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Xiang H, Zhang T, Al-Danakh A, Yang D, Wang L. Neuromodulation in Chronic Pelvic Pain: A Narrative Review. Pain Ther 2022; 11:789-816. [PMID: 35834103 PMCID: PMC9314476 DOI: 10.1007/s40122-022-00405-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/14/2022] [Indexed: 01/11/2023] Open
Abstract
Chronic primary pelvic pain syndrome (CPPPS) is a heterogeneous disease with unknown pathogenesis and a lack of distinct pathological features, which complicates diagnosis and therapy and has a significant impact on patients' daily life. Because pharmacological management is ineffective and long-term use may result in additional system damage, developing a more effective treatment is critical. Neuromodulation has advanced rapidly over the last few decades, and various types of neuromodulations have demonstrated efficacy in the treatment of CPPPS. In this article we discuss the evolution of neuromodulation technology in the treatment of chronic pelvic pain, its application to various subtypes of chronic pelvic pain, and the comparison of relevant efficacy and parameter differences, as well as assess the relative advantages and disadvantages of sacral neuromodulation, percutaneous tibial nerve stimulation , transcutaneous electrical nerve stimulation, electroacupuncture, and pudendal neuromodulation. Furthermore, it was noted that chronic pelvic pain should be evaluated in terms of pain, associated symptoms, psychological problems, and quality of life. Although neuromodulation approaches have been shown to be effective in treating chronic pelvic pain, more extensive multicenter trials are required to confirm this.
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Affiliation(s)
- Hao Xiang
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Dalian, 116021, China
| | - Tingting Zhang
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Dalian, 116011, China
| | - Abdullah Al-Danakh
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Dalian, 116021, China
| | - Deyong Yang
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Dalian, 116021, China.
- Healinghands (Dalian) Clinic, Dalian, Liaoning, China.
| | - Lina Wang
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Dalian, 116021, China.
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Manisha U, Anuradha L. Effect of high frequency transcutaneous electrical nerve stimulation at root level menstrual pain in primary dysmenorrhea. J Bodyw Mov Ther 2021; 26:108-112. [PMID: 33992229 DOI: 10.1016/j.jbmt.2020.12.025] [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: 07/24/2019] [Revised: 10/02/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Primary dysmenorrhea (PD) is a painful menstruation due to contractions in the uterus that induce ischemic pain associated with normal pelvic anatomy. OBJECTIVE The purpose of the study is to evaluate the effect of High TENS application (root level) among adolescent girls of PD. METHODOLOGY 140 adolescent girls were included with 14-19 years of age and randomly allocated into two groups of Experimental and Control group. The measurement of lower abdominal pain, referred low back pain, and referred bilateral thighs pain was performed by numerical pain rating scale and measurement of systolic as well as diastolic blood pressure by aneroid sphygmomanometer. The data collection was done before and after the intervention. RESULTS & CONCLUSION There were highly significant difference in intragroup and intergroup comparison of all the outcome variables in group A (p value < 0.001). The study concluded that High frequency TENS application at root level show significant improvement for managing primary dysmenorrhea.
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Affiliation(s)
- Uttam Manisha
- Department of Sports Science, Punjabi University, Patiala, India.
| | - Lehri Anuradha
- Department of Sports Science, Punjabi University, Patiala, India
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Mortier A, Cardaillac C, Perrouin-Verbe MA, Meurette G, Ploteau S, Lesveque A, Riant T, Dochez V, Thubert T. [Pelvic and perineal pain after genital prolapse: A literature review]. Prog Urol 2020; 30:571-587. [PMID: 32651103 DOI: 10.1016/j.purol.2020.06.001] [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: 05/25/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Pelvic and perineal pain after genital prolapse surgery is a serious and frequent post-operative complication which diagnosis and therapeutic management can be complex. MATERIALS ET METHODS A literature review was carried out on the Pubmed database using the following words and MeSH : genital prolapse, pain, dyspareunia, genital prolapse and pain, genital prolapse and dyspareunia, genital prolapse and surgery, pain and surgery. RESULTS Among the 133 articles found, 74 were selected. Post-operative chronic pelvic pain persisting more than 3 months after surgery according to the International Association for the Study of Pain. It can be nociceptive, neuropathic or dysfunctional. Its diagnosis is mainly clinical. Its incidence is estimated between 1% and 50% and the risk factors are young age, the presence of comorbidities, history of prolapse surgery, severe prolapse, preoperative pain, invasive surgical approach, simultaneous placement of several meshes, less operator experience, increased operative time and early post-operative pain. The vaginal approach can cause a change in compliance and vaginal length as well as injury to the pudendal, sciatic and obturator nerves and in some cases lead to myofascial pelvic pain syndrome, whereas the laparoscopic approach can lead to parietal nerve damage. Therapeutic management is multidisciplinary and complex. CONCLUSION Pelvic pain after genital prolapse surgery is still obscure to this day.
