at last available follow-up compared to baseline values, was performed together with meta-regression analysis.
RESULTS
After screening 1001 records, 18 full-text manuscripts were selected, comprising 13 randomized clinical trials and five comparative studies. They covered overall 896 patients of both sexes and several subtype of CPPS (interstitial cystitis/bladder pain syndrome, chronic prostatitis/prostate pain syndrome, chronic scrotal pain, gynecological pelvic pain, myofascial pelvic pain). The clinical and methodological heterogeneity of studies included makes it difficult to do an overall estimation of the real effect of BTX-A on pain and other functional outcomes of various CPPS subtypes. However, considering pooled meta-analysis results, a benefit in pain relief was showed for BTX-A-treated patients both in the overall studies populations and in the overall cohorts of patients with CPP due to bladder, prostate, and gynecological origin.
CONCLUSIONS
BTX-A could be an efficacious treatment for some specific CPPS subtypes. Higher level studies are needed to assess the efficacy and safety of BTX-A and provide objective indications for its use in CPPS management.
Topics: Adult; Aged; Aged, 80 and over; Botulinum Toxins, Type A; Chronic Pain; Female; Humans; Injections, Intravenous; Middle Aged; Neurotoxins; Pelvic Pain; Prospective Studies; Treatment Outcome
PubMed: 35051002
DOI: 10.3390/toxins14010025 -
Acta Obstetricia Et Gynecologica... Nov 2003A systematic review of prospective controlled clinical trials was performed to assess the effectiveness of physical therapy interventions for the prevention and... (Review)
Review
BACKGROUND
A systematic review of prospective controlled clinical trials was performed to assess the effectiveness of physical therapy interventions for the prevention and treatment of pregnancy-related back and pelvic pain. Pregnancy-related low back and pelvic pain has an impact on daily life for many women. Prevention and treatment of back and pelvic pain is therefore an important issue for all those concerned with women's health.
METHODS
All prospective controlled clinical trials retrieved by systematic searching of electronic databases, checking of reference lists and contacting of authors were examined. Two reviewers independently selected trials for inclusion and independently assessed the internal validity of the included trials. Authors were contacted to obtain missing information.
RESULTS
Nine trials with a total of 1350 patients were reviewed. Except for three high-quality studies, the validity of the trials was moderate to low. Two high-quality studies showed no difference in pain intensity and functional status between the exercise groups and the control groups. In the third high-quality study significant reduction in sick leave was found in favor of water gymnastics compared with no intervention. Because the included trials were considered heterogeneous with regard to study design, population intervention and outcome, no meta-analysis was performed.
CONCLUSIONS
Because of heterogeneity and the varying quality of the studies no strong evidence exists concerning the effect of physical therapy interventions on the prevention and treatment of back and pelvic pain related to pregnancy. Future studies should meet current methodological standards, and interventions to be evaluated should be based on established theoretical framework.
Topics: Female; Humans; Low Back Pain; Pelvic Pain; Physical Therapy Modalities; Pregnancy; Pregnancy Complications
PubMed: 14616270
DOI: 10.1034/j.1600-0412.2003.00125.x