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Obstetrics and Gynecology Clinics of... Jun 2022Chronic pelvic pain (CPP) is multifactorial in etiology and heterogeneous in presentation. Identification of all pain contributors is essential for successful... (Review)
Review
Chronic pelvic pain (CPP) is multifactorial in etiology and heterogeneous in presentation. Identification of all pain contributors is essential for successful management. Chronic overlapping pain conditions (COPCs) are a specified group of chronic pain conditions that commonly co-occur in patients. We briefly review individual COPCs and highlight risk factors and mechanisms that appear to be applicable across COPCs. We review evaluation and communication strategies that may help establish a productive therapeutic relationship between clinicians and patients. Management should include treatment of peripheral pain generators as well as co-occurring psychological conditions and central sensitization when present.
Topics: Chronic Disease; Chronic Pain; Female; Humans; Pelvic Pain
PubMed: 35636805
DOI: 10.1016/j.ogc.2022.02.006 -
Frontiers in Neuroendocrinology Apr 2022Endometriosis is a chronic pain disorder that affects young women, impairing their physical, mental and social well-being. Apart from personal suffering, it imposes a... (Review)
Review
Endometriosis is a chronic pain disorder that affects young women, impairing their physical, mental and social well-being. Apart from personal suffering, it imposes a significant economic burden on the healthcare system. We analyzed studies reporting comorbid mental disorders in endometriosis based on the ICD/DSM criteria, discussing them in the context of available neuroimaging studies. We postulate that at least one-third of endometriosis patients suffer from mental disorders (mostly depression or anxiety) and require psychiatric or psychotherapeutic support. According to three neuroimaging studies involving patients with endometriosis, brain regions related not only to pain processing but also to emotion, cognition, self-regulation and reward likely constitute the so-called "endometriosis brain". It is not clear, however, whether the neurobiological changes seen in these patients are caused by chronic pain, mental comorbidities or endometriosis itself. Given the paucity of high-quality data on mental comorbidities and neurobiological correlates in endometriosis, further research is needed.
Topics: Anxiety; Brain; Chronic Pain; Endometriosis; Female; Humans; Pelvic Pain
PubMed: 35202605
DOI: 10.1016/j.yfrne.2022.100988 -
Journal of Minimally Invasive Gynecology 2013To describe rates of pelvic pain in university women ages 18 and older and to explore the barriers to adequate health care for pelvic pain in this population.
STUDY OBJECTIVE
To describe rates of pelvic pain in university women ages 18 and older and to explore the barriers to adequate health care for pelvic pain in this population.
DESIGN
A cross-sectional study (Canadian Task Force classification II-2).
SETTING
University of Florida, Gainesville, FL.
PATIENTS
A total of 2000 female students at the University of Florida were randomly selected for participation.
INTERVENTIONS
The 2000 sample members were sent a questionnaire to be completed online.
MEASUREMENTS AND MAIN RESULTS
The online questionnaire was hosted through the REDCap electronic data capture tool hosted at the University of Florida. This questionnaire included demographic items, general health and health behavior questions, measures to assess different types of pelvic pain (e.g., dysmenorrheal; dyspareunia; urinary, bowel, and vulvar pain), items regarding barriers to care for pelvic pain problems, and quality of life measures. Data were exported to SAS software (SAS Institute Inc., Cary, NC) for analysis. Of the 2000 subjects who received the questionnaire invitation, 390 filled out the questionnaire, yielding a response rate of 19.5%. Respondents' ages ranged from 18 to 62 with a mean of 23 years. A total of 72.8% of respondents reported experiencing pelvic pain over the past 12 months. Dysmenorrhea was reported by nearly 80% of participants, over one third of participants noted deep dyspareunia, and a significant proportion of participants reported symptoms related to bowel movements. Vulvar symptoms, including superficial dyspareunia, were reported by 21.5% of participants. Most participants with pelvic pain (78.8%) have not received any diagnosis for their pain, whereas 73.6% reported not yet having visited a doctor. Significant barriers to receiving adequate medical care were reported, including difficulty with insurance coverage and physicians' lack of time and knowledge or interest in chronic pelvic pain conditions.