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Affiliation(s)
- A Mortier
- Service de gynécologie, CHU de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France
| | - C Cardaillac
- Service de gynécologie, CHU de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France
| | - M-A Perrouin-Verbe
- Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France; GREEN, groupe de recherche clinique en neuro-urologie, GRCUPMC01, 75020 Paris, France
| | - G Meurette
- Service de chirurgie viscérale, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France; Centre fédératif de pelvi-périnéologie, Nantes, France
| | - S Ploteau
- Service de gynécologie, CHU de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France; Centre fédératif de pelvi-périnéologie, Nantes, France
| | - A Lesveque
- Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France; Centre fédératif de pelvi-périnéologie, Nantes, France
| | - T Riant
- Centre fédératif de pelvi-périnéologie, Nantes, France
| | - V Dochez
- Service de gynécologie, CHU de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France; CIC, Centre d'investigation clinique, CHU de Nantes, 5, allée de l'Île-Gloriette, 44093 Nantes cedex 01, France
| | - T Thubert
- Service de gynécologie, CHU de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France; CIC, Centre d'investigation clinique, CHU de Nantes, 5, allée de l'Île-Gloriette, 44093 Nantes cedex 01, France; GREEN, groupe de recherche clinique en neuro-urologie, GRCUPMC01, 75020 Paris, France; Centre fédératif de pelvi-périnéologie, Nantes, France.
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Cottrell AM, Schneider MP, Goonewardene S, Yuan Y, Baranowski AP, Engeler DS, Borovicka J, Dinis-Oliveira P, Elneil S, Hughes J, Messelink BJ, de C Williams AC. Benefits and Harms of Electrical Neuromodulation for Chronic Pelvic Pain: A Systematic Review. Eur Urol Focus 2020; 6:559-571. [PMID: 31636030 DOI: 10.1016/j.euf.2019.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 09/04/2019] [Accepted: 09/17/2019] [Indexed: 12/12/2022]
Abstract
CONTEXT Patients with chronic pelvic pain (CPP) may have pain refractory to conventional pain management strategies. Neuromodulation could provide relief of pain. OBJECTIVE To evaluate the benefits and harms of neuromodulation for CPP. EVIDENCE ACQUISITION A comprehensive search of EMBASE, PUBMED, and SCOPUS was performed for the entire database to January 2018. Studies were selected, data were extracted, and quality was assessed by two independent reviewers. A meta-analysis was used to combine randomized controlled trials (RCTs); otherwise, a narrative analysis was used. EVIDENCE SYNTHESIS After screening 1311 abstracts, 36 studies including eight RCTs were identified, enrolling 1099 patients. Studies covered a broad range in terms of phenotypes of CPP and methods of neuromodulation. A meta-analysis was possible for percutaneous tibial nerve stimulation and transcutaneous electrical nerve stimulation, which showed improvement in pain. Only narrative synthesis was possible for other modalities (sacral nerve stimulation, spinal cord stimulation, intravaginal electrical stimulation, and pudendal nerve stimulation) which appeared to reduce pain in patients with CPP. Treatments generally improved quality of life but with variable reporting of adverse events. Many studies showed high risks of bias and confounding. CONCLUSIONS While electrical neuromodulation may improve symptoms in CPP, further work is needed with high-quality studies to confirm it. PATIENT SUMMARY Neuromodulation may be useful in reducing pain and improving quality of life in patients with chronic pelvic pain, but more research is needed.
