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Margueritte F, Fritel X, Serfaty A, Coeuret-Pellicer M, Fauconnier A. Screening women in young adulthood for disabling dysmenorrhoea: a nationwide cross-sectional study from the CONSTANCES cohort. Reprod Biomed Online 2024; 49:103861. [PMID: 38735232 DOI: 10.1016/j.rbmo.2024.103861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 01/13/2024] [Accepted: 01/30/2024] [Indexed: 05/14/2024]
Abstract
RESEARCH QUESTION How do different warning indicators help to identify disabling dysmenorrhoea among women in young adulthood? DESIGN A nationwide cross-sectional study of women aged 18-25 years from the CONSTANCES cohort was constructed. Disability was assessed with the Global Activity Limitation Indicator question 'For the past 6 months, have you been limited in routine activities?Yes, severely limited/Yes, limited/ No, not limited'. Dysmenorrhoea pain intensity and other chronic pelvic pain symptoms (dyspareunia and non-menstrual pain) were evaluated according to questions from a specific questionnaire. Probability of disability was estimated using a logistic prediction model according to dysmenorrhoea intensity, other indicators of pelvic pain symptoms and other obvious covariates. The results of the predictive model of disabling dysmenorrhoea were presented on a nomogram. RESULTS Among 6377 women, the rate of disability was estimated at 7.5%. Increased intensity of dysmenorrhoea (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.04-1.13), increased frequency of dyspareunia (from OR 1.69, 95% CI 1.33-2.14 up to OR 3.41, 95% CI 2.16-5.38) non-menstrual chronic pelvic pain (OR 1.75, 95% CI 1.40-2.19), body mass index over 25 kg/m2 (OR 1.45, 95% CI 1.17-1.80) and non-use of the hormonal contraceptive pill (OR 1.29, 95% CI 1.05-1.59) were significantly associated with disability. According to the nomogram, a predicted probability of 15% or more could be chosen as a threshold. This represents almost 4.6% of young women in this sample being classified at risk of disabling dysmenorrhoea. CONCLUSIONS Dysmenorrhoea pain intensity and associated pelvic pain symptoms are warning indicators that can be measured to help screen young women who may suffer from disabling dysmenorrhoea.
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Affiliation(s)
- François Margueritte
- Team RISCQ 'Clinical risk and security on women's health and perinatal health', Université Paris-Saclay, UVSQ, Montigny-le-Bretonneux, France; Primary Care and Prevention Team, CESP, INSERM, Villejuif, France; Department of Gynecology and Obstetrics, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, Poissy, France.
| | - Xavier Fritel
- Department of Obstetrics and Gynaecology, La Miletrie University Hospital, Poitiers, France; INSERM CIC 1402, Poitiers University, Poitiers, France
| | - Annie Serfaty
- Team RISCQ 'Clinical risk and security on women's health and perinatal health', Université Paris-Saclay, UVSQ, Montigny-le-Bretonneux, France; Department of Medical Information, Territorial Hospital Group (GHT), Aisne-Nord/Haute-Somme, Saint Quentin Hospital, Aisne, France
| | - Mireille Coeuret-Pellicer
- Population-Based Epidemiological Cohorts, UMS 11, Paris-Saclay University, Versailles St Quentin University, Université de Paris, INSERM, Villejuif, France
| | - Arnaud Fauconnier
- Team RISCQ 'Clinical risk and security on women's health and perinatal health', Université Paris-Saclay, UVSQ, Montigny-le-Bretonneux, France; Department of Gynecology and Obstetrics, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, Poissy, France
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Nassiri Kigloo H, Itani R, Montreuil T, Feferkorn I, Raina J, Tulandi T, Mansour F, Krishnamurthy S, Suarthana E. Endometriosis, chronic pain, anxiety, and depression: A retrospective study among 12 million women. J Affect Disord 2024; 346:260-265. [PMID: 37956828 DOI: 10.1016/j.jad.2023.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 08/25/2023] [Accepted: 11/09/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND There is a lack of information regarding the impact of the physical symptoms associated with endometriosis and chronic pain on the mental health and well-being of affected women. Thus, our study aimed to evaluate the relationship between endometriosis, chronic pain, anxiety, and depression. OBJECTIVE Our study aimed to evaluate the relationship between endometriosis, chronic pain, and mental health disorders among women registered in a large database until 2014. STUDY DESIGN This was a retrospective population-based study involving 12,904,324 hospitalized women from the Healthcare Cost and Utilization Project (HCUP) database between 2007 and 2014. We calculated the prevalence of chronic pain, endometriosis, anxiety, and depression during the study period. We used multivariate logistic regression to examine the relationship between these variables. RESULTS An upward pattern was noted in the prevalence of chronic pain, while an opposite trend was seen for endometriosis during the study period. After adjusting for sociodemographic characteristics and comorbidities, including depression, the highest odds ratio of experiencing anxiety appeared in the group with both chronic pain and endometriosis (OR = 2.719, 95 % CI 2.481-2.979). LIMITATIONS HCUP is a cross-sectional administrative database that does not link patients' records over the years. Thus, we could not establish any temporal association between endometriosis, chronic pain, anxiety, and depression. CONCLUSION Potential associations were identified between endometriosis, with and without chronic pain, anxiety, and depression. We recommended that clinicians provide proper medical management of endometriosis-related pain through symptom management and adequate counseling for those suffering from anxiety and depression.
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Affiliation(s)
- Hormoz Nassiri Kigloo
- Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada; Faculty of Medicine, University Laval, Québec City, Québec, Canada
| | - Rayan Itani
- Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada
| | - Tina Montreuil
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Ido Feferkorn
- Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada
| | - Jason Raina
- Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada
| | - Togas Tulandi
- Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada
| | - Fady Mansour
- Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada
| | | | - Eva Suarthana
- Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada.
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Paspulati RM. Chronic Pelvic Pain: Role of Imaging in the Diagnosis and Management. Semin Ultrasound CT MR 2023; 44:501-510. [PMID: 37879545 DOI: 10.1053/j.sult.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Chronic pelvic pain (CPP) in women is not uncommon, and it may be difficult to identify the exact cause difficult to manage. It is major health problem for women that affects the quality of their daily lives. The etiology of chronic pelvic pain may be of gynecological or non-gynecological origin and associated with several predisposing and precipitating factors. Psychological and social factors also contribute to the syndrome of CPP and must be evaluated before managing these patients. Due to multifactorial etiology, CPP needs a multidisciplinary approach for diagnosis and management. A detailed history and physical examination supported by appropriate laboratory tests and imaging are the keys to diagnosis. In this paper, the role of imaging in diagnosis and management of CPP is reviewed. Imaging findings should be correlated with detailed clinical examination findings as there are imaging findings that may be unrelated and not the cause of CPP in a particular patient, imaging findings should be correlated with the clinical circumstances.
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Affiliation(s)
- Raj Mohan Paspulati
- Department of Diagnostic and Interventional Radiology, Moffitt Cancer Center, Tampa, Florida; Department of Medical Oncology, University of South Florida, Tampa, Florida.
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Hansrani V, Riding D, Seif MW, Caress AL, Payne K, Ghosh J, McCollum CN. Transvenous occlusion of incompetent pelvic veins to treat chronic pelvic pain in women: A randomised controlled trial. BJOG 2023; 130:1362-1369. [PMID: 37095614 DOI: 10.1111/1471-0528.17512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/18/2023] [Accepted: 03/30/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVE To investigate the effectiveness of transvenous occlusion of incompetent pelvic veins in women presenting with chronic pelvic pain (CPP) in improving symptoms and quality of life. DESIGN Patient-blinded randomised controlled trial with objective outcome measures. Results were analysed on an intention-to-treat basis. SETTING Gynaecology and Vascular Surgery Services of two teaching hospitals in northwest England. POPULATION Sixty women aged 18-54 years presenting with CPP after exclusion of other pathology, and who were found to have pelvic vein incompetence. METHODS Participants were randomised and assigned to contrast venography alone or contrast venography plus transvenous occlusion of the incompetent pelvic veins. MAIN OUTCOME MEASURE The primary outcome was change in pain score measured using the short-form McGill Pain Score (SF-MPQ) and the Visual Analogue Score (VAS) recorded at 12 months post-randomisation. Secondary outcomes included quality of life using the EQ-5D instrument, symptomatic improvement and procedure-related complications. RESULTS Sixty participants were randomised to transvenous occlusion of incompetent pelvic veins or venography only. At 12 months, median pain scored 2 (3-10) in the intervention group versus 9 (5-22) in controls (p = 0.016). Pain on the VAS scored 15 (0-3) versus 53 (20-71), respectively (p = 0.002). Median EQ-5D improved after intervention from 0.79 (0.74-0.84) to 0.84 (0.79-1.00; p = 0.008) over 12 months. No major complications were reported. CONCLUSION Transvenous occlusion of pelvic vein incompetence reduced pain scores, improved quality of life and diminished symptom burden with no major reported complications. TRIAL REGISTRATION ISRCTN 15091500.
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Affiliation(s)
- Vivak Hansrani
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
| | - David Riding
- Manchester Vascular Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Mourad W Seif
- St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ann-Louise Caress
- Health Services Research, Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Katherine Payne
- Health Economics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Jonathan Ghosh
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Charles N McCollum
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
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Analgesic Efficacy of Acupuncture on Chronic Pelvic Pain: A Systemic Review and Meta-Analysis Study. Healthcare (Basel) 2023; 11:healthcare11060830. [PMID: 36981487 PMCID: PMC10048458 DOI: 10.3390/healthcare11060830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
Chronic pelvic pain (CPP) is the pain occurred in the pelvic region longer than six months. The monotherapy of medicine may not adequate for the pain management of CPP and multidisciplinary approaches have been more recommended. The aim of this study is to evaluate the pain management efficacy of acupuncture compared with a control group on CPP. The articles of randomized controlled trial on CPP in PubMed and Embase databases were screened between January 2011 and September 2022 without language restriction to evaluate the treatment efficacy of acupuncture. The visual analogue scale/numerical rating scale (VAS/NRS) and total pain scores of National Institutes of Health—chronic prostatitis symptom index (NIH-CPSI) were served as outcome variables. Post-intervention mean scores were extracted and pooled for meta-analysis. Seventeen studies including 1455 patients were selected for meta-analysis. Both total pain scores of NIH-CPSI and VAS/NAS data revealed significant lower pain level in the acupuncture group than in the control group. Moreover, monotherapy with acupuncture revealed a significantly lower pain level than in the control group in both total pain scores of NIH-CPSI and VAS/NRS. These results indicated that acupuncture may have beneficial effects on pain management for CPP, even when administrated as a monotherapy.
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Origo D, Dal Farra F, Bruni MF, Catalano A, Marzagalli L, Bruini I. Are fascial strains involved in chronic pelvic pain syndrome? An exploratory matched case-control study. Int Urol Nephrol 2023; 55:511-518. [PMID: 36522568 DOI: 10.1007/s11255-022-03448-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Chronic pelvic pain (CPP) and chronic pelvic pain syndrome (CPPS) do not have a definite cause, even if their impact on quality of life was demonstrated. Furthermore, there is evidence of myofascial dysfunctions in a large number of CPP/CPPS, so that the role of fascia can be hypothesized. METHODS The aim of this exploratory matched case-control study was to assess whether fascial strains (FS) represent a factor associated with CPP/CPPS. The study followed the "Strengthening the Reporting of Observational Studies in Epidemiology" (STROBE) statement. We collected data from 189 subjects (cases: 58; controls: 131) who attended the clinic. The participants were managed through a 2:1 enrollment ratio. A standardized booklet requested for clinical information, previous FS and the following questionnaires: "National Institutes of Health Chronic Prostatitis Symptom Index" (NIH-CPSI), "Hospital Anxiety and Depression Scale" (HADS), "Fear Avoidance Belief Questionnaire" (FABQ). Each subject underwent a palpatory assessment to detect abnormal palpatory findings in the pelvic area. RESULTS The analyses showed that episiotomy, genito-urinary infections and surgery had a significantly increased odds ratio (OR) of 4.13, 3.1 and 3.08, respectively. FS as a whole had a significantly raised OR: 2.22 (1.14 to 4.33). The analysis was adjusted for physical activity and for type of job and OR decreased to 1.94 (0.82 to 4.61), losing its significance (p = 0.129). A strong correlation between symptoms' impact and CPP/CPPS was detected (rpbs = 0.710; p < 0.001) and a moderate one (0.3 < rpbs < 0.7; p < 0.001) was found considering anxiety, depression and abnormal palpatory findings. CONCLUSION This exploratory study suggests that FS could represent an etiological factor for developing CPP/CPPS. However, further research on fascial dysfunctions and relative implications in CPP/CPPS is needed for confirmation.