CONCLUSION
Pelvic pain in younger women is a critical public health issue experienced by a significant portion of the population. Significant awareness deficits and barriers to care exist. Careful study of the barriers to receiving adequate medical care reported by these women will allow researchers to describe how best to improve care for these syndromes.
Topics: Adolescent; Adult; Cross-Sectional Studies; Dysmenorrhea; Dyspareunia; Female; Health Services Accessibility; Humans; Middle Aged; Pelvic Pain; Students; Surveys and Questionnaires; Universities
PubMed: 23981982
DOI: 10.1016/j.jmig.2013.05.003 -
BJOG : An International Journal of... Nov 2018To estimate the prevalence of pelvic pain and model associations with potential demographic, obstetric, gynaecological and psychosocial determinants.
OBJECTIVE
To estimate the prevalence of pelvic pain and model associations with potential demographic, obstetric, gynaecological and psychosocial determinants.
DESIGN, SETTING AND SAMPLE
A cohort study of women born between 1972 and 1973 in Dunedin, New Zealand, most recently assessed when aged 38 years (95% of survivors retained); 429 women were eligible for analysis.
METHODS
Women self-completed reproductive health questionnaires at ages 21, 26, 32 and 38 years, with questions on dysmenorrhoea at ages 13 and 15, and on all pelvic pain at age 38. Prevalence and 95% confidence intervals (CI) were calculated and Poisson regression used to model associations.
MAIN OUTCOME MEASURES
The prevalence of pain and adjusted relative risks (ARR) for potential explanatory factors.
RESULTS
Over half (54.5%, 95% CI 49.7-59.3%) of women experienced pelvic pain in the past 12 months at age 38. Dysmenorrhoea was reported by 46.2% (41.3-51.3%), dyspareunia by 11.6% (8.7-15.2%) and other pelvic pain (OPP) by 17.3% (13.8-21.2%). After adjusting for multiple factors, pregnancy (ARR 0.60, 95% CI 0.32-1.13) and childbirth (ARR 0.52, 95% CI 0.25-1.09) were borderline protective for dyspareunia and OPP, respectively. However, childbirth was not associated with dysmenorrhoea (ARR 0.97, 95% CI 0.74-1.28). Dysmenorrhoea and dyspareunia were strongly associated, and both were associated with endometriosis.
CONCLUSIONS
Our data confirm that female pelvic pain is common, and suggest common gynaecological and obstetric causal pathways, but there was no strong evidence supporting a benefit of childbirth for dysmenorrhoea. Further research on obstetric events and pelvic pain is needed, with both being common experiences.
TWEETABLE ABSTRACT
Pelvic pain was common at age 38, especially dysmenorrhoea (46.2%), and no improvement was detected following childbirth.
Topics: Adult; Dysmenorrhea; Female; Humans; Longitudinal Studies; New Zealand; Pain Measurement; Pelvic Pain; Prevalence; Prospective Studies; Risk Factors; Surveys and Questionnaires; Young Adult
PubMed: 29675890
DOI: 10.1111/1471-0528.15247 -
BioMed Research International 2022Palmitoylethanolamide is reported to solve pain and neuroinflammation in different models of chronic and neurodegenerative diseases. Some concerns have been illustrated... (Review)
Review
BACKGROUND
Palmitoylethanolamide is reported to solve pain and neuroinflammation in different models of chronic and neurodegenerative diseases. Some concerns have been illustrated for cautiously interpreting the available literature on the topic. Specifically, there is a lack of evidence about palmitoylethanolamide and female chronic pelvic pain. Concerns will be best solved by randomized trials. The present study was aimed at finding the best responders to micronized palmitoylethanolamide in female patient with chronic pelvic pain, using the existing literature at individual patient level, to help further randomized trial planning.
METHODS
After a systematic research, eligible studies (the ones enrolled female patients treated for chronic pelvic pain or for dyspareunia, dysuria, dyschezia, and dysmenorrhea with or without chronic pelvic pain) were assessed at individual patient data level. Conditional probabilities were calculated to assess variables conditioning the rates of good responders (pain score points more or equal to 3 reduction), poor responders (2 pain score reduction), and nonresponders at a three-month follow-up.