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Affiliation(s)
| | | | | | - Yuhong Yuan
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Andrew P Baranowski
- University College London and University College Hospital and the National Hospital for Neurology and Neurosurgery, London, UK
| | | | | | | | - Sohier Elneil
- National Hospital for Neurology and Neurosurgery, London, UK
| | - John Hughes
- The James Cook University Hospital, Middlesbrough, UK
| | - Bert J Messelink
- Department of Urology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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Yokozuka M, Nagai M, Katsura R, Kenmyo K. Analgesia by Sacral Surface Electrical Stimulation for Primary Dysmenorrhoea. JOURNAL OF REHABILITATION MEDICINE - CLINICAL COMMUNICATIONS 2020; 3:1000027. [PMID: 33884129 PMCID: PMC8008724 DOI: 10.2340/20030711-1000027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/01/2020] [Indexed: 12/01/2022]
Abstract
Objective To evaluate the effects of analgesia by sacral surface electrical stimulation on lower abdominal pain in women with primary dysmenorrhoea. Design Explorative study. Participants Eleven female university students, who regularly experience difficulty in their university work due to menstrual pain, or who use analgesics for more than one day each month, were recruited. Methods Sacral surface electrical stimulation, 5 Hz for 15 min, was performed after the onset of menstruation. Electrodes were placed on the skin, directly above the second and fourth sacral foramina. Visual analogue scale and degree of pain (calculated by using a low current to assess pain) were determined before and after electrical stimulation. Results Visual analogue scale score and degree of pain decreased significantly immediately after electrical stimulation (p < 0.001). A correlation was observed between visual analogue scale score and degree of pain before and after electrical stimulation (r=0.516, p <0.001). No side-effects were observed in any participant. Conclusion Sacral surface electrical stimulation may provide immediate pain relief in women with dysmenorrhoea and lower abdominal pain.
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Affiliation(s)
- Mieko Yokozuka
- Preparing Section for New Faculty of Medical Science, Fukushima Medical University, Fukushima, Japan
| | - Mayumi Nagai
- Department of Rehabilitation, Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University, Sendai, Japan
| | - Rieko Katsura
- Department of Rehabilitation, Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University, Sendai, Japan
| | - Kayoko Kenmyo
- Department of Rehabilitation, Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University, Sendai, Japan
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Oladosu FA, Tu FF, Hellman KM. Nonsteroidal antiinflammatory drug resistance in dysmenorrhea: epidemiology, causes, and treatment. Am J Obstet Gynecol 2018; 218:390-400. [PMID: 28888592 DOI: 10.1016/j.ajog.2017.08.108] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/14/2017] [Accepted: 08/31/2017] [Indexed: 11/25/2022]
Abstract
Although nonsteroidal antiinflammatory drugs can alleviate menstrual pain, about 18% of women with dysmenorrhea are unresponsive, leaving them and their physicians to pursue less well-studied strategies. The goal of this review is to provide a background for treating menstrual pain when first-line options fail. Research on menstrual pain and failure of similar drugs in the antiplatelet category suggested potential mechanisms underlying nonsteroidal antiinflammatory drug resistance. Based on these mechanisms, alternative options may be helpful for refractory cases. This review also identifies key pathways in need of further study to optimize menstrual pain treatment.
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Perez Machado AF, Perracini MR, Cruz Saraiva de Morais AD, da Silva BO, Driusso P, Liebano RE. Microwave diathermy and transcutaneous electrical nerve stimulation effects in primary dysmenorrhea: clinical trial protocol. Pain Manag 2017; 7:359-366. [PMID: 28936905 DOI: 10.2217/pmt-2017-0021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The aim of this study will be to analyze the effects of microwave diathermy (MWD) and transcutaneous electrical nerve stimulation (TENS) on primary dysmenorrhea. Eighty eight women, age range 18-44 years, with no previous pregnancy, no practice physical activities, a BMI of ≤29.9 kg/m2, a regular menstrual cycle and a diagnosis of primary dysmenorrhea, with menstrual pain ranging from mild to severe, will be selected. The participants will be randomized into four groups: MWD and TENS, MWD and placebo TENS, placebo MWD and TENS, and placebo MWD and placebo TENS. Pain will be measured using the visual numeric scale and the McGill Pain Questionnaire; the pressure pain threshold using a digital algometer and conditioned pain modulation using the cold pressor test. Brazilian Clinical Trials Registry (RBR-5QKCK4. Registered on 16 March 2016).