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Affiliation(s)
- Daniele Origo
- Research Department, SOMA Osteopathic Institute Milan, Viale Sarca 336 F, 20126, Milan, Italy
| | - Fulvio Dal Farra
- Research Department, SOMA Osteopathic Institute Milan, Viale Sarca 336 F, 20126, Milan, Italy. .,Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
| | - Maria Federica Bruni
- Research Department, SOMA Osteopathic Institute Milan, Viale Sarca 336 F, 20126, Milan, Italy
| | - Andrea Catalano
- Research Department, SOMA Osteopathic Institute Milan, Viale Sarca 336 F, 20126, Milan, Italy
| | - Lorenzo Marzagalli
- Research Department, SOMA Osteopathic Institute Milan, Viale Sarca 336 F, 20126, Milan, Italy
| | - Irene Bruini
- Research Department, SOMA Osteopathic Institute Milan, Viale Sarca 336 F, 20126, Milan, Italy
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Ford RW, Winokur RS. Pelvic Venous Disorders (PeVD). Semin Intervent Radiol 2022; 39:483-489. [PMID: 36561941 PMCID: PMC9767768 DOI: 10.1055/s-0042-1757938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pelvic venous disorders (PeVDs) have replaced the concept of pelvic congestion syndrome encompassing venous origin chronic pelvic pain (VO-CPP) in women. The evaluation of women with VO-CPP includes the assessment for other causes of pelvic pain as well as imaging evaluation for pelvic varicosities measuring greater than 5 mm diameter, ovarian vein diameter, and flow direction, as well as iliac vein diameter and signs of compression. Proper identification of these patients can lead to high degrees of success eliminating chronic pelvic pain following ovarian vein embolization and/or iliac vein stenting. Strong encouragement is provided to use the symptoms, varices, pathophysiology classification for these patients and upcoming research studies on the specific symptoms of patients with VO-CPP will help elucidate patient selection for intervention. Additional future randomized controlled trials are also upcoming to evaluate for outcomes of ovarian vein embolization and iliac vein.
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Affiliation(s)
- Robert W. Ford
- Division of Interventional Radiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Ronald S. Winokur
- Division of Interventional Radiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Ryan A, Healey M, Cheng C, Dior U, Reddington C. Central sensitisation in pelvic pain: A cohort study. Aust N Z J Obstet Gynaecol 2022; 62:868-874. [PMID: 35950448 DOI: 10.1111/ajo.13596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Central sensitisation (CS) leads to pain amplification and impacts on the management of pelvic pain (PP). Identification of CS in patients with PP may provide additional treatment pathways and improve patient outcomes. AIMS The aims are to quantify the prevalence of questionnaire-predicted CS (QPCS) in patients presenting with PP and investigate associations between QPCS and clinical variables. MATERIALS AND METHODS This was an observational, cross-sectional study. Subjects with PP completed a questionnaire comprising four validated tools: the Central Sensitisation Inventory (CSI) for QPCS, Pain Catastrophising Scale for Catastrophising Trait, Bladder Pain/Interstitial Cystitis Symptom Score for bladder pain syndrome (BPS) and the Rome IV criteria for irritable bowel syndrome (IBS). RESULTS One hundred and eleven women were enrolled in the study; 74.8% (n = 83) had a CSI score of >40, indicating the presence of QPCS. Subjects with QPCS were more likely to screen positive for catastrophising trait (odds ratio (OR) 3.57, 95% CI 1.19-10.76, P = 0.02), BPS (OR 11.77, 95% CI 2.13-64.89, P = 0.005) and IBS (OR 2.6, 95% CI 1.05-6.43, P = 0.04). They were more likely to experience pain for more than two years (OR 4.98, 95% CI 1.94-12.82, P = 0.001) and other pain symptoms involving bladder (OR 9.87, 95% CI 2.52-38.67, P = 0.001), bowel (OR 3.13, 95% CI 1.31-7.48, P = 0.01), back (OR 4.17, 95% CI 1.66-10.51, P = 0.002) and vulva (OR 3.61, 95% CI 1.21-10.82, P = 0.02). They also had higher previous diagnoses of mental health disorder (OR 3.5, 95% CI 1.5-8.4, P = 0.005) or IBS (OR 8.9, 95% CI 1.6-49.1, P = 0.01). CONCLUSIONS QPCS occurs frequently in patients with PP, and subjects with QPCS experience more prolonged and complex pain.
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Affiliation(s)
- Amelia Ryan
- Waitemata District Health Board, Auckland, New Zealand
| | | | | | - Uri Dior
- Endometriosis Centre, Hadassah-Hebrew University Hospital, Jerusalem, Israel
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Marks SK, Rodriguez NA, Shah A, Garcia AN, Ritter L, Pierce AN. Clinical Review of Neuromusculoskeletal Complementary and Alternative Approaches for the Treatment of Chronic Pelvic Pain Syndrome. Cureus 2022; 14:e27077. [PMID: 35989846 PMCID: PMC9388957 DOI: 10.7759/cureus.27077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/17/2022] Open
Abstract
Chronic pelvic pain syndrome (CPPS) is a functional pain disorder characterized by ongoing pain in the apparent absence of clinically identifiable causes. The prevalence of functional pain disorders demonstrates the importance of adequate management of ongoing symptomatology, but due to the uncertain etiology and myriad patient presentation phenotypes, reliable treatment options are difficult to implement. New interventions involving non-pharmacological approaches to pain management have been investigated across a spectrum of clinical and pre-clinical studies. Given that conservative care such as exercise, counseling, and musculoskeletal therapy is widely recommended as first-line treatment for CPPS, an updated review of these and related methodologies are needed. Familiarizing physicians and the public with the newest evidence for complementary and alternative medicine (CAM) and other conservative care treatments will assist with the promotion of evidence-based practices in a safe and reliable manner. This review aimed to summarize the current evidence and proposed mechanisms for non-pharmacological treatment specific to CAM and management of chronic pelvic pain centered on neuromusculoskeletal focused intervention such as acupuncture, auriculotherapy, manipulation, manual therapy, myofascial release, and phototherapy. The discussion suggests that reported improvements in pelvic pain or related symptomatology may be attributed to changes in the peripheral inflammasome and somatic origins of peripheral sensitization. Robustness of the included clinical studies is discussed throughout the review, and attention is paid to delineating inclusion criteria of formally diagnosed CPPS compared to general pelvic or abdominal pain. Overall, this review consolidates the current state of evidence regarding the utilization of non-traditional interventions using CAM techniques for the management of chronic pelvic pain and recommends a future direction for the field.
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Symptomatic pelvic venous insufficiency: a review of the current controversies in pathophysiology, diagnosis, and management. Clin Radiol 2022; 77:409-417. [DOI: 10.1016/j.crad.2022.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/25/2022] [Indexed: 11/19/2022]
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Is gabapentin effective and safe in the treatment of chronic pelvic pain in women: a systematic review and meta-analysis. Int Urogynecol J 2022; 33:1071-1081. [PMID: 35013759 DOI: 10.1007/s00192-021-05017-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/14/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Chronic pelvic pain (CPP) affects 2.1-24% of women, causing physical and psychological damage to women around the world. Based on the efficacy of gabapentin in the treatment of chronic pain, we conducted this study to evaluate the efficacy and safety of gabapentin in reducing pain in women with CPP. METHODS Systematic searches were performed in the electronic databases of PubMed, Embase, Web of Science, Scopus, Cochrane, and Clinicalkey databases. Studies focused on comparing the efficacy of gabapentin and placebo in the treatment of female CPP patients were included. RevMan 5.4 was used to analyze the results and risk of bias. Two investigators independently selected eligible studies and extracted related pain scores and side effects for meta-analysis. RESULTS In total, 4 RCTs were enrolled in the meta-analysis, totaling 425 patients. Among patients receiving gabapentin, the average pain scores in 3 and 6 months were significantly lower than those in the placebo group(p < 0.00001). The results showed that there was no statistical difference between gabapentin and placebo in the reduction of pain scores from baseline(p = 0.41). The incidence of side effects in the gabapentin group was significantly higher than that in the placebo group (p < 0.00001). CONCLUSION This systematic review and meta-analysis demonstrated that for women with CPP, gabapentin was significantly different from placebo in average pain scores at 3 and 6 months. However, the two drugs did not differ in the reduction in pain scores from baseline. Gabapentin can bring more significant side effects, whether they are common side effects or serious side effects.
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Margueritte F, Fritel X, Zins M, Goldberg M, Panjo H, Fauconnier A, Ringa V. The Underestimated Prevalence of Neglected Chronic Pelvic Pain in Women, a Nationwide Cross-Sectional Study in France. J Clin Med 2021; 10:jcm10112481. [PMID: 34205077 PMCID: PMC8199870 DOI: 10.3390/jcm10112481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 11/16/2022] Open
Abstract
Dysmenorrhoea, dyspareunia, and non-menstrual chronic pelvic pain (NMCPP) are symptoms that are probably underreported and neglected. This study aimed to assess the prevalence and overlapping relations between these symptoms among a general population of French women of reproductive age. A cross-sectional study among the nationwide CONSTANCES cohort study recruiting a representative sample of women within different French areas was constructed. Women aged 18–49 years (n = 21,287) who reported periods in the previous three months and experienced intercourse at least once were asked about prevalence of three types of chronic pelvic pain: mild, moderate and severe dysmenorrhea; dyspareunia assessed according to its frequency; NMCPP from a binary question. Between the start of 2012 through the end of 2017, 21,287 women were enrolled, 39.8% of them (95% confidence interval (CI), 39.2–40.5) reported moderate to severe dysmenorrhea; 20.3% (95% CI, 18.7–21.9) of the youngest group (18–24 years) reported severe dysmenorrhea. Dyspareunia was reported to happen often or always by 7.9% (95% CI, 7.5–8.2) and peaked among the youngest women at 12.8% (95% CI, 11.5–14.1). NMCPP was reported by 17.0% (95% CI, 16.5–17.5). Moreover, 7.5% (95% CI, 6.4–8.6) of the women reported two or more types of severe or frequent pain. More attention should be paid to this substantial proportion (7.5%) of French women of reproductive age who experience multiple, severe and frequent pelvic pain symptoms.
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Affiliation(s)
- François Margueritte
- Centre for Research in Epidemiology and Population Health, INSERM U1018, Gender, Health Sexuality Team, 16 Avenue Paul Vaillant Couturier, 94800 Villejuif, France; (X.F.); (H.P.); (V.R.)
- INSERM CIC 1402, Université de Poitiers, CHU de Poitiers, 86000 Poitiers, France
- Population-Based Epidemiological Cohorts-INSERM, Paris Saclay University, UVSQ, 94800 Villejuif, France; (M.Z.); (M.G.)
- Department of Gynaecology and Obstetrics, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, 10 Rue du Champ Gaillard, 78103 Poissy, France;
- Correspondence: ; Tel.: +33-67-473-5-602
| | - Xavier Fritel
- Centre for Research in Epidemiology and Population Health, INSERM U1018, Gender, Health Sexuality Team, 16 Avenue Paul Vaillant Couturier, 94800 Villejuif, France; (X.F.); (H.P.); (V.R.)
- INSERM CIC 1402, Université de Poitiers, CHU de Poitiers, 86000 Poitiers, France
| | - Marie Zins
- Population-Based Epidemiological Cohorts-INSERM, Paris Saclay University, UVSQ, 94800 Villejuif, France; (M.Z.); (M.G.)
- Population-Based Epidemiological Cohorts-INSERM, Université de Paris, 75006 Paris, France
| | - Marcel Goldberg
- Population-Based Epidemiological Cohorts-INSERM, Paris Saclay University, UVSQ, 94800 Villejuif, France; (M.Z.); (M.G.)
- Population-Based Epidemiological Cohorts-INSERM, Université de Paris, 75006 Paris, France
| | - Henri Panjo
- Centre for Research in Epidemiology and Population Health, INSERM U1018, Gender, Health Sexuality Team, 16 Avenue Paul Vaillant Couturier, 94800 Villejuif, France; (X.F.); (H.P.); (V.R.)
| | - Arnaud Fauconnier
- Department of Gynaecology and Obstetrics, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, 10 Rue du Champ Gaillard, 78103 Poissy, France;
- Research Unit 7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, Paris-Saclay University, UVSQ, 78180 Montigny-le-Bretonneux, France
| | - Virginie Ringa
- Centre for Research in Epidemiology and Population Health, INSERM U1018, Gender, Health Sexuality Team, 16 Avenue Paul Vaillant Couturier, 94800 Villejuif, France; (X.F.); (H.P.); (V.R.)