RESULTS
Only cases treated with palmitoylethanolamide comicronized with polydatin for a short period can be assessed. Good responders are more than 50%. In chronic pelvic pain, there is a 19.0% conditional probability to find good responders among patients with pain score at enrolment of 6 to 8 and of 6.8% to find poor responders among patients with a pain score at enrolment of 6 to 8. Painful disease does not matter on responders' rates.
CONCLUSION
Best responders to comicronized palmitoylethanolamide/polydatin are patients with pain score higher than 6 at enrolment, irrespective of other variables.
Topics: Amides; Chronic Pain; Dysmenorrhea; Endometriosis; Ethanolamines; Female; Glucosides; Humans; Palmitic Acids; Pelvic Pain; Stilbenes
PubMed: 35578721
DOI: 10.1155/2022/8620077 -
International Journal of Molecular... Jul 2016Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is one of the most common urologic diseases, and no curative treatments have been identified. Low-intensity... (Review)
Review
Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is one of the most common urologic diseases, and no curative treatments have been identified. Low-intensity pulsed ultrasound (LIPUS) has been successfully used in promoting tissue healing, inhibiting inflammation and pain, differentiating stem cells, and stimulating nerve regeneration/muscle regeneration, as well as enhancing angiogenesis. Very recently, LIPUS has been proven an effective approach for CP/CPPS. This review summarizes the possible mechanisms responsible for the therapeutic effect of LIPUS for CP/CPPS. To search publications relevant to the topics of this review, the search engine for life sciences of Entrez was used. We reviewed the available evidence from 1954 through 2015 concerning LIPUS for CP/CPPS. According to the literature, both transrectal and transperineal approaches of LIPUS are effective for CP/CPPS.
Topics: Chronic Disease; Humans; Male; Neovascularization, Physiologic; Pelvic Pain; Prostatitis; Signal Transduction; Temperature; Ultrasonic Therapy; Vascular Endothelial Growth Factor A
PubMed: 27376284
DOI: 10.3390/ijms17071057 -
Journal of Vascular Surgery. Venous and... Jan 2015Chronic pelvic pain accounts for up to 30% of outpatient gynecologic visits in the United States, potentially affecting up to 40% of the female population during their... (Review)
Review
BACKGROUND
Chronic pelvic pain accounts for up to 30% of outpatient gynecologic visits in the United States, potentially affecting up to 40% of the female population during their lifetime. Pelvic congestion syndrome (PCS) is defined as chronic pelvic pain resulting from reflux or obstruction of the gonadal, gluteal, or periuterine veins, sometimes associated with perineal or vulvar varices. It can also be caused by compression of the left renal vein (LRV) between the superior mesenteric artery and the aorta, also known as the nutcracker syndrome. Whereas PCS accounts for up to 30% of patients presenting with chronic pelvic pain, it is frequently underdiagnosed. We reviewed the literature to investigate the current state of the diagnosis and treatment of this disorder.
METHODS
An online database search was performed with MEDLINE. MeSH headings included PCS, chronic pelvic pain, ovarian vein reflux, nutcracker syndrome, renal vein obstruction, pelvic varicosities, labial varicosities, embolization, treatment, and therapies.
RESULTS
Our MEDLINE search revealed more than 3756 references to chronic pelvic pain. Specific references to PCS, pelvic chronic pain, ovarian vein reflux, nutcracker syndrome, renal vein obstruction, pelvic varicosities, labial varicosities, embolization, treatment, and therapies, however, included only 260 references. Thirty-seven references were small series including fewer than 50 patients or individual case reports documenting medical, surgical, or endovascular treatment of PCS. The majority of these papers demonstrated successful treatment of symptoms from PCS with embolization of one or both ovarian veins in addition to treatment of refluxing internal iliac vein branches. In addition, open surgery and, more recently, endovascular stenting of LRV obstruction have shown some promise in alleviating symptoms attributed to nutcracker syndrome.
CONCLUSIONS
Diagnosis of PCS requires a careful history, physical examination, and noninvasive imaging. Several large case series have demonstrated the efficacy of embolotherapy in the reduction of pelvic pain; thus, it is the most favored treatment option for patients with PCS. For patients with outflow obstruction due to nutcracker syndrome, a limited number of studies have demonstrated remission of symptoms with stenting of the LRV as an alternative to open surgery.