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Affiliation(s)
- Aline Fernanda Perez Machado
- Master's & Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo/SP, Brazil
| | - Monica Rodrigues Perracini
- Master's & Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo/SP, Brazil
| | | | - Bruna Oliveira da Silva
- Department of Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo/SP, Brazil
| | - Patricia Driusso
- Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos/SP, Brazil
| | - Richard Eloin Liebano
- Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos/SP, Brazil
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Potur DC, Kömürcü N. The effects of local low-dose heat application on dysmenorrhea. J Pediatr Adolesc Gynecol 2014; 27:216-21. [PMID: 24656704 DOI: 10.1016/j.jpag.2013.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 10/12/2013] [Accepted: 11/01/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This is a controlled, prospective study which compares the effects of a low-dose heat patch for self-medication on the reduction of pain symptoms in dysmenorrhea. METHODS The sample group included female sophomore students studying at a university in Istanbul, Turkey, between 2007 and 2008. These female participants completed the Dysmenorrhea Identification Form to determine the sample group, and a total of 193 female students possessed the eligible criteria. The research control group consisted of 66 patients, the analgesia group consisted of 61, and the heat patch group consisted of 66. The control group did not use any treatments, while the self-medication group used analgesic medication (single dose), and the heat patch group applied a heat patch on the lower abdomen, against the skin, for an application period of 2 menstrual cycles. Using a visual analog scale (VAS), the pain severity was recorded at the baseline, after 4 hours of intervention, and after 8 hours of intervention. The data were examined using ANOVA. RESULTS There were significant differences between the groups in terms of pain severity after 8 hours of application (P < .001). All groups had similar pain levels at baseline and during the fourth and eighth hours, with no significant differences between the groups during the first and the second menstrual cycles (P > .05). CONCLUSION The authors conclude that the heat patch is an effective method for reducing dysmenorrhea.
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Affiliation(s)
- Dilek Coşkuner Potur
- Faculty of Health Sciences, Division of Nursing, Department of Obstetrics and Gynecology Nursing, Marmara University, Istanbul, Turkey.
| | - Nuran Kömürcü
- Faculty of Health Sciences, Division of Nursing, Department of Obstetrics and Gynecology Nursing, Marmara University, Istanbul, Turkey
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Harel Z. Dysmenorrhea in adolescents and young adults: an update on pharmacological treatments and management strategies. Expert Opin Pharmacother 2013; 13:2157-70. [PMID: 22984937 DOI: 10.1517/14656566.2012.725045] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Dysmenorrhea is the most common gynecologic complaint among adolescents/young adults. Dysmenorrhea is usually primary and is associated with normal ovulatory cycles and with no pelvic pathology. Potent prostaglandins and potent leukotrienes play an important role in generating primary dysmenorrhea symptoms. Adolescents/young adults with severe dysmenorrhea symptoms may have pelvic abnormalities, such as endometriosis or uterine anomalies (secondary dysmenorrhea). AREAS COVERED This review provides an update on treatments and management strategies of dysmenorrhea in adolescents/young adults. Medical literature articles were retrieved using a Medline search on primary and secondary dysmenorrhea. Original articles from peer-reviewed journals were selected based on relevance. EXPERT OPINION Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) is the preferred initial treatment for dysmenorrhea in nonsexually active adolescents/young adults. Adolescents/young adults with symptoms that do not respond to NSAIDs for three menstrual periods should be offered hormonal treatment, such as combined estrogen and progestin oral contraceptive pills (OCPs), for three menstrual cycles. If dysmenorrhea does not improve within 6 months of NSAIDs and OCPs, a laparoscopy is indicated to look for endometriosis, which is the most common reason for secondary dysmenorrhea.