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Mohiuddin M, Park R, Wesselmann U, Pukall C, Jarvi K, Nickel C, Doiron C, Gilron I. Efficacy and Safety of Drug Combinations for Chronic Pelvic Pain: Protocol for a Systematic Review. JMIR Res Protoc 2021; 10:e21909. [PMID: 33999006 PMCID: PMC8167620 DOI: 10.2196/21909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 02/24/2021] [Accepted: 04/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background Chronic pelvic pain with various etiologies and mechanisms affects men and women and is a major challenge. Monotherapy is often unsuccessful for chronic pelvic pain, and combinations of different classes of medications are frequently prescribed, with the expectation of improved outcomes. Although a number of combination trials for chronic pelvic pain have been reported, we are not aware of any systematic reviews of the available evidence on combination drug therapy for chronic pelvic pain. Objective We have developed a protocol for a systematic review to evaluate available evidence of the efficacy and safety of drug combinations for chronic pelvic pain. Methods This systematic review will involve a detailed search of randomized controlled trials investigating drug combinations to treat chronic pelvic pain in adults. The databases searched will include the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE from their inception until the date the searches are run to identify relevant studies. The primary outcome will be pain relief measured using validated scoring tools. Secondary outcomes, where reported, will include the following: adverse events, serious adverse events, sexual function, quality of life, and depression and anxiety. Methodological quality of each included study will be assessed using the Cochrane Risk of Bias Tool. Results The systematic review defined by this protocol is expected to synthesize available good quality evidence on combination drug therapy in chronic pelvic pain, which may help guide future research and treatment choices for patients and their health care providers. Conclusions This review will provide a clearer understanding of the efficacy and safety of combination pharmacological therapy for chronic pelvic pain. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020192231; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=192231 International Registered Report Identifier (IRRID) PRR1-10.2196/21909
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Affiliation(s)
- Mohammed Mohiuddin
- Department of Anesthesiology & Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Rex Park
- Department of Anesthesiology & Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Ursula Wesselmann
- Departments of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Neurology and Psychology, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Caroline Pukall
- Department of Psychology, Centre for Neuroscience Studies, School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Keith Jarvi
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Curtis Nickel
- Department of Urology, Queen's University, Kingston, ON, Canada
| | | | - Ian Gilron
- Department of Anesthesiology & Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
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14
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Orlando MS, Moulder JK, Carrillo JF, Carey ET, Findley AD, Atashroo D, Dassel M. Chronic Pelvic Pain Educational Experience Among Minimally Invasive Gynecologic Surgery Fellows and Recent Graduates: A Needs Assessment. J Minim Invasive Gynecol 2021; 28:1903-1911. [PMID: 33962024 DOI: 10.1016/j.jmig.2021.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE Learning to evaluate and treat chronic pelvic pain (CPP) is an established curriculum objective within the Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS). Our aim was to investigate current educational experiences related to the evaluation and management of CPP and the impacts of those experiences on FMIGS fellows and recent fellowship graduates, including satisfaction, confidence in management, and clinical interest in CPP. DESIGN The AAGL-Elevating Gynecologic Surgery Special Interest Group for pelvic pain developed a 33-item survey tool to investigate the following topics: (1) current educational experiences with the assessment and management of patients with CPP, (2) satisfaction with fellowship training in CPP, (3) perceived preparedness to treat patients with CPP, (4) plans to incorporate management of CPP into clinical practice, and (5) perceived desires to expand CPP exposure. Composite scores were created to examine experiences related to diseases associated with CPP and pharmaceutical and procedural treatment options. SETTING Electronic survey. PATIENTS Not applicable. INTERVENTIONS The survey was distributed via AAGL email lists and offered on FMIGS social media sites from August 2017 to November 2017 to all active FMIGS fellows and individuals who graduated the fellowship during the preceding 5 years. MEASUREMENTS AND MAIN RESULTS Fifty-three of 82 (65%) current FMIGS fellows and 104 of 169 (62%) recent fellowship graduates completed the survey. Only 66% of current fellows endorsed working with a fellowship faculty member whose clinical work focused on CPP. Most current fellows reported having a "good amount" of experience or "extensive" experience with superficial endometriosis (39/53, 74%) and deeply infiltrative endometriosis (34/53, 64%), whereas the majority reported having "no" or "little" experience with frequently comorbid conditions like irritable bowel syndrome (68%), pelvic floor tension myalgia (55%), and interstitial cystitis/painful bladder syndrome (51%). For both current fellows and recent graduates, increased CPP Disease Experience composite scores were associated with satisfaction with CPP training (current fellows odds ratio [OR] 1.9, p =.002; recent graduates OR 1.5, p < .001), perceived preparedness to treat patients with CPP (current fellows OR 2.0, p = .0021; recent graduates OR 1.5, p <.001), and the desire to incorporate the treatment of CPP into future clinical practice (current fellows OR 1.8, p = .0099; recent graduates OR 1.3, p = .0178). More than 80% (43/53) of current fellows indicated that they believed an expanded pelvic pain curriculum should be part of the FMIGS fellowship. CONCLUSION This needs assessment of FMIGS fellows and recent graduates suggests that there are gaps between FMIGS curriculum objectives and current educational experiences, and that fellows desire increased CPP exposure. Expansion and standardization of the CPP educational experience is needed and could lead to increased focus on this disease process among subspecialty benign gynecologic surgeons.
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Affiliation(s)
- Megan S Orlando
- Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic (Drs. Orlando and Dassel), Cleveland, Ohio.
| | - Janelle K Moulder
- Department of Obstetrics and Gynecology, Wake Forest University School of Medicine (Dr. Moulder), Winston-Salem, North Carolina
| | - Jorge F Carrillo
- Department of Obstetrics and Gynecology, University of Central Florida College of Medicine (Dr. Carrillo); Orlando VA Healthcare System (Dr. Carrillo), Orlando, Florida
| | - Erin T Carey
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill (Dr. Carey), Chapel Hill, North Carolina
| | - Austin D Findley
- Department of Obstetrics and Gynecology, University of Kansas (Dr. Findley), Kansas City, Kansas
| | - Diana Atashroo
- Department of Obstetrics and Gynecology, Stanford University (Dr. Atashroo), Palo Alto, California
| | - Mark Dassel
- Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic (Drs. Orlando and Dassel), Cleveland, Ohio; Department of Obstetrics and Gynecology, University of Utah (Dr. Dassel), Salt Lake City, Utah
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15
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Pontifex A, Savin C, Park C, Nunes AF, Chalmers KJ, Neumann PB, Ng L, Thompson JA. How Might We Screen for Psychological Factors in People With Pelvic Pain? An e-Delphi Study. Phys Ther 2021; 101:6126511. [PMID: 33533398 DOI: 10.1093/ptj/pzab015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/20/2020] [Accepted: 11/22/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Persistent pelvic pain (PPP) is a complex condition often influenced by psychological factors that can alter treatment outcomes. These factors are potentially modifiable; however, currently there is no instrument to screen for them. The purpose of this study was to determine: (1) which psychological factors should be screened in individuals with PPP, and (2) the most appropriate statements to represent these psychological factors. METHODS The study used a focus group design followed by an electronic-Delphi (e-Delphi) process. A focus group consisting of 8 experts was conducted to determine the relevant psychological factors to screen. These results informed round 1 of the e-Delphi process, consisting of a panel of 14 pain/pelvic pain experts. The e-Delphi process consisted of 3 rounds of online surveys and 2 teleconference discussions to establish consensus on the most appropriate statement to screen for each of the psychological factors. RESULTS The focus group identified 13 relevant psychological factors. During the e-Delphi process, relevant screening statements were assessed using a 100-point allocation system. Experts could reword and suggest new statements. Statements were assessed for consensus and stability and were eliminated as the rounds progressed if they met the exclusion criteria. At the termination of round 3, there were 15 statements remaining. CONCLUSION The final list of 15 statements will assist clinicians in screening for psychological factors and is an important step for clinicians in providing psychologically informed care to people with PPP. Future research should determine the psychometric properties of the statements to determine their clinical utility as a questionnaire. IMPACT This study has refined a list of statements to help screen for psychological factors in individuals with PPP. Developed robustly using an e-Delphi method, this list is an important first step forward for clinicians to provide psychologically informed care to these individuals.
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Affiliation(s)
- Angela Pontifex
- School of Physiotherapy and Exercise Sciences, Curtin University, Perth, WA, Australia
| | - Caris Savin
- School of Physiotherapy and Exercise Sciences, Curtin University, Perth, WA, Australia
| | - Caitlin Park
- School of Physiotherapy and Exercise Sciences, Curtin University, Perth, WA, Australia
| | - Alina Filipe Nunes
- School of Physiotherapy and Exercise Sciences, Curtin University, Perth, WA, Australia
| | - K Jane Chalmers
- School of Science and Health, Western Sydney University, Campbelltown, NSW, Australia.,IIMPACT in Health, University of South Australia, North Terrace, Adelaide, SA, Australia
| | - Patricia B Neumann
- School of Health Sciences, University of South Australia, North Terrace, Adelaide, SA, Australia
| | - Leo Ng
- School of Physiotherapy and Exercise Sciences, Curtin University, Perth, WA, Australia
| | - Judith A Thompson
- School of Physiotherapy and Exercise Sciences, Curtin University, Perth, WA, Australia
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16
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Urits I, Schwartz R, Bangalore Siddaiah H, Kikkeri S, Chernobylsky D, Charipova K, Jung JW, Imani F, Khorramian M, Varrassi G, Cornett EM, Kaye AD, Viswanath O. Inferior Hypogastric Block for the Treatment of Chronic Pelvic Pain. Anesth Pain Med 2021; 11:e112225. [PMID: 34221944 PMCID: PMC8241820 DOI: 10.5812/aapm.112225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/30/2021] [Accepted: 01/30/2021] [Indexed: 12/11/2022] Open
Abstract
Context Pelvic pain is described as pain originating from the visceral or somatic system localizing to the pelvis, the anterior abdominal wall at the level of or below the umbilicus, lumbosacral back in either men or women. Evidence Acquisition Narrative review. Results Chronic pelvic pain can be a complex disorder that may involve multiple systems such as urogynecological, gastrointestinal, neuromusculoskeletal, and psychosocial systems. The etiopathogenesis for chronic pain remains unknown for many patients. For achieving optimal patient management, a multimodal and individualized assessment of each patient is the best strategy. Conclusions There are non-pharmacologic treatments as well as pharmacologic treatments. In addition to these treatment options, inferior hypogastric plexus block is a promising treatment modality.
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Affiliation(s)
- Ivan Urits
- Southcoast Health, Southcoast Health Physicians Group Pain Medicine, Wareham, MA
- LSU Health Shreveport, Department of Anesthesiology, Shreveport, LA
| | - Ruben Schwartz
- Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL
| | | | | | | | | | - Jai Won Jung
- Georgetown University School of Medicine, Washington, DC
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Khorramian
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | | | - Elyse M. Cornett
- LSU Health Shreveport, Department of Anesthesiology, Shreveport, LA
- Corresponding Author: LSU Health Shreveport, Department of Anesthesiology, Shreveport, LA.
| | - Alan David Kaye
- LSU Health Shreveport, Department of Anesthesiology, Shreveport, LA
| | - Omar Viswanath
- LSU Health Shreveport, Department of Anesthesiology, Shreveport, LA
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ
- Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
- Valley Anesthesiology and Pain Consultants – Envision Physician Services, Phoenix, AZ
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17
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Panisch LS, Tam LM. The Role of Trauma and Mental Health in the Treatment of Chronic Pelvic Pain: A Systematic Review of the Intervention Literature. TRAUMA, VIOLENCE & ABUSE 2020; 21:1029-1043. [PMID: 30599814 DOI: 10.1177/1524838018821950] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Chronic pelvic pain (CPP) is a widespread health issue with unclear etiology that has been linked to a history of trauma among women. This condition is known to be highly comorbid with, and potentially exacerbated by psychiatric conditions, as well as other gynecological concerns and functional pain syndromes. Many comorbid conditions are also related to a history of trauma, and cases of CPP with comorbidity are known to be resistant to treatment. While the prevalence of a traumatic history among females with CPP has been established, less is known about how the role of trauma is addressed in the intervention literature. The purpose of this systematic review was to explore how the role of trauma, and to a lesser extent, mental health, is addressed in modern intervention studies for females with CPP. All qualitative and quantitative studies providing primary or secondary results of an intervention for females with CPP published between January 1998 and May 2018 were included and coded independently by two reviewers. Twenty-eight articles met inclusion criteria. Of these, none focused exclusively on patients with a history of trauma; one study implicitly focused on trauma-specific symptoms as an outcome, while two studies screened patients for a history of trauma. Of the 10 studies with a focus on mental health, only three simultaneously addressed trauma. To address this gap in the literature, future studies can prioritize intervention designs that place emphasis on the role of trauma in regard to patient characteristics and outcome variables.