Topics: Chronic Pain; Embolization, Therapeutic; Female; Humans; Ovary; Pelvic Pain; Renal Veins; Syndrome; Varicose Veins
PubMed: 26993690
DOI: 10.1016/j.jvsv.2014.05.007 -
International Braz J Urol : Official... 2004
Clinical Trial
Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Doxycycline; Female; Humans; Leukoplakia; Middle Aged; Pelvic Pain; Treatment Outcome; Urinary Tract Infections
PubMed: 15679988
DOI: No ID Found -
International Urogynecology Journal Jan 2024The mid-urethral sling (MUS) has been used for more than 30 years to cure stress urinary incontinence. The objective of this study was to assess whether surgical...
INTRODUCTION AND HYPOTHESIS
The mid-urethral sling (MUS) has been used for more than 30 years to cure stress urinary incontinence. The objective of this study was to assess whether surgical technique affects the outcome after more than ten years, regarding dyspareunia and pelvic pain.
METHODS
In this longitudinal cohort study we used the Swedish National Quality Register of Gynecological Surgery to identify women who underwent MUS surgery in the period 2006-2010. Out of 4348 eligible women, 2555 (59%) responded to the questionnaire sent out in 2020-2021. The two main surgical techniques, the retropubic and the obturatoric approach, were represented by 1562 and 859 women respectively. The Urogenital Distress Inventory-6 (UDI-6) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), as well as general questions concerning the MUS surgery, were sent out to the study population. Dyspareunia and pelvic pain were defined as primary outcomes. Secondary outcomes included PISQ-12, general satisfaction, and self-reported problems due to sling insertion.
RESULTS
A total of 2421 women were included in the analysis. Among these, 71% responded to questions regarding dyspareunia and 77% responded to questions regarding pelvic pain. In a multivariate logistic regression analysis of the primary outcomes, we found no difference in reported dyspareunia (15% vs 17%, odds ratio (OR) 1.1, 95% CI 0.8-1.5) or in reported pelvic pain (17% vs 18%, OR 1.0, 95% CI 0.8-1.3) between the retropubic and obturatoric techniques among study responders.
CONCLUSION
Dyspareunia and pelvic pain 10-14 years after insertion of a MUS do not differ with respect to surgical technique.
Topics: Female; Humans; Dyspareunia; Urologic Surgical Procedures; Suburethral Slings; Longitudinal Studies; Urinary Incontinence, Stress; Pelvic Pain; Treatment Outcome
PubMed: 37428179
DOI: 10.1007/s00192-023-05585-3 -
Tidsskrift For Den Norske Laegeforening... Nov 2010Pelvic girdle pain (PGP) usually presents during pregnancy. About 25% of all pregnant women and 5% of all women suffer from postpartum lumbopelvic pain causing them to... (Review)
Review
BACKGROUND
Pelvic girdle pain (PGP) usually presents during pregnancy. About 25% of all pregnant women and 5% of all women suffer from postpartum lumbopelvic pain causing them to seek medical help. This article discusses possible causes, diagnostic aspects and treatment of PGP.
MATERIAL AND METHOD
The paper is based on literature identified through non-systematic searches in PubMed, Medline, Embase, Cinahl and Cochrane. Only randomized controlled trials were considered for effect of treatment.
RESULTS
Possible underlying mechanisms are hormonal, biomechanical, inadequate motor control and stress of ligament structures. The diagnosis should be based on pain location and several clinical tests. Characteristic signs are problems with walking, standing and sitting. There is evidence for the existence of PGP subgroups that require different treatment. It is well documented that individualized physiotherapy focused on body awareness and specific functional training, has a good and long-lasting effect. Patients with PGP may benefit from reassuring information based on medical history and clinical examination. When needed, patients may be referred to targeted individualized physiotherapy which is continuously evaluated. Few seem to have effect of general or stabilizing exercises.
INTERPRETATION
General or stabilizing exercises seem to have miner effect in a number of women.
Topics: Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Female; Humans; Pelvic Floor; Pelvic Pain; Physical Therapy Modalities; Pregnancy; Pregnancy Complications; Puerperal Disorders
PubMed: 21052118
DOI: 10.4045/tidsskr.09.0702