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Affiliation(s)
- Zeev Harel
- Warren Alpert Medical School of Brown University, Department of Pediatrics, Division of Adolescent Medicine/Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI 02903, USA.
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Spears LG. A narrative review of medical, chiropractic, and alternative health practices in the treatment of primary dysmenorrhea. J Chiropr Med 2011; 4:76-88. [PMID: 19674650 DOI: 10.1016/s0899-3467(07)60117-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2004] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Primary dysmenorrhea and related issues are discussed as they influence the gynecological and social health of females during adolescence, adulthood, and senior maturity. Health practitioners are exposed to multiple approaches towards the management of menstrual pain. Clinical and social viewpoints target the causation, development, diagnosis, manifestation and management of primary dysmenorrhea. This narrative review includes the topic of the doctor-patient relationship in efforts of cultivating effectively communicative health practitioners. Controversial topics related to primary dysmenorrhea and the quality of life for women are addressed. DATA SOURCES A search for literature reviews, case studies, laboratory research, and clinical trials from 1985-2004 was performed using the MEDLINE database. Sources of additional information included textbooks, national organizational literature and contemporary articles. DISCUSSION Menstrual pain is a prevalent experience yet it is socially taboo for conversation; as such, it poses a hindrance to its management. The communication between the doctor and patient is a critical barrier point between establishing a diagnosis and determining an appropriate treatment plan. A multi-disciple treatment plan varies as much as patients themselves vary in personal experiences, needs, and preferences. CONCLUSIONS Medicinal prophylactics, physical therapeutics, non-acidic diets, herbal supplements, eastern therapies and the chiropractic manual adjustments of the spine are effective methods for the management of primary dysmenorrhea. The non-invasive management of primary dysmenorrhea includes the chiropractic adjustment with complimentary modalities, and other alternative health care practices. Medicinal prophylactics are invasive and pose a higher risk to long-term chemical exposure, side effects or irreversible conditions.
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Affiliation(s)
- Lolita G Spears
- Chiropractic student, Logan Chiropractic College, St. Louis, MO
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Ali S, Ali H. Treating Abdominal Pain in Children: What Do We Know? CLINICAL PEDIATRIC EMERGENCY MEDICINE 2010. [DOI: 10.1016/j.cpem.2010.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Wang MC, Hsu MC, Chien LW, Kao CH, Liu CF. Effects of Auricular Acupressure on Menstrual Symptoms and Nitric Oxide for Women with Primary Dysmenorrhea. J Altern Complement Med 2009; 15:235-42. [DOI: 10.1089/acm.2008.0164] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mei-Chuan Wang
- Department of Nursing, National Taipei College of Nursing, Taipei, Taiwan, Republic of China
| | - Mei-Chi Hsu
- Department of Nursing, I-Shou University, Taiwan, Republic of China
| | - Li-Wei Chien
- Department of Obstetrics and Gynecology, Taipei Medical University and Hospital, Taipei, Taiwan
| | - Chien-Huei Kao
- National Taipei College of Nursing, Taipei, Taiwan, Republic of China
| | - Chi-Feng Liu
- Graduate Institute of Integration of Traditional Chinese Medicine with Western Nursing, National Taipei College of Nursing, Taipei, Taiwan, Republic of China
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Harel Z. Dysmenorrhea in adolescents and young adults: from pathophysiology to pharmacological treatments and management strategies. Expert Opin Pharmacother 2008; 9:2661-72. [DOI: 10.1517/14656566.9.15.2661] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Affiliation(s)
- Zeev Harel
- Division of Adolescent Medicine, Hasbro Children's Hospital, 593 Eddy Street, Providence, RI 02903, USA.
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Abstract
PURPOSE OF REVIEW The purpose of this article is to summarize new findings in the area of chronic pelvic pain in women of childbearing age. RECENT FINDINGS Particular attention over the past few years has been paid to the multidisciplinary approach in diagnosing and treating chronic pelvic pain, because it is common knowledge that different medical specialties very often deal with patients affected by this condition. SUMMARY A classification of chronic pelvic pain is presented, along with the recommended evaluation, diagnostic investigations, and treatment of this condition, based on recent reports in the literature.