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Affiliation(s)
- Lisa S Panisch
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Lauren M Tam
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
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18
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Hämmerli S, Kohl-Schwartz A, Imesch P, Rauchfuss M, Wölfler MM, Häberlin F, von Orelli S, Leeners B. Sexual Satisfaction and Frequency of Orgasm in Women With Chronic Pelvic Pain due to Endometriosis. J Sex Med 2020; 17:2417-2426. [PMID: 33032958 DOI: 10.1016/j.jsxm.2020.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dyspareunia, one of the main symptoms of the chronic gynecological pelvic pain disorder endometriosis, may interfere with the likelihood of reaching an orgasm, yet for women with dyspareunia, no data on orgasm rates in different sexual activities are available. AIM The aim of this study was to evaluate the ability to reach an orgasm and its association with sexual satisfaction during different sexual activities in women with a chronic pelvic pain disorder and in healthy control women. METHODS A set of questionnaires including the brief index of sexual functioning and global sexual functioning was used to evaluate sexuality in women affected with endometriosis (n = 434) and a nonaffected control group (n = 434) recruited in German-speaking countries. OUTCOMES The primary outcome measure of this study was the orgasm rate during different types of sexual activities. RESULTS Only the ability to have an orgasm during sexual intercourse (P = .002) but not during masturbation (P = .509) or partnered noncoital sexual activities (P = .229) is affected by endometriosis. Dyspareunia was associated with a reduced ability to experience an orgasm during intercourse for endometriosis patients (P = .020) and control women (P = .006). The ability to orgasm during noncoital sexual activities (P = .006) and sexual intercourse (P = .038) was associated with a higher sexual satisfaction in women with endometriosis. For controls, only the ability to achieve an orgasm with sexual intercourse was associated with sexual satisfaction (P = .038). CLINICAL IMPLICATIONS Sexual counselling as part of medical support could help couples living with chronic pelvic pain of the female partner integrate noncoital sexual activities in their sex lives, leading to fewer sex-related problems and higher sexual desire and satisfaction. STRENGTHS AND LIMITATIONS This study is the first to examine different ways of achieving an orgasm and sexual satisfaction in a large group of women with endometriosis and a matched control group. The breadth of the questionnaire allowed a differentiated analysis of factors influencing the likelihood of achieving an orgasm and overall sexual satisfaction. The one limitation is that the length and the intimate nature of the questionnaire possibly resulted in reluctance to answer this part of the questionnaire. CONCLUSION Partnered noncoital sexual activities may represent an alternative to reach orgasm for women with endometriosis-related chronic pelvic pain or anorgasmia during sexual intercourse. Hämmerli S, Kohl-Schwartz A, Imesch P, et al. Sexual Satisfaction and Frequency of Orgasm in Women With Chronic Pelvic Pain due to Endometriosis. J Sex Med 2020;17:2417-2426.
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Affiliation(s)
- Silvan Hämmerli
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| | - Alexandra Kohl-Schwartz
- Division of Gynecological Endocrinology and Reproductive Medicine, Bern University Hospital, Bern, Switzerland
| | - Patrick Imesch
- Department of Gynecology, University Hospital Zurich, Zurich, Switzerland
| | | | - Monika M Wölfler
- Department of Obstetrics and Gynecology, University Hospital Graz, Graz, Austria
| | - Felix Häberlin
- Department of Gynecology and Obstetrics, Canton Hospital St. Gallen, St. Gallen, Switzerland
| | - Stephanie von Orelli
- Department of Gynecology and Obstetrics, Triemli Hospital Zurich, Zurich, Switzerland
| | - Brigitte Leeners
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland.
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19
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Tafti D, Krause K, Dillon R, Flores R, Cecava ND. Sigmoid cancer mimicking ovarian echotexture on transvaginal ultrasound: Case report with literature review. Radiol Case Rep 2020; 15:2482-2492. [PMID: 33014234 PMCID: PMC7522440 DOI: 10.1016/j.radcr.2020.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/15/2020] [Accepted: 09/20/2020] [Indexed: 11/29/2022] Open
Abstract
Ultrasound is a first line imaging modality for the evaluation of female pelvic pain. Pelvic pain constitutes one of the most common reasons for presentation to the emergency department with increasing use of point of care ultrasound. Infrequently, point of care or formal ultrasound evaluation may lead to misdiagnosis of extraovarian disease. This can have serious consequences, especially if an extraovarian malignancy is mistaken for a normal ovary or an ovary with a benign process. We present a case of a 41-year-old female who presented to the emergency department for a chief complaint of pelvic pain and vaginal bleeding. Transvaginal ultrasound demonstrated a left adnexal mass, later characterized as a sigmoid colon cancer on MRI and pathology, simulating ovarian echotexture with peripheral hypoechoic components resembling follicles. This article will review the literature of various cases of extraovarian pathology misidentified as ovarian processes and highlight the importance of considering these extraovarian mimickers to prevent potential morbidity and mortality of a missed diagnosis.
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Affiliation(s)
- Dawood Tafti
- Department of Radiology, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, San Antonio, TX, 78234, USA
| | - Katherine Krause
- Department of Pathology, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, San Antonio, TX, 78234, USA
| | - Rebecca Dillon
- Department of Radiology, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, San Antonio, TX, 78234, USA
| | - Rebecca Flores
- Department of Radiology, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, San Antonio, TX, 78234, USA
| | - Nathan D Cecava
- Department of Radiology, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, San Antonio, TX, 78234, USA.,Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA.,Texas A&M School of Medicine, 8447 Riverside Pkwy, Bryan, TX 77807, USA
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20
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Horne AW, Vincent K, Hewitt CA, Middleton LJ, Koscielniak M, Szubert W, Doust AM, Daniels JP. Gabapentin for chronic pelvic pain in women (GaPP2): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2020; 396:909-917. [PMID: 32979978 PMCID: PMC7527829 DOI: 10.1016/s0140-6736(20)31693-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/15/2020] [Accepted: 07/27/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Chronic pelvic pain affects 2-24% of women worldwide and evidence for medical treatments is scarce. Gabapentin is effective in treating some chronic pain conditions. We aimed to measure the efficacy and safety of gabapentin in women with chronic pelvic pain and no obvious pelvic pathology. METHODS We performed a multicentre, randomised, double-blind, placebo-controlled randomised trial in 39 UK hospital centres. Eligible participants were women with chronic pelvic pain (with or without dysmenorrhoea or dyspareunia) of at least 3 months duration. Inclusion criteria were 18-50 years of age, use or willingness to use contraception to avoid pregnancy, and no obvious pelvic pathology at laparoscopy, which must have taken place at least 2 weeks before consent but less than 36 months previously. Participants were randomly assigned in a 1:1 ratio to receive gabapentin (titrated to a maximum dose of 2700 mg daily) or matching placebo for 16 weeks. The online randomisation system minimised allocations by presence or absence of dysmenorrhoea, psychological distress, current use of hormonal contraceptives, and hospital centre. The appearance, route, and administration of the assigned intervention were identical in both groups. Patients, clinicians, and research staff were unaware of the trial group assignments throughout the trial. Participants were unmasked once they had provided all outcome data at week 16-17, or sooner if a serious adverse event requiring knowledge of the study drug occurred. The dual primary outcome measures were worst and average pain scores assessed separately on a numerical rating scale in weeks 13-16 after randomisation, in the intention-to-treat population. Self-reported adverse events were assessed according to intention-to-treat principles. This trial is registered with the ISRCTN registry, ISCRTN77451762. FINDINGS Participants were screened between Nov 30, 2015, and March 6, 2019, and 306 were randomly assigned (153 to gabapentin and 153 to placebo). There were no significant between-group differences in both worst and average numerical rating scale (NRS) pain scores at 13-16 weeks after randomisation. The mean worst NRS pain score was 7·1 (standard deviation [SD] 2·6) in the gabapentin group and 7·4 (SD 2·2) in the placebo group. Mean change from baseline was -1·4 (SD 2·3) in the gabapentin group and -1·2 (SD 2·1) in the placebo group (adjusted mean difference -0·20 [97·5% CI -0·81 to 0·42]; p=0·47). The mean average NRS pain score was 4·3 (SD 2·3) in the gabapentin group and 4·5 (SD 2·2) in the placebo group. Mean change from baseline was -1·1 (SD 2·0) in the gabapentin group and -0·9 (SD 1·8) in the placebo group (adjusted mean difference -0·18 [97·5% CI -0·71 to 0·35]; p=0·45). More women had a serious adverse event in the gabapentin group than in the placebo group (10 [7%] of 153 in the gabapentin group compared with 3 [2%] of 153 in the placebo group; p=0·04). Dizziness, drowsiness, and visual disturbances were more common in the gabapentin group. INTERPRETATION This study was adequately powered, but treatment with gabapentin did not result in significantly lower pain scores in women with chronic pelvic pain, and was associated with higher rates of side-effects than placebo. Given the increasing reports of abuse and evidence of potential harms associated with gabapentin use, it is important that clinicians consider alternative treatment options to off-label gabapentin for the management of chronic pelvic pain and no obvious pelvic pathology. FUNDING National Institute for Health Research.
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Affiliation(s)
- Andrew W Horne
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
| | - Katy Vincent
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Catherine A Hewitt
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Lee J Middleton
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Magda Koscielniak
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Wojciech Szubert
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Ann M Doust
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Jane P Daniels
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
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21
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Tempest N, Efstathiou E, Petros Z, Hapangama DK. Laparoscopic Outcomes after Normal Clinical and Ultrasound Findings in Young Women with Chronic Pelvic Pain: A Cross-Sectional Study. J Clin Med 2020; 9:E2593. [PMID: 32785173 PMCID: PMC7464721 DOI: 10.3390/jcm9082593] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 07/28/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022] Open
Abstract
Chronic pelvic pain (CPP) is one of the most common chronic pain problems experienced by women, with prevalence rates comparable to asthma and back pain. However, it is poorly understood and causative pathology is only seldom found. We aimed to establish prevalence of abnormal findings at diagnostic laparoscopy in young women with CPP after normal findings at clinical examination and pelvic ultrasound scan. Information was retrospectively collected on all laparoscopies undertaken on women aged 16-30 years with normal preoperative findings over a 24-month period. One-hundred-and-fifty women (mean age 25 years and BMI 24.5) were included with laparoscopic examination revealing normal anatomy in 110 (73.3%) and pathology in 40 (27.2%). Endometriosis was detected in 30 (20%); 25 (16.7%) stage 1, 2 (1.3%) stage 2, 2 (1.3%) stage 3 and 1 (0.7%) stage 4. Most laparoscopies carried out on young women with CPP and normal clinical examination and pelvic ultrasound scan showed no significant clinical stigmata of pelvic disease. Women should be fully informed of the multifactorial nature of CPP and there should be a comprehensive management pathway for these women, as proceeding with invasive laparoscopy does not provide additional benefit when investigating CPP in the context of risk, cost and effect on long-term wellbeing.
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Affiliation(s)
- Nicola Tempest
- Liverpool Women’s Hospital NHS Foundation Trust, member of Liverpool Health Partners affiliations, Liverpool L8 7SS, UK;
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, member of Liverpool Health Partners affiliations, Liverpool L8 7SS, UK; (E.E.); (Z.P.)
| | - Ekaterina Efstathiou
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, member of Liverpool Health Partners affiliations, Liverpool L8 7SS, UK; (E.E.); (Z.P.)
| | - Zena Petros
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, member of Liverpool Health Partners affiliations, Liverpool L8 7SS, UK; (E.E.); (Z.P.)
| | - Dharani K. Hapangama
- Liverpool Women’s Hospital NHS Foundation Trust, member of Liverpool Health Partners affiliations, Liverpool L8 7SS, UK;
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, member of Liverpool Health Partners affiliations, Liverpool L8 7SS, UK; (E.E.); (Z.P.)
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Hughes C, May S. A directional preference approach for chronic pelvic pain, bladder dysfunction and concurrent musculoskeletal symptoms: a case series. J Man Manip Ther 2020; 28:170-180. [PMID: 31702976 PMCID: PMC7480605 DOI: 10.1080/10669817.2019.1668994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Chronic pelvic pain (CPP) with concurrent musculoskeletal and bladder symptoms is a complex and challenging problem. However, clinically the co-existence of these symptoms is not routinely questioned, and their musculoskeletal source is not investigated thoroughly. The purpose of this case series is to present the use of Mechanical Diagnosis and Therapy (MDT) principles in seven patients with concurrent chronic pelvic pain, bladder dysfunction and musculoskeletal symptoms. CASE DESCRIPTIONS Seven patients with coexisting pelvic health and musculoskeletal signs and symptoms were retrospectively reviewed. Most common symptoms were urinary frequency, incontinence, pelvic pain, nocturia, dyspareunia, bladder dyssynergia, and lumbar, pelvic or hip pain. All patients failed to recognize the possible interconnectedness of the two sets of symptoms. Each exhibited a directional preference (DP) and subsequent MDT provisional classification of derangement was established; the use of DP forces abolished or dramatically improved both symptoms and mobility impairments. In all cases DP was for sustained sagittal forces initially, but ultimately lateral forces and mobilization were indicated. OUTCOMES Changes in Pelvic Floor Impact Questionnaire, Care Connections Pelvic Floor and Lumbar spine were all clinically significant and exceeded minimally Clinical Important Differences several times. Average of 5.8 sessions per patient was noted. Follow-up at an average of 3.3 years revealed ongoing satisfaction and confidence in independent self-management. DISCUSSION These case studies highlight the importance of ensuring expansion of intake questions for possible co-existence of symptoms in both pelvic and musculoskeletal patients, possibly suggesting a mechanical intervention is indicated. Provisional subclassification into 'Mechanical Pelvic Syndrome' is proposed. Level of Evidence: 4.
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Affiliation(s)
| | - Stephen May
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
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23
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Panisch LS. Conceptualizations of dissociation and somatization in literature on chronic pelvic pain in women: A scoping review. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2020. [DOI: 10.1016/j.ejtd.2019.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Lima MF, Lima IA, Heinrich-Oliveira V. Endovascular treatment of pelvic venous congestion syndrome in a patient with duplication of the inferior vena cava and unusual pelvic venous anatomy: literature review. J Vasc Bras 2019; 19:e20190017. [PMID: 31921319 PMCID: PMC6944397 DOI: 10.1590/1677-5449.190017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Chronic pelvic pain affects approximately one-third of all women and is responsible for about 20% of all gynecological consultations. The authors report a rare case of symptomatic pelvic venous congestion in the presence of duplication of the inferior vena cava and inter-iliac communication through the right hypogastric vein that was treated via an endovascular approach with embolization of varicose pelvic veins. The published literature is reviewed.
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Abstract
OBJECTIVE The aim of the present study was to analyze balance ability and posture in postmenopausal women with chronic pelvic pain (CPP). METHODS This study includes a sample of 48 women with CPP recruited from the Gynecology Service of Virgen de las Nieves and San Cecilio Hospitals in Granada (Spain) and 48 healthy control women matched with respect to age and anthropometric characteristics. Outcome variables collected included: balance ability (Mini-Balance Evaluation Systems Test and Timed Up an Go Test) and posture (photogrammetry and Spinal Mouse). RESULTS Significant differences were found in all Mini Best Test subscales: total (P < 0.001), anticipatory (P = 0.002), reactive postural control (P < 0.001), sensory orientation (P < 0.001), and dynamic gait (P < 0.001), and all Timed Up and Go test subscales: alone (P < 0.001), with manual (P = 0.002) and cognitive task (P = 0.030). Significant differences were also found on spinal cervical angles with a forward head posture in women with CPP; global spine alignment exhibited more deviation in the women with CPP (P < 0.001); and a higher percentage of women with CPP (58%) presented with increased thoracic kyphosis and lumbar lordosis. Cohen's d was used to calculate the effect size. Some subscales of balance and posture tests showed a large effect size (d ≥0.8), indicating a more consistent result. CONCLUSIONS Women with CPP presented poor balance including anticipatory, reactive postural control, sensory orientation, dynamic gait, and dual task-related conditions. Posture showed higher values on the dorsal angle and lower sacral inclination, less spine alignment, and a more prevalent posture with increased kyphosis and lumbar lordosis.
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26
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Cichowski SB, Rogers RG, Komesu Y, Murata E, Qualls C, Murata A, Murata G. A 10-yr Analysis of Chronic Pelvic Pain and Chronic Opioid Therapy in the Women Veteran Population. Mil Med 2019; 183:e635-e640. [PMID: 29788455 DOI: 10.1093/milmed/usy114] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Indexed: 02/01/2023] Open
Abstract
Introduction Chronic pelvic pain (CPP) affects an estimated 30% of women Veterans. Previous research shows high rates of narcotic abuse in the women Veteran population. Narcotics are not recommended for the treatment of CPP. Understanding how CPP impacts narcotic prescribing in the women Veteran population is critical to addressing the public health crisis of opioid abuse. Our objective was to compare chronic opioid therapy (COT) prescribed 5 yr prior to and following CPP diagnosis and to identify predictors of COT as well as adverse events associated with COT. We choose to look at 10 yr of data because we thought this time period would provide unique insight into the longitudinal associations of CPP and COT and was available in the database. Materials and Methods Women with non-cancer CPP were included for analyses from the Veteran's Affairs Corporate Database Warehouse. COT was defined as 90 d of opiates/calendar year for each of the 5 yr proceeding and following the diagnosis of CPP. Patient characteristics and potential variables influencing COT were collected. We compared baseline demographics between the women who received COT to the women who did not receive COT to find additional demographic predictors of COT in association with CPP. Multivariable analysis identified predictors of COT in this population of women with CPP. We utilized an interrupted time series analysis to understand the impact of the diagnosis of CPP on COT. Results A total of 49,601 women met inclusion criteria with an average age of 40.1 ± 11.5 yr; 37.3% self-characterized as being a racial minority and 24% had a history of military sexual trauma. Chronic use increased significantly (p < 0.001) in the 5 yr preceding the diagnosis of CPP from 6.3% (n = 3124) of women at time -5 to 13.6% (n = 6746) at time 0. In the first year following the diagnosis of CPP, 16.8% (n = 8,333) of women with CPP met the criteria for COT (p < 0.001) and 15% (n = 7440) of women with CPP remained in the COT group for the remaining 5 yr following the diagnosis. On average women in the COT group had 250-292 d of opioids/year. When comparing women who received chronic narcotics following the diagnosis of CPP versus those who did not receive chronic narcotics, women who received COT were older, more likely to smoke and more frequently diagnosed with other pain conditions such as back pain, headaches, and fibromyalgia. (All p < 0.001). In the multivariable model, predictors of COT following CPP diagnosis included prior COT (OR = 10.0 (95% CI 9.4, 10.6), a positive history of military sexual trauma, smoking, and other chronic pain conditions. Conclusions The distinct pattern of prescribing shown in this cohort may mean COT is prescribed for CPP and this prescribing pattern contributes to the adverse events associated with COT. As COT is not recommended for CPP, physicians need more education on the therapies available to help CPP patients.
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Affiliation(s)
- Sara B Cichowski
- Albuquerque Veterans Health Administration, 1501 San Pedro Dr Se, Albuquerque, NM.,Department of OB/GYN, University of New Mexico, 1 University Dr, Albuquerque, NM
| | - Rebecca G Rogers
- Albuquerque Veterans Health Administration, 1501 San Pedro Dr Se, Albuquerque, NM
| | - Yuko Komesu
- Albuquerque Veterans Health Administration, 1501 San Pedro Dr Se, Albuquerque, NM
| | - Erin Murata
- Albuquerque Veterans Health Administration, 1501 San Pedro Dr Se, Albuquerque, NM
| | - Clifford Qualls
- Department of OB/GYN, University of New Mexico, 1 University Dr, Albuquerque, NM
| | - Allison Murata
- Department of OB/GYN, University of New Mexico, 1 University Dr, Albuquerque, NM
| | - Glen Murata
- Department of OB/GYN, University of New Mexico, 1 University Dr, Albuquerque, NM
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Development and initial validation of an electronic personal assessment questionnaire for menstrual, pelvic pain and gynaecological hormonal disorders (ePAQ-MPH). Eur J Obstet Gynecol Reprod Biol 2019; 238:148-156. [PMID: 31132692 DOI: 10.1016/j.ejogrb.2019.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/15/2019] [Accepted: 05/18/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Menstrual disorders, pelvic-pain and gynaecological hormonal conditions in women can have a significant impact on quality-of-life. Reliable assessment and monitoring of these intimate conditions is challenging. Patient reported outcome measures (PROMs) can be invaluable in providing objective assessment, but no comprehensive PROM assessing all of these conditions and their impact on quality of life is currently available. The purpose of this study was to develop and undertake initial psychometric testing of a comprehensive interactive electronic patient reported outcome measure for these conditions. STUDY DESIGN A prototype electronic PROM (ePAQ-MPH) was developed following systematic literature review, semi structured interviews with 25 patients and expert panel review. Exploratory factor analysis was undertaken in 291 women attending a menstrual-disorders clinic; establishing a domain structure and enabling item reduction. Two validated PROMS (Women's Health Questionnaire and Menstrual Distress Questionnaire) were completed to assess criterion validity in 213 patients. Test-retest reliability was carried out in 30 women completing ePAQ-MPH at least one week apart. Patients' views on 'Value' and 'Burden' were assessed in 278 women using a validated 10-item survey measuring questionnaire utility (QQ-10). Confirmatory factor analysis (CFA) of the revised version of ePAQ-MPH following item reduction was undertaken in a different sample of 254 women. RESULTS Exploratory factor analysis identified 18 domains (Cronbach's α > 0.7) and 30 redundant items. Test-retest analysis found acceptable intra-class correlations of 0.6-0.9 (p < 0.05). Eight domains were compared with Menstrual Distress Questionnaire showing moderate or strong correlation in seven domains. Ten domains were compared with Women's Health Questionnaire, six of which showed moderate correlation. Mean QQ-10 Value and Burden scores were 76 and 25, respectively (SD=15.8 and 15.5). The mean completion time for ePAQ-MPH was 31 min. CFA of the revised version 2 instrument with 15 domains showed good model fit. CONCLUSIONS Whilst wider psychometric testing of the revised version of ePAQ-MPH is required, including in different settings and in assessments of data quality and responsiveness, initial analysis provides some evidence for reliability, validity and acceptability of this multi-dimensional electronic PROM. ePAQ-MPH shows potential for both patient assessment and roles in service evaluation and research.
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28
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Khan KS, Tryposkiadis K, Tirlapur SA, Middleton LJ, Sutton AJ, Priest L, Ball E, Balogun M, Sahdev A, Roberts T, Birch J, Daniels JP, Deeks JJ. MRI versus laparoscopy to diagnose the main causes of chronic pelvic pain in women: a test-accuracy study and economic evaluation. Health Technol Assess 2019; 22:1-92. [PMID: 30045805 DOI: 10.3310/hta22400] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Chronic pelvic pain (CPP) symptoms in women are variable and non-specific; establishing a differential diagnosis can be hard. A diagnostic laparoscopy is often performed, although a prior magnetic resonance imaging (MRI) scan may beneficial. OBJECTIVES To estimate the accuracy and added value of MRI in making diagnoses of (1) idiopathic CPP and (2) the main gynaecological causes of CPP. To quantify the impact MRI can have on decision-making with respect to triaging for therapeutic laparoscopy and to conduct an economic evaluation. DESIGN Comparative test-accuracy study with cost-effectiveness modelling. SETTING Twenty-six UK-based hospitals. PARTICIPANTS A total of 291 women with CPP. METHODS Pre-index information concerning the patient's medical history, previous pelvic examinations and ultrasound scans was collected. Women reported symptoms and quality of life at baseline and 6 months. MRI scans and diagnostic laparoscopy (undertaken and interpreted blind to each other) were the index tests. For each potential cause of CPP, gynaecologists indicated their level of certainty that the condition was causing the pelvic pain. The analysis considered both diagnostic laparoscopy as a reference standard for observing structural gynaecological causes and consensus from a two-stage expert independent panel for ascertaining the cause of CPP. The stage 1 consensus was based on pre-index, laparoscopy and follow-up data; for stage 2, the MRI scan report was also provided. The primary analysis involved calculations of sensitivity and specificity for the presence or absence of each structural gynaecological cause of pain. A decision-analytic model was developed, with a 6-month time horizon. Two strategies, laparoscopy or MRI, were considered and populated with study data. RESULTS Using reference standards of laparoscopic and expert panel diagnoses, MRI scans had high specificity but poor sensitivity for observing deep-infiltrating endometriosis, endometrioma, adhesions and ovarian cysts. MRI scans correctly identified 56% [95% confidence interval (CI) 48% to 64%] of women judged to have idiopathic CPP, but missed 46% (95% CI 37% to 55%) of those considered to have a gynaecological structural cause of CPP. MRI added significant value, over and above the pre-index information, in identifying deep-infiltrating endometriosis (p = 0.006) and endometrioma (p = 0.02) as the cause of pain, but not for other gynaecological structural causes or for identifying idiopathic CPP (p = 0.08). Laparoscopy was significantly more accurate than MRI in diagnosing idiopathic CPP (p < 0.0001), superficial peritoneal endometriosis (p < 0.0001), deep-infiltrating endometriosis (p < 0.0001) and endometrioma of the ovary (p = 0.02) as the cause of pelvic pain. The accuracy of laparoscopy appeared to be able to rule in these diagnoses. Using MRI to identify women who require therapeutic laparoscopy would lead to 369 women in a cohort of 1000 receiving laparoscopy unnecessarily, and 136 women who required laparoscopy not receiving it. The economic analysis highlighted the importance of the time horizon, the prevalence of CPP and the cut-off values to inform the sensitivity and specificity of MRI and laparoscopy on the model results. MRI was not found to be a cost-effective diagnostic approach in any scenario. CONCLUSIONS MRI was dominated by laparoscopy in differential diagnosis of women presenting to gynaecology clinics with CPP. It did not add value to information already gained from history, examination and ultrasound about idiopathic CPP and various gynaecological conditions. TRIAL REGISTRATION Current Controlled Trials ISRCTN13028601. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 40. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Khalid S Khan
- Women's Health Research Unit, Queen Mary University of London, London, UK
| | | | - Seema A Tirlapur
- Women's Health Research Unit, Queen Mary University of London, London, UK
| | - Lee J Middleton
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Andrew J Sutton
- Health Economics Unit, University of Birmingham, Birmingham, UK.,Leeds Institute of Health Sciences and NIHR Diagnostic Evidence Co-operative Leeds, University of Leeds, Leeds, UK
| | - Lee Priest
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Elizabeth Ball
- Obstetrics and Gynaecology, Barts Health NHS Trust, London, UK
| | - Moji Balogun
- Radiology Department, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Anju Sahdev
- Radiology Department, Barts Health NHS Trust, London, UK
| | - Tracy Roberts
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | | | - Jane P Daniels
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK.,Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Jonathan J Deeks
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
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Abstract
Background Pelvic pain (PP) is a debilitating condition that is challenging to manage. Despite differences in suspected etiologies of different PP conditions, common clinical signs and symptoms make it appropriate to group these diagnoses. The presence of neuro-musculoskeletal impairments in PP suggests that physical therapists are ideally situated to be included as part of the health care team managing this condition; however, little information is available to guide physical therapist management of PP. Objectives As a first step to developing management guidelines, we sought to determine common interventions currently used by physical therapists to manage PP. Study Design Descriptive survey. Methods A modified Delphi approach was used to identify broad categories of interventions that were then used to build a survey. Purposeful selection with snowball recruiting methods was used to collect responses from practitioners. Frequency data were collected for survey responses. Chi-square analysis determined associations among responses based on practitioner training. Results A total of 984 responses from 17 different countries were analyzed. The primary responses were from physical therapists in the USA and Canada. The majority of respondents were board-certified clinical specialists. More than 80% of physical therapist respondents indicated that they "frequently used" education, exercise, and manual therapy for patients with PP. The most common interventions considered effective but not frequently used were cognitive-behavioral therapy, dry needling, acupuncture, topical medications, and internal pelvic manual therapy techniques. Geographical differences in patterns of usespecific manual therapy and exercise interventions were noted. Differences were also noted on the basis of the levels of advanced postprofessional training. Conclusion Physical therapists routinely use education, manual therapy, and exercise to manage pelvic pain conditions.