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Affiliation(s)
- Mirjana Lovrincevic
- Department of Anesthesiology and Pain Medicine, Roswell Park Cancer Institute, University at Buffalo, State University of New York, Buffalo, New York 14263, USA.
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Abstract
Dysmenorrhea is the most common gynecologic complaint among adolescent and young adult females. Dysmenorrhea in adolescents and young adults is usually primary (functional), and is associated with normal ovulatory cycles and with no pelvic pathology. In approximately 10% of adolescents and young adults with severe dysmenorrhea symptoms, pelvic abnormalities such as endometriosis or uterine anomalies may be found. Potent prostaglandins and potent leukotrienes play an important role in generating dysmenorrhea symptoms. Nonsteroidal anti-inflammatory drugs (NSAID) are the most common pharmacologic treatment for dysmenorrhea. Adolescents and young adults with symptoms that do not respond to treatment with NSAIDs for 3 menstrual periods should be offered combined estrogen/progestin oral contraceptive pills for 3 menstrual cycles. Adolescents and young adults with dysmenorrhea who do not respond to this treatment should be evaluated for secondary causes of dysmenorrhea. The care provider's role is to explain about pathophysiology of dysmenorrhea to every adolescent and young adult female, address any concern that the patient has about her menstrual period, and review effective treatment options for dysmenorrhea with the patient.
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Affiliation(s)
- Zeev Harel
- Associate Professor of Pediatrics, Division of Adolescent Medicine/Hasbro Children's Hospital and Department of Pediatrics, Brown University, Providence, Rhode Island 02903, USA.
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Abstract
AIM This paper presents the findings of a study that assessed the effects of acupressure at the Sanyinjiao point on symptoms of primary dysmenorrhoea among adolescent girls. BACKGROUND Dysmenorrhoea is the most common gynaecological disorder among adolescents. Traditional Chinese acupressure derived from acupuncture is a non-invasive technique. Despite renewed interest in the use of acupressure, relatively few studies have been undertaken to examine its effects on primary dysmenorrhoea. METHODS An experimental study was conducted between December 2000 and August 2001. Participants were female students attending a technical college in Taiwan. None of the 69 participants had a prior history of gynaecological disease or secondary dysmenorrhoea, and all were rated higher than five for pain on a visual analogue scale from 0 to 10. The experimental group (n = 35) received acupressure at Sanyinjiao (above the ankle) while the control group (n = 34) rested for 20 min, while the control group underwent rest in the school health centre for 20 min without receiving acupressure. Fifty participants (30 experimental, 20 control) completed the 4-6-week follow-up session. Five instruments were used to collect pretest and post-test data at each session: (1) Visual Analogue Scale for pain; (2) the Short-Form McGill Pain Questionnaire; (3) the Menstrual Distress Questionnaire; (4) the Visual Analogue Scale for anxiety; and, for the experimental group only, (5) the Acupressure Self-Assessment Form. Data were analysed using the chi-square test, two-sample t-test and repeated measures two-way anova. RESULTS Acupressure at Sanyinjiao during the initial session reduced the pain and anxiety typical of dysmenorrhoea. In the self-treatment follow-up session, acupressure at Sanyinjiao significantly reduced menstrual pain but not anxiety. Thirty-one (87%) of the 35 experimental participants reported that acupressure was helpful, and 33 (94%) were satisfied with acupressure in terms of its providing pain relief and psychological support during dysmenorrhoea. CONCLUSION The findings suggest that acupressure at Sanyinjiao can be an effective, cost-free intervention for reducing pain and anxiety during dysmenorrhoea, and we recommend its use for self-care of primary dysmenorrhoea.
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Affiliation(s)
- Huei-Mein Chen
- Assistant Professor, Chung Hwa College of Medical Technology, Tainan, Taiwan
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De Angelis C, Perrone G, Santoro G, Nofroni I, Zichella L. Suppression of pelvic pain during hysteroscopy with a transcutaneous electrical nerve stimulation device. Fertil Steril 2003; 79:1422-7. [PMID: 12798892 DOI: 10.1016/s0015-0282(03)00363-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) as a pain control method during office hysteroscopy. DESIGN A prospective, randomized study. SETTING Centre for Minimally Invasive Surgery, Department of Gynecological Science and Perinatology, "La Sapienza" University, Rome, Italy. PATIENT(S) One hundred forty-two patients undergoing office hysteroscopy. INTERVENTION(S) Application of a TENS device on the patient's abdomen before and during office hysteroscopy. MAIN OUTCOME MEASURES The level of pain experienced by the patients was assessed using a 10 cm visual analog scale; the side effects and changes in the hemodynamic parameters were evaluated. RESULT(S) The patients treated with TENS during hysteroscopy (group A, n = 71) were compared with a control group (group B, n = 71) on whom the TENS device was not used. The women in the TENS group experienced a significantly lower level of pain during hysteroscopy. No differences in side effects were observed between both group. CONCLUSION(S) TENS is a simple, efficient, and safe method of relieve pain during office hysteroscopy.
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Affiliation(s)
- Carlo De Angelis
- Department of Gynecological Science and Perinatology, Policlinico Umberto I, University of Rome La Sapienza., Italy.
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19
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Abstract
Dysmenorrhea is the most common gynecologic complaint among adolescent girls. Despite progress in understanding the physiology of dysmenorrhea and the availability of effective treatments, many adolescent girls do not seek medical advice or are undertreated. Dysmenorrhea in adolescents is usually primary (functional), and is associated with normal ovulatory cycles and no pelvic pathology. In approximately 10% of adolescents with severe dysmenorrhea, pelvic abnormalities such as endometriosis or uterine anomalies may be found. Potent prostaglandins from the second series and potent leukotrienes from the fourth series play an important role in generating dysmenorrhea symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common pharmacologic treatment for dysmenorrhea. A loading dose of NSAIDs (typically twice the regular dose) should be used as initial treatment for dysmenorrhea in adolescents followed by a regular dose until symptoms abate. Adolescents with symptoms that do not respond to treatment with NSAIDs for three menstrual periods should be offered combined estrogen/ progestin oral contraceptive pills for three menstrual cycles. Adolescents with dysmenorrhea who do not respond to this treatment should be evaluated for secondary causes of dysmenorrhea. Adolescent care providers have the important roles of educating adolescent girls about menstruation-associated symptoms, as well as evaluating and effectively treating patients with dysmenorrhea.
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Affiliation(s)
- Zeev Harel
- Division of Adolescent Medicine, Hasbro Children's Hospital, 593 Eddy Street, Providence, RI 02903, USA.
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Sharp BAC, Taylor DL, Thomas KK, Killeen MB, Dawood MY. Cyclic Perimenstrual Pain and Discomfort: The Scientific Basis for Practice. J Obstet Gynecol Neonatal Nurs 2002. [DOI: 10.1177/0884217502239207] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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21
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Abstract
Menopause, premenstrual syndrome, dysmenorrhea, female fertility, and mastalgia are common problems not easily treated by conventional medicine. Women often seek alternative therapies to help address these conditions. Some evidence points to the efficacy of black cohosh, exercise, and possibly Kava and St. John's wort, in the treatment of menopausal symptoms. Clinical trials indicate that symptoms of premenstrual syndrome may be alleviated with calcium, magnesium, vitamin E. Thiamine, omega-3 fatty acids, the Japanese herbal concoction, TSS, and calcium have proved useful in treating women with dysmenorrhea. Symptoms of mastalgia may be attenuated by evening primrose oil, chaste tree and flaxseed oil may be helpful.
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Affiliation(s)
- Mohamad Sidani
- Department of Family Medicine, LSU School of Medicine-New Orleans, 200 West Esplanade, Suite 510, Kenner, LA 70065, USA.