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Mahran A, Baaklini G, Hassani D, Abolella HA, Safwat AS, Neudecker M, Hijaz AK, Mahajan ST, Siegel SW, El-Nashar SA. Sacral neuromodulation treating chronic pelvic pain: a meta-analysis and systematic review of the literature. Int Urogynecol J 2019; 30:1023-1035. [PMID: 30874835 DOI: 10.1007/s00192-019-03898-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/05/2019] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- Amr Mahran
- Division of Female Pelvic Medicine and Reconstructive Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Mailstop MAC 5034, Cleveland, OH, 44106, USA.,Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Urology, Assiut University, Assiut, Egypt
| | - Gina Baaklini
- Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Daisy Hassani
- Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt
| | | | | | - Mandy Neudecker
- Core Library, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Adonis K Hijaz
- Division of Female Pelvic Medicine and Reconstructive Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Mailstop MAC 5034, Cleveland, OH, 44106, USA.,Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Sangeeta T Mahajan
- Division of Female Pelvic Medicine and Reconstructive Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Mailstop MAC 5034, Cleveland, OH, 44106, USA
| | | | - Sherif A El-Nashar
- Division of Female Pelvic Medicine and Reconstructive Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Mailstop MAC 5034, Cleveland, OH, 44106, USA. .,Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt.
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Khilnani NM, Meissner MH, Learman LA, Gibson KD, Daniels JP, Winokur RS, Marvel RP, Machan L, Venbrux AC, Tu FF, Pabon-Ramos WM, Nedza SM, White SB, Rosenblatt M. Research Priorities in Pelvic Venous Disorders in Women: Recommendations from a Multidisciplinary Research Consensus Panel. J Vasc Interv Radiol 2019; 30:781-789. [PMID: 30857986 DOI: 10.1016/j.jvir.2018.10.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/08/2018] [Accepted: 10/11/2018] [Indexed: 12/17/2022] Open
Abstract
Pelvic venous disorders (PeVDs) in women can present with chronic pelvic pain, lower-extremity and vulvar varicosities, lower-extremity swelling and pain, and left-flank pain and hematuria. Multiple evidence gaps exist related to PeVDs with the consequence that nonvascular specialists rarely consider the diagnosis. Recognizing this, the Society of Interventional Radiology Foundation funded a Research Consensus Panel to prioritize a research agenda to address these gaps. This paper presents the proceedings and recommendations from that Panel.
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Affiliation(s)
- Neil M Khilnani
- Division of Interventional Radiology, New York Presbyterian Hospital, Weill Cornell Medical College, 2315 Broadway, Fourth Floor, New York, New York 10128.
| | - Mark H Meissner
- Division of Vascular Surgery, University of Washington Medical Center, Seattle, Washington
| | - Lee A Learman
- Department of Obstetrics and Gynecology, Charles A. Schmidt School of Medicine, Florida Atlantic University, Boca Raton, Florida
| | | | - Jane P Daniels
- Clinical Trials Unit, University of Nottingham, Nottingham, United Kingdom
| | - Ronald S Winokur
- Division of Interventional Radiology, New York Presbyterian Hospital, Weill Cornell Medical College, 2315 Broadway, Fourth Floor, New York, New York 10128
| | | | - Lindsay Machan
- Departments of Radiology and Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony C Venbrux
- Division of Interventional Radiology, George Washington University School of Medicine, Washington, DC
| | - Frank F Tu
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois; Department of Obstetrics and Gynecology, North Shore University Medical Group, Skokie, Illinois
| | - Waly M Pabon-Ramos
- Division of Interventional Radiology, Duke University School of Medicine, Durham, North Carolina
| | - Susan M Nedza
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sarah B White
- Division of Interventional Radiology, Froedtert Hopsital, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mel Rosenblatt
- Connecticut Image-Guided Surgery, Fairfield, Connecticut
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Rockett M, Creanor S, Squire R, Barton A, Benger J, Cocking L, Ewings P, Eyre V, Smith JE. The impact of emergency department patient-controlled analgesia (PCA) on the incidence of chronic pain following trauma and non-traumatic abdominal pain. Anaesthesia 2018; 74:69-73. [PMID: 30367688 PMCID: PMC6587467 DOI: 10.1111/anae.14476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2018] [Indexed: 12/19/2022]
Abstract
The effect of patient-controlled analgesia during the emergency phase of care on the prevalence of persistent pain is unkown. We studied individuals with traumatic injuries or abdominal pain 6 months after hospital admission via the emergency department using an opportunistic observational study design. This was conducted using postal questionnaires that were sent to participants recruited to the multi-centre pain solutions in the emergency setting study. Patients with prior chronic pain states or opioid use were not studied. Questionnaires included the EQ5D, the Brief Pain Inventory and the Hospital Anxiety and Depression scale. Overall, 141 out of 286 (49% 95%CI 44-56%) patients were included in this follow-up study. Participants presenting with trauma were more likely to develop persistent pain than those presenting with abdominal pain, 45 out of 64 (70%) vs. 24 out of 77 (31%); 95%CI 24-54%, p < 0.001. There were no statistically significant associations between persistent pain and analgesic modality during hospital admission, age or sex. Across both abdominal pain and traumatic injury groups, participants with persistent pain had lower EQ5D mobility scores, worse overall health and higher anxiety and depression scores (p < 0.05). In the abdominal pain group, 13 out of 50 (26%) patients using patient-controlled analgesia developed persistent pain vs. 11 out of 27 (41%) of those with usual treatment; 95%CI for difference (control - patient-controlled analgesia) -8 to 39%, p = 0.183. Acute pain scores at the time of hospital admission were higher in participants who developed persistent pain; 95%CI 0.7-23.6, p = 0.039. For traumatic pain, 25 out of 35 (71%) patients given patient-controlled analgesia developed persistent pain vs. 20 out of 29 (69%) patients with usual treatment; 95%CI -30 to 24%, p = 0.830. Persistent pain is common 6 months after hospital admission, particularly following trauma. The study findings suggest that it may be possible to reduce persistent pain (at least in patients with abdominal pain) by delivering better acute pain management. Further research is needed to confirm this hypothesis.
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Affiliation(s)
- M Rockett
- Anaesthesia and Pain Medicine, Plymouth University Hospitals NHS Trust, Plymouth, UK
| | - S Creanor
- Clinical Trials and Medical Statistics, University of Plymouth, UK
| | - R Squire
- Plymouth University Hospitals NHS Trust, Plymouth, UK
| | - A Barton
- NIHR Research Design Service South West, London, UK
| | - J Benger
- Emergency Care, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | | | - P Ewings
- NIHR Research Design Service South West, London, UK
| | - V Eyre
- Re:Cognition Health Ltd, Plymouth, UK
| | - J E Smith
- Emergency Medicine, Plymouth University Hospitals NHS Trust, Plymouth, UK
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Hayes CJ, Li X, Li C, Shah A, Kathe N, Bhandari NR, Payakachat N. Health-Related Quality of Life among Chronic Opioid Users, Nonchronic Opioid Users, and Nonopioid Users with Chronic Noncancer Pain. Health Serv Res 2018; 53:3329-3349. [PMID: 29479700 PMCID: PMC6153159 DOI: 10.1111/1475-6773.12836] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Evaluate the association between opioid therapy and health-related quality of life (HRQoL) in participants with chronic, noncancer pain (CNCP). DATA SOURCES Medical Expenditure Panel Survey Longitudinal, Medical Conditions, and Prescription Files. STUDY DESIGN Using a retrospective cohort study design, the Mental Health Component (MCS12) and Physical Health Component (PCS12) scores of the Short Form-12 Version 2 were assessed to measure mental and physical HRQoL. DATA COLLECTION Chronic, noncancer pain participants were classified as chronic, nonchronic, and nonopioid users. One-to-one propensity score matching was employed to match chronic opioid users to nonchronic opioid users plus nonchronic opioid users and chronic opioid users to nonopioid users. PRINCIPAL FINDINGS A total of 5,876 participants were identified. After matching, PCS12 was not significantly different between nonchronic versus nonopioid users (LSM Diff = -0.98, 95% CI: -2.07, 0.10), chronic versus nonopioid users (LSM Diff = -2.24, 95% CI: -4.58, 0.10), or chronic versus nonchronic opioid users (LSM Diff = -2.23, 95% CI: -4.53, 0.05). Similarly, MCS12 was not significantly different between nonchronic versus nonopioid users (LSM Diff = 0.76, 95% CI: -0.46, 1.98), chronic versus nonopioid users (LSM Diff = 1.08, 95% CI: -1.26, 3.42), or chronic versus nonchronic opioid users (LSM Diff = -0.57, 95% CI: -2.90, 1.77). CONCLUSIONS Clinicians should evaluate opioid use in participants with CNCP as opioid use is not correlated with better HRQoL.
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Affiliation(s)
- Corey J. Hayes
- Division of Pharmaceutical Evaluation and PolicyDepartment of Pharmacy PracticeUniversity of Arkansas for Medical Sciences College of PharmacyLittle RockAR
- NIDAT32 Addiction Research Training Program, Psychiatric Research InstituteUniversity of Arkansas for Medical Sciences College of MedicineLittle RockAR
| | - Xiaocong Li
- Department of Health Policy and ManagementUniversity of Arkansas for Medical Sciences College of Public HealthLittle RockAR
| | - Chenghui Li
- Division of Pharmaceutical Evaluation and PolicyDepartment of Pharmacy PracticeUniversity of Arkansas for Medical Sciences College of PharmacyLittle RockAR
| | - Anuj Shah
- Division of Pharmaceutical Evaluation and PolicyDepartment of Pharmacy PracticeUniversity of Arkansas for Medical Sciences College of PharmacyLittle RockAR
| | - Niranjan Kathe
- Division of Pharmaceutical Evaluation and PolicyDepartment of Pharmacy PracticeUniversity of Arkansas for Medical Sciences College of PharmacyLittle RockAR
| | - Naleen Raj Bhandari
- Division of Pharmaceutical Evaluation and PolicyDepartment of Pharmacy PracticeUniversity of Arkansas for Medical Sciences College of PharmacyLittle RockAR
| | - Nalin Payakachat
- Division of Pharmaceutical Evaluation and PolicyDepartment of Pharmacy PracticeUniversity of Arkansas for Medical Sciences College of PharmacyLittle RockAR
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Cervigni M, Onesti E, Ceccanti M, Gori MC, Tartaglia G, Campagna G, Panico G, Vacca L, Cambieri C, Libonati L, Inghilleri M. Repetitive transcranial magnetic stimulation for chronic neuropathic pain in patients with bladder pain syndrome/interstitial cystitis. Neurourol Urodyn 2018; 37:2678-2687. [DOI: 10.1002/nau.23718] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 05/06/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Mauro Cervigni
- Department of Women's Health and Newborns; Interstitial Cystitis Referral Center; University Hospital Foundation A. Gemelli; Rome Italy
| | - Emanuela Onesti
- Department of Human Neuroscience; Rare Neuromuscular Diseases Centre; Sapienza University; Rome Italy
| | - Marco Ceccanti
- Department of Human Neuroscience; Rare Neuromuscular Diseases Centre; Sapienza University; Rome Italy
| | - Maria C. Gori
- Department of Human Neuroscience; Rare Neuromuscular Diseases Centre; Sapienza University; Rome Italy
| | - Giorgio Tartaglia
- Department of Human Neuroscience; Rare Neuromuscular Diseases Centre; Sapienza University; Rome Italy
| | - Giuseppe Campagna
- Department of Women's Health and Newborns; Interstitial Cystitis Referral Center; University Hospital Foundation A. Gemelli; Rome Italy
| | - Giovanni Panico
- Department of Women's Health and Newborns; Interstitial Cystitis Referral Center; University Hospital Foundation A. Gemelli; Rome Italy
| | - Lorenzo Vacca
- Department of Women's Health and Newborns; Interstitial Cystitis Referral Center; University Hospital Foundation A. Gemelli; Rome Italy
| | - Chiara Cambieri
- Department of Human Neuroscience; Rare Neuromuscular Diseases Centre; Sapienza University; Rome Italy
| | - Laura Libonati
- Department of Human Neuroscience; Rare Neuromuscular Diseases Centre; Sapienza University; Rome Italy
| | - Maurizio Inghilleri
- Department of Human Neuroscience; Rare Neuromuscular Diseases Centre; Sapienza University; Rome Italy
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Fuentes-Márquez P, Cabrera-Martos I, Valenza MC. Physiotherapy interventions for patients with chronic pelvic pain: A systematic review of the literature. Physiother Theory Pract 2018; 35:1131-1138. [PMID: 29757068 DOI: 10.1080/09593985.2018.1472687] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Objective: To summarize the available scientific evidence on physiotherapy interventions in the management of chronic pelvic pain (CPP). Data Sources: A systematic review of randomized controlled trials was performed. An electronic search of MEDLINE, CINAHL, and Web of Science databases was performed to identify relevant randomized trials from 2010-2016. Study Selection: Manuscripts were included if at least one of the comparison groups received a physiotherapy intervention. Studies were assessed in duplicate for data extraction and risk of bias using the Physiotherapy Evidence Database scale PEDro. Data Extraction and Synthesis: Eight of the studies screened met the inclusion criteria. Four manuscripts studied the effects of electrotherapy including intravaginal electrical stimulation, short wave diathermy, respiratory-gated auricular vagal afferent nerve stimulation, percutaneous tibial nerve stimulation, and sono-electro-magnetic therapy with positive results. Three studies focused on manual assessing the efficacy of myofascial versus massage therapy in two of them and ischemic compression for trigger points. Conclusions: Although physiotherapy interventions show some beneficial effects, evidence cannot support the results. Heterogeneity in terms of population phenotype, methodological quality, interpretation of results, and operational definition result in little overall evidence to guide treatment.
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Affiliation(s)
- Pedro Fuentes-Márquez
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Irene Cabrera-Martos
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Marie Carmen Valenza
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
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Vincent K, Baranowski A, Bhattacharya S, Birch J, Cheong Y, Cregg R, Daniels J, Hewitt CA, Macfarlane GJ, Middleton L, Szubert W, Tracey I, Williams ACDC, Horne AW. GaPP2, a multicentre randomised controlled trial of the efficacy of gabapentin for the management of chronic pelvic pain in women: study protocol. BMJ Open 2018; 8:e014924. [PMID: 29391360 PMCID: PMC5879736 DOI: 10.1136/bmjopen-2016-014924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Chronic pelvic pain (CPP) affects more than 1 million UK women with associated healthcare costs of £158 million annually. Current evidence supporting interventions when no underlying pathology is identified is very limited and treatment is frequently inadequate. Gabapentin (a GABA analogue) is efficacious and often well tolerated in other chronic pain conditions. We have completed a successful pilot randomised controlled trial Gabapentin for Pelvic Pain 1 (GaPP1) and here describe the protocol for our definitive multicentre trial to assess the efficacy of gabapentin in the management of CPP in women Gabapentin for Pelvic Pain 2 (GaPP2). METHODS AND ANALYSIS We plan to perform a double-blind placebo-controlled randomised multicentre clinical trial, recruiting 300 women with CPP from up to 40 National Health Service hospitals within the UK. After randomisation, women will titrate their medication (gabapentin or placebo) over a 4-week period to a maximum of 2700 mg or placebo equivalent and will then maintain a stable dose for a 12-week period. Response to treatment will be monitored with validated questionnaires and coprimary outcome measures of average and worst pain scores will be employed. The primary objective is to test the hypothesis that treatment with gabapentin has the potential to provide an effective oral treatment to alleviate pain in women with CPP in the absence of any obvious pelvic pathology. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Coventry and Warwick Research Ethics Committee (REC 15/WM/0036). Data will be presented at international conferences and published in peer-reviewed journals. We will make the information obtained from the study available to the public through national bodies and charities. TRIAL REGISTRATION NUMBER ISRCTN77451762; Pre-results.
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Affiliation(s)
- Katy Vincent
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
| | - Andrew Baranowski
- Pain Management Centre, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Siladitya Bhattacharya
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | | | - Ying Cheong
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Roman Cregg
- Pain Management Centre, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Jane Daniels
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Catherine A Hewitt
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Gary J Macfarlane
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Lee Middleton
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Wojciech Szubert
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, Edinburgh, UK
| | - Irene Tracey
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Amanda C de C Williams
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Andrew W Horne
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, Edinburgh, UK
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Abstract
Chronic pelvic pain (CPP) affects 24% of premenopausal women, accounts for 20%-30% of UK gynecology outpatient appointments, and has an annual pan-European economic cost of €3.8 billion. Despite extensive investigation, often including laparoscopy, up to 55% of women do not receive a diagnosis and endure persistent symptoms. In these patients, clinical management focuses on symptom control rather than treatment. It is possible that pelvic vein incompetence (PVI) is a cause of CPP, although the quality of studies investigating an association is generally low. PVI may develop during and after pregnancy, as uterine blood flow increases significantly, pushing venous valve leaflets apart, and enabling retrograde venous flow. Analogies with varicose veins of the lower limb are helpful, and symptoms are similar. Women with symptomatic PVI report a dull pelvic ache that is worse on standing and sitting and persists throughout the day. It can be relieved by lying down. Early treatments for PVI included laparoscopic ligation; however, since the advent of endovascular occlusive techniques, treatments have lower risk and lower cost, and can be undertaken without sedation or anesthetic. However, there have been no high-quality randomized controlled trials of interventions and, therefore, the evidence is limited to single-center case series.
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Affiliation(s)
| | - Vivak Hansrani
- Department of Vascular Surgery, University Hospital of South Manchester, Manchester, UK
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Aikimbaev K, Balli T, Akgul E, Aksungur E. Ovarian vein diameters measured by MDCT in women without evidence of pelvic congestion syndrome. HEART VESSELS AND TRANSPLANTATION 2017. [DOI: 10.24969/hvt.2017.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Manual acupuncture plus usual care versus usual care alone in the treatment of endometriosis-related chronic pelvic pain: study protocol for a randomised controlled feasibility study. Pilot Feasibility Stud 2017; 4:10. [PMID: 28694989 PMCID: PMC5500924 DOI: 10.1186/s40814-017-0152-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/08/2017] [Indexed: 11/30/2022] Open
Abstract
Background Endometriosis is the most common cause of chronic pelvic pain worldwide. Non-surgical treatments are effective for only 30–50% of women and have a significant side effect burden that leads to high discontinuation rates. Surgery can be effective but is expensive and invasive, and symptoms tend to recur within 5 years. There is early evidence that acupuncture may be effective in treating endometriosis-related chronic pelvic pain, showing clinically significant analgesia. Both levels of inflammation and pain processing have been shown to be altered in women with chronic pelvic pain. Acupuncture has been shown to reduce inflammation and change central pain processing in other conditions, but research on women with endometriosis is currently lacking. The aim of this feasibility study is to provide data on recruitment rates, retention, appropriateness of outcome measures, minimal clinically important difference in numeric rated scales for pain and the potential effect of acupuncture on pain processing and markers of inflammation in endometriosis-related CPP. Methods We will include women aged 18–45 years with a diagnosis of endometriosis via laparoscopy in the past 5 years. A total of 30 participants will be recruited and randomly allocated in a 1:1 ratio to receive acupuncture or usual care. Women in the acupuncture group will receive two 45-min treatment sessions per week for 8 weeks (total of 16 sessions). Women in the usual care group will continue with their current treatment regimen. The primary feasibility outcomes are recruitment rates, retention rates and the safety and acceptability of the intervention; secondary patient-centred outcomes include a change in 0–10 daily pelvic pain ratings, the Endometriosis Health Profile 30 (EHP-30) and changes in conditioned pain modulation, resting and task-related EEG activity and inflammatory markers. Analyses will be performed blind to group allocation. Discussion This is a two-armed, assessor blind, randomised controlled feasibility trial. Data will be compared at baseline and trial completion 8 weeks later. Outcomes from this feasibility study will inform a larger, fully powered clinical trial should the treatment show trends for potential effectiveness. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12617000053325 (http://www.ANZCTR.org.au/ACTRN12617000053325.aspx). Electronic supplementary material The online version of this article (doi:10.1186/s40814-017-0152-9) contains supplementary material, which is available to authorized users.
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Mental disorders in patients with chronic pelvic pain syndrome (CPPS). J Psychosom Res 2017; 98:19-26. [PMID: 28554368 DOI: 10.1016/j.jpsychores.2017.04.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/13/2017] [Accepted: 04/21/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Chronic pelvic pain syndrome (CPPS) is a debilitating pain condition with prevalence rates between 2.0% and 26.6%. Studies indicate that CPPS is often associated with psychosocial factors, but little is known about the presence of full-blown mental disorders in female and male patients with CPPS. Therefore, the aim of this study was to investigate the frequencies of mental disorders in patients with CPPS. METHODS Cross-sectional data were collected from patients visiting a specialized outpatient clinic. Frequencies of mental disorders were investigated using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and compared to the general population. Furthermore, self-rating questionnaires were used to assess somatic symptom severity (PHQ-15), depression severity (PHQ-9) and anxiety severity (GAD-7). RESULTS Data from 178 CPPS patients (60.1% female; age M=49.1, SD=18.0) were analyzed. Of the total sample, 95.2% (95% CI 90.8-97.9) suffered from at least one mental disorder. The most prevalent mental disorders were somatoform disorders (91.7%; 95% CI 86.4-95.4), followed by mood disorders (50.6%; 95% CI 42.8-58.4) and anxiety disorders (32.1%; 95% CI 25.2-39.8). The self-reported symptom burden was also significantly higher than in the general population. Compared to men, women met the diagnoses of somatoform (p=0.012) and anxiety disorders (p=0.027) significantly more often and reported a significantly higher total somatic symptom severity (p=0.001). CONCLUSION Our results provide evidence for a clinically relevant psychosocial symptom burden in patients with CPPS, indicating the need for the examination of psychopathologies and multi-professional treatment for this patient group.
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Reliability and Validity of the Medical Outcomes Study Short Form-12 Version 2 (SF-12v2) in Adults with Non-Cancer Pain. Healthcare (Basel) 2017; 5:healthcare5020022. [PMID: 28445438 PMCID: PMC5492025 DOI: 10.3390/healthcare5020022] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/20/2017] [Accepted: 04/23/2017] [Indexed: 12/26/2022] Open
Abstract
Limited evidence exists on how non-cancer pain (NCP) affects an individual's health-related quality of life (HRQoL). This study aimed to validate the Medical Outcomes Study Short Form-12 Version 2 (SF-12v2), a generic measure of HRQoL, in a NCP cohort using the Medical Expenditure Panel Survey Longitudinal Files. The SF Mental Component Summary (MCS12) and SF Physical Component Summary (PCS12) were tested for reliability (internal consistency and test-retest reliability) and validity (construct: convergent and discriminant; criterion: concurrent and predictive). A total of 15,716 patients with NCP were included in the final analysis. The MCS12 and PCS12 demonstrated high internal consistency (Cronbach's alpha and Mosier's alpha > 0.8), and moderate and high test-retest reliability, respectively (MCS12 intraclass correlation coefficient (ICC): 0.64; PCS12 ICC: 0.73). Both scales were significantly associated with a number of chronic conditions (p < 0.05). The PCS12 was strongly correlated with perceived health (r = 0.52) but weakly correlated with perceived mental health (r = 0.25). The MCS12 was moderately correlated with perceived mental health (r = 0.42) and perceived health (r = 0.33). Increasing PCS12 and MCS12 scores were significantly associated with lower odds of reporting future physical and cognitive limitations (PCS12: OR = 0.90 95%CI: 0.89-0.90, MCS12: OR = 0.94 95%CI: 0.93-0.94). In summary, the SF-12v2 is a reliable and valid measure of HRQoL for patients with NCP.