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22
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23
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Abstract
This review examines the prevalence, associated morbidity, and treatment of primary dysmenorrhea in adolescent girls. Relevant literature was examined by systematic, evidence-based review using MEDLINE and Cochrane Collaboration databases. Dysmenorrhea is highly prevalent during adolescence. Despite differences in measurement methods, 20%-90% of adolescent girls report dysmenorrhea and about 15% of adolescents describe their dysmenorrhea as severe. During adolescence, dysmenorrhea leads to high rates of school absence and activity nonparticipation. Most adolescents with dysmenorrhea self-medicate with over-the-counter preparations; few consult healthcare providers. Combined oral contraceptives (COC) are an accepted treatment for dysmenorrhea in nonadolescent women. However, data supporting the efficacy of COC is limited. Very small studies show decreased prostaglandin in menstrual fluid associated with high-dose COC use. Larger studies are limited to cross-sectional comparisons showing lower prevalence of dysmenorrhea in low-dose COC users compared to non-COC users. One small, randomized controlled trial including some adolescents demonstrated an improvement in dysmenorrhea with high-dose COC treatment compared to placebo. The efficacy of low-dose COC in the treatment of adolescent dysmenorrhea has yet to be determined. If effective, well-established safety and noncontraceptive health benefits may make COC an ideal treatment for dysmenorrhea in adolescent girls.
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Affiliation(s)
- A R Davis
- Department of Obstetrics and Gynecology, Columbia University, 630 W. 168th Street, New York, NY 10032, USA.
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24
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Abstract
Dysmenorrhea presents as painful periods that start two to three years after menarche. The pain usually begins when the bleeding starts and lasts for 48-32 hours. The cause of menstrual cramps and associated symptoms in primary dysmenorrhea is related to prostaglandin production. In secondary dysmenorrhea, there is documented pelvic pathology that causes the painful menstrual cramps, and treatment is cause related. Available treatments for primary dysmenorrhea--NSAIDS, oral combined contraceptives, beta-blockers, psychotherapeutic methods, and cervical dilatation--are discussed.
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Affiliation(s)
- E Deligeoroglou
- 2nd Department of Obstetrics and Gynecology, University of Athens Aretaieion Hospital, Greece.
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25
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Schlaff WD. Infertility treatment in women over 40 years of age. J Womens Health (Larchmt) 1998; 7:471-2. [PMID: 9611706 DOI: 10.1089/jwh.1998.7.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- W D Schlaff
- University of Colorado Health Sciences Center Denver, USA
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26
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Kaplan B, Rabinerson D, Lurie S, Bar J, Krieser UR, Neri A. Transcutaneous electrical nerve stimulation (TENS) for adjuvant pain-relief during labor and delivery. Int J Gynaecol Obstet 1998; 60:251-5. [PMID: 9544709 DOI: 10.1016/s0020-7292(97)00275-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We examined the efficacy of transcutaneous electrical nerve stimulation (TENS) in general and the new Freemom TENS device (LifeCare, Israel) in particular, for pain relief during labor and delivery. METHODS The study group consisted of 104 women. Forty-six nulliparas (44.2%) and 58 multiparas (55.8%), all of whom used the TENS device for pain relief during labor. All participants completed a questionnaire on the degree of pain relief afforded them by TENS during the delivery and related questions. The objective evaluation was based on the documented labor and delivery parameters including medical interventions during delivery. RESULTS The majority of subjects (72% of the nulliparas and 69% of the multiparas) considered TENS effective for the relief of pain during labor. Most of them (67% of the nulliparas and 60% of the multiparas) responded positively to the use of TENS in future deliveries. Sixty-five percent of the multiparas considered TENS at least as effective as the other pain relief methods they had used before. TENS significantly reduced the duration of the first stage of labor P < 0.001 for nulliparas, P < 0.005 for multiparas and it significantly decreased the amount of analgesics administered to individual patients. No significant difference was found in fetal heart rate tracings, Apgar scores and cord blood pH between the study group and an equal number of matched controls who used other forms of pain management. CONCLUSIONS TENS is an effective non-pharmacological, non-invasive adjuvant pain relief modality for use in labor and delivery. TENS application reduced the duration of the first stage of labor and the amount of analgesic drug administered. There were no adverse effects on mothers or newborns.
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Affiliation(s)
- B Kaplan
- Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Campus Petach Tiqva, Israel
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