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Twiddy H, Bradshaw A, Chawla R, Johnson S, Lane N. Female chronic pelvic pain: the journey to diagnosis and beyond. Pain Manag 2017; 7:155-159. [PMID: 28073312 DOI: 10.2217/pmt-2016-0052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Hannah Twiddy
- The Pain Management Department, the Walton Centre NHS Trust, Liverpool, UK
| | - Alison Bradshaw
- The Pain Management Department, the Walton Centre NHS Trust, Liverpool, UK
| | - Rajiv Chawla
- The Pain Management Department, the Walton Centre NHS Trust, Liverpool, UK
| | - Selina Johnson
- The Pain Management Department, the Walton Centre NHS Trust, Liverpool, UK.,Institute of Translational Medicine, The University of Liverpool, Liverpool, UK
| | - Natalie Lane
- The Pain Management Department, the Walton Centre NHS Trust, Liverpool, UK
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Saxena R, Gupta M, Shankar N, Jain S, Saxena A. Effects of yogic intervention on pain scores and quality of life in females with chronic pelvic pain. Int J Yoga 2017; 10:9-15. [PMID: 28149062 PMCID: PMC5225749 DOI: 10.4103/0973-6131.186155] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Context: Chronic pelvic pain (CPP) is a common condition of women of the reproductive age group. It has a negative impact on a woman's personal health and quality of life (QOL). Practicing yoga has shown numerous benefits in various chronic painful conditions. Aim: To study the effects of yogic intervention on pain scores and quality of life in females of reproductive age group with CPP, on conventional therapy. Settings and Design: It is a follow-up, randomized case-control study done in a tertiary care hospital. Subjects and Methods: Sixty female patients of CPP in the age group of 18–45 years were randomly divided into Group I (n = 30) and Group II (n = 30). Group I received only conventional therapy in the form of NSAIDS and Group II received yoga therapy in the form of asanas, pranayama, and relaxation along with the conventional therapy for 8 weeks. They were assessed twice (pre- and post-treatment) for pain scores through visual analog scale (VAS) score and QOL by the World Health Organization quality of life-BREF (WHOQOL-BREF) questionnaire. Statistical Analysis Used: Repeated measure ANOVA followed by Tukey's test. P < 0.05 was considered significant. Results: After 8 weeks of yogic intervention, Group II patients showed a significant decrease in intensity of pain seen by a decrease in VAS score (P < 0.001) and improvement in the quality of life with a significant increase (P < 0.001) in physical, psychological, social, and environmental domain scores of WHOQOL-BREF. Conclusions: The practice of yoga causes a reduction in the pain intensity and improves the quality of life in patients with chronic pelvic pain.
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Affiliation(s)
- Rahul Saxena
- Department of Physiology, Guru Teg Bahadur Hospital, University College of Medical Sciences, New Delhi, India
| | - Manish Gupta
- Department of Physiology, Guru Teg Bahadur Hospital, University College of Medical Sciences, New Delhi, India
| | - Nilima Shankar
- Department of Physiology, Guru Teg Bahadur Hospital, University College of Medical Sciences, New Delhi, India
| | - Sandhya Jain
- Department of Obstetrics and Gynaecology, Guru Teg Bahadur Hospital, University College of Medical Sciences, New Delhi, India
| | - Arushi Saxena
- Department of Obstetrics and Gynaecology, Guru Teg Bahadur Hospital, University College of Medical Sciences, New Delhi, India
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Priya K, Rajaram S, Goel N. Comparison of combined hormonal vaginal ring and low dose combined oral hormonal pill for the treatment of idiopathic chronic pelvic pain: a randomised trial. Eur J Obstet Gynecol Reprod Biol 2016; 207:141-146. [DOI: 10.1016/j.ejogrb.2016.10.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/25/2016] [Accepted: 10/21/2016] [Indexed: 10/20/2022]
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Champaneria R, Shah L, Moss J, Gupta JK, Birch J, Middleton LJ, Daniels JP. The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness. Health Technol Assess 2016; 20:1-108. [PMID: 26789334 DOI: 10.3310/hta20050] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Pelvic congestion syndrome (PCS) is described as chronic pelvic pain (CPP) arising from dilated and refluxing pelvic veins, although the causal relationship between pelvic vein incompetence (PVI) and CPP is not established. Non-invasive screening methods such as Doppler ultrasound and magnetic resonance venography are used before confirmation by venography. Percutaneous embolisation has become the principal treatment for PCS, with high success rates often cited. OBJECTIVES Our proposal aimed to systematically and critically review the definitions and diagnostic criteria of PCS, the association between PVI and CPP, the accuracy of various non-invasive imaging techniques and the effectiveness of embolisation for PVI; and to identify factors associated with successful outcome. We also wished to survey clinicians and patients to assess awareness and management of PCS and gauge the enthusiasm for further research. DATA SOURCES A comprehensive search strategy encompassing various terms for pelvic congestion, pain, imaging techniques and embolisation was deployed in 17 bibliographic databases, including MEDLINE, EMBASE and Web of Science. There was no restriction on study design. METHODS Methodological quality was assessed using appropriate tools. Online surveys were sent to clinicians and patients. The quality and heterogeneity generally precluded meta-analysis and so results were tabulated and described narratively. RESULTS We identified six association studies, 10 studies involving ultrasound, two studies involving magnetic resonance venography, 21 case series and one poor-quality randomised trial of embolisation. There were no consistent diagnostic criteria for PCS. We found that the associations between CPP and PVI were generally fairly similar, with three of five studies with sufficient data showing statistically significant associations (odds ratios of between 31 and 117). The prevalence of PVI ranged widely, although the majority of women with PVI had CPP. Transvaginal ultrasound with Doppler and magnetic resonance venography are both useful screening methods, although the data on accuracy are limited. Early substantial relief from pain symptoms was observed in approximately 75% of women undergoing embolisation, a figure which generally increased over time and was sustained. Reintervention rates were generally low. Transient pain was a common occurrence following foam embolisation, while there was a < 2% risk of coil migration. Confidence in the embolisation technique is reasonably high, although there is a desire to strengthen the evidence base. Even among women with CPP, fewer than half had any knowledge about PCS. CONCLUSIONS The data supporting the diagnosis and treatment of PCS are limited and of variable methodological quality. There is some evidence to tentatively support a causative association, but it cannot be categorically stated that PVI is the cause of CPP in women with no other pathology, as the six most pertinent drew on clinically disparate populations and defined PVI inconsistently. Embolisation appears to provide symptomatic relief in the majority of women and is safe. However, the majority of included studies of embolism were relatively small case series and only the randomised controlled trial was considered at risk of potential biases. There is scope and demand for considerable further research. The question of the association of PVI and CPP requires a well-designed and well-powered case-control study, which will also provide data to derive a diagnostic standard. An adequately powered randomised trial is essential to provide evidence on the effectiveness of embolisation, but this faces methodological challenges. STUDY REGISTRATION This study is registered as PROSPERO CRD42012002237 and CRD42012002238. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Rita Champaneria
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Laila Shah
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Jonathan Moss
- Department of Radiology, North Glasgow University Hospitals, Glasgow, UK
| | - Janesh K Gupta
- Institute of Metabolism and Systems Biology, University of Birmingham, Birmingham, UK
| | | | - Lee J Middleton
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Jane P Daniels
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
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Mueller ER, Damaser MS, Mallampalli MP, Losada L. Women's Urological Health as a Priority to the Woman Well Visit. Womens Health Issues 2016; 26:476-7. [PMID: 27448751 DOI: 10.1016/j.whi.2016.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Elizabeth R Mueller
- Departments of Urology & Obstetrics/Gynecology Loyola University Chicago, Stritch School of Medicine/Loyola University Medical Center, Maywood, Il
| | - Margot S Damaser
- Biomedical Engineering Department and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Research Service, Louis Stokes Cleveland Dept of Veterans Affairs Medical Center, Cleveland, OH
| | - Monica P Mallampalli
- Vice President, Scientific Affairs, Society for Women's Health Research, Washington D.C
| | - Liliana Losada
- Associate Director, Scientific Affairs, Society for Women's Health Research, Washington D.C
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Losada L, Amundsen CL, Ashton-Miller J, Chai T, Close C, Damaser M, DiSanto M, Dmochowski R, Fraser MO, Kielb SJ, Kuchel G, Mueller ER, Parker-Autry C, Wolfe AJ, Mallampalli MP. Expert Panel Recommendations on Lower Urinary Tract Health of Women Across Their Life Span. J Womens Health (Larchmt) 2016; 25:1086-1096. [PMID: 27285829 PMCID: PMC5116700 DOI: 10.1089/jwh.2016.5895] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Urologic and kidney problems are common in women across their life span and affect their daily life, including physical activity, sexual relations, social life, and future health. Urological health in women is still understudied and the underlying mechanisms of female urological dysfunctions are not fully understood. The Society for Women's Health Research (SWHR®) recognized the need to have a roundtable discussion where researchers and clinicians would define the current state of knowledge, gaps, and recommendations for future research directions to transform women's urological health. This report summarizes the discussions, which focused on epidemiology, clinical presentation, basic science, prevention strategies, and efficacy of current therapies. Experts around the table agreed on a set of research, education, and policy recommendations that have the potential to dramatically increase awareness and improve women's urological health at all stages of life.
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Affiliation(s)
- Liliana Losada
- 1 Scientific Affairs, Society for Women's Health Research (SWHR®) , Washington, District of Columbia
| | - Cindy L Amundsen
- 2 Departments of Obstetrics and Gynecology and Surgery, Duke University , Durham, North Carolina
| | - James Ashton-Miller
- 3 Department of Biomechanical Engineering, University of Michigan , Ann Arbor, Michigan
| | - Toby Chai
- 4 Department of Urology, Yale School of Medicine , New Haven, Connecticut
| | - Clare Close
- 5 Close Pediatric Urology , Las Vegas, Nevada
| | - Margot Damaser
- 6 Department of Biomedical Engineering, Cleveland Clinic and Louis Stokes Cleveland VA Medical Center , Cleveland, Ohio
| | - Michael DiSanto
- 7 Department of Biomedical Sciences and Surgery, Cooper Medical School of Rowan University , Camden, New Jersey
| | - Roger Dmochowski
- 8 Department of Urology, Vanderbilt University , Nashville, Tennessee
| | - Matthew O Fraser
- 9 Department of Surgery, Division of Urology, Duke University Medical Center , Durham, North Carolina
| | - Stephanie J Kielb
- 10 Department of Urology and Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - George Kuchel
- 11 Department of Geriatrics and Gerontology, UConn Center on Aging , Farmington, Connecticut
| | - Elizabeth R Mueller
- 12 Department Obstetrics/Gynecology and Urology, Loyola University Medical Center, Loyola University Chicago , Maywood, Illinois
| | - Candace Parker-Autry
- 13 Department of Obstetrics and Gynecology, Wake Forest University , Baptist Medical Center, Winston-Salem, North Carolina
| | - Alan J Wolfe
- 14 Department of Microbiology and Immunology, Loyola University Chicago , Maywood, Illinois
| | - Monica P Mallampalli
- 1 Scientific Affairs, Society for Women's Health Research (SWHR®) , Washington, District of Columbia
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Abstract
Migraine is prevalent in women during the fertile age. Indeed, both neuroendocrine events related to reproductive stages (menarche, pregnancy, and menopause) and menstrual cyclicity and the use of exogenous sex hormones, such as hormonal contraception and replacement therapy, may cause significant changes in the clinical pattern of migraine. Menstrual migraine may be more severe, long-lasting, and refractory to both acute and prophylactic treatment and, therefore, requires tailored strategies. The use of headache diaries, which makes it possible to record prospectively the characteristics of every attack, is of paramount importance for evaluating the time pattern of headache and for identifying a clear link with menstrual cycle-related features. Estrogen variations are highly implicated in modulating the threshold to challenges by altering neuronal excitability, cerebral vasoactivity, pain sensitivity, and neuroendocrine axes throughout the menstrual cycle and not only at the time of menstruation. On the other hand, estrogen withdrawal may really constitute a triggering factor for migraine in women with peculiar characteristics of vulnerability with menstruation or following the discontinuation of exogenous estrogen, as happens with hormonal contraception during the fertile age or with hormone therapy at menopause. In addition, exogenous estrogen may contribute to the occurrence of neurological symptoms, such as aura. When aura occurs, hormonal treatment should be discontinued.
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Affiliation(s)
- Rossella E Nappi
- Research Center of Reproductive Medicine and Unit of Gynecological Endocrinology and Menopause, Department of Internal Medicine and Endocrinology, IRCCS Maugeri Foundation, University of Pavia, Pavia, Italy.
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Hagemann CT, Kirste UM. Assessment of persistent pelvic pain after hysterectomy: Neuropathic or nociceptive? Scand J Pain 2016; 11:127-129. [PMID: 28850452 DOI: 10.1016/j.sjpain.2016.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Cecilie Therese Hagemann
- Department for Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Obstetrics and Gynaecology/Multidisciplinary Pain Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Unni Merete Kirste
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
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Pain Control and Palliative Treatments. Updates Surg 2016. [DOI: 10.1007/978-88-470-5767-8_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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