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Wissing MC, van der Net L, Engels Y, Vissers KCP, Kluivers KB, Wal SVD, Notten KJB. Lessons learned from the experiences of patients with chronic pelvic pain syndrome (CPP syndrome) with a multidisciplinary consultation: a qualitative study. Reg Anesth Pain Med 2024:rapm-2024-105548. [PMID: 38866558 DOI: 10.1136/rapm-2024-105548] [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: 04/09/2024] [Accepted: 05/30/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Chronic pelvic pain syndrome is a complex multifactorial condition with an increasing prevalence probably due to a rising awareness. Chronic pelvic pain syndrome is pain in the pelvic area and often accompanied with complaints in other organ systems of the lesser pelvis. Patients with chronic pelvic pain syndrome who present at our center are evaluated in a standardized care pathway with an integrated multidisciplinary consultation. The team works in a single center and consists of gynecologists, pain specialists, urologists, a pelvic floor physiotherapist and a psychologist. The aim of this interview study is to evaluate the value of the multidisciplinary consultation from the patient's perspectives. METHODS In a qualitative study, we evaluated the experiences and perspectives of patients with chronic pelvic pain syndrome concerning the multidisciplinary consultation at the Radboud University Medical Center. Semistructured interviews were conducted with patients with chronic pelvic pain syndrome who attended a multidisciplinary consultation between 2019 and 2022. All interviews were transcribed verbatim, coded and analyzed via ATLAS.ti with the conventional content analysis. RESULTS Data saturation was reached after seven interviews, followed by three confirmative interviews. In total, 10 patients (22-76 years) participated in the study. Three relevant themes were identified in the interviews: the deleterious effects of pain on overall health, the importance of the design of the multidisciplinary consultation, and the performance of healthcare professionals (knowledge, skills and interaction with patients and colleagues). Participants suggested that although the consultation did not improve their pain experience, there was value in having a comprehensive assessment of their disease. Patients preferred the consultation to occur at the beginning of the care. Additionally, they acknowledged the performance of healthcare providers and having their complaints recognized. However, some participants suggested the need for additional attention to mental health issues during the multidisciplinary consultation. DISCUSSION Even though patients did not perceive the multidisciplinary consultation to improve their pain experience, they appreciated the sense of recognition by this team. CONCLUSION A multidisciplinary consultation is of value from the patients' perspective. A suggestion for improvement emerged where the multidisciplinary consultation should occur at the beginning of the patient journey.
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Affiliation(s)
- Myrthe C Wissing
- Department of Gynecology and Obstetrics, Radboudumc, Nijmegen, The Netherlands
| | - Lotte van der Net
- Department of Gynecology and Obstetrics, Radboudumc, Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative medicine, Radboudumc, Nijmegen, The Netherlands
| | - Kris C P Vissers
- Department of Anesthesiology, Pain and Palliative medicine, Radboudumc, Nijmegen, The Netherlands
| | - Kirsten B Kluivers
- Department of Gynecology and Obstetrics, Radboudumc, Nijmegen, The Netherlands
| | - Selina van der Wal
- Department of Anesthesiology, Pain and Palliative medicine, Radboudumc, Nijmegen, The Netherlands
| | - Kim J B Notten
- Department of Gynecology and Obstetrics, Radboudumc, Nijmegen, The Netherlands
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Singh SS, Allaire C, Al-Nourhji O, Bougie O, Bridge-Cook P, Duigenan S, Kroft J, Lemyre M, Leonardi M, Leyland N, Maheux-Lacroix S, Wessels J, Wahl K, Yong PJ. Guideline No. 449: Diagnosis and Impact of Endometriosis - A Canadian Guideline. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102450. [PMID: 38555044 DOI: 10.1016/j.jogc.2024.102450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
OBJECTIVE To provide a contemporary approach to the understanding of the impact and methods for the diagnosis of endometriosis in Canada. TARGET POPULATION Individuals, families, communities, health care providers, and health care administrators who are affected by, care for patients with, or manage delivery of services for endometriosis. OPTIONS The diagnosis of endometriosis is facilitated by a detailed history, examination, and imaging tests with providers who are experienced in endometriosis care. Surgical evaluation with pathology confirms a diagnosis of endometriosis; however, it is not required for those whose diagnosis was confirmed with imaging. OUTCOMES There is a need to address earlier recognition of endometriosis to facilitate timely access to care and support. Education directed at the public, affected individuals and families, health care providers, and health care administrators are essential to reduce delays in diagnosis and treatment. BENEFITS, HARMS, AND COSTS Increased awareness and education about the impact and approach to diagnosis may support timely access to care for patients and families affected by endometriosis. Earlier and appropriate care may support a reduced health care system burden; however, improved clinical evaluation may require initial investments. EVIDENCE Each section was reviewed with a unique search strategy representative of the evidence available in the literature related to the area of focus. The literature searches for each section of this guideline are listed in Appendix A and include information from published systematic reviews described in the text. VALIDATION METHODS The recommendations were developed following two rounds of review by a national expert panel through an iterative 2-year consensus process. Further details on the process are shared in Appendix B. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See Appendix C (Table C1 for definitions and Table C2 for interpretations of strong and conditional recommendations). INTENDED AUDIENCE This guideline is intended to support health care providers and policymakers involved in the care of those impacted by endometriosis and the systems required to support them. TWEETABLE ABSTRACT Endometriosis impact and diagnosis updated guidelines for Canadian health care providers and policymakers. SUMMARY STATEMENTS RECOMMENDATIONS.
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Singh SS, Allaire C, Al-Nourhji O, Bougie O, Bridge-Cook P, Duigenan S, Kroft J, Lemyre M, Leonardi M, Leyland N, Maheux-Lacroix S, Wessels J, Wahl K, Yong PJ. Directive clinique n o 449 : Directive canadienne sur le diagnostic et les impacts de l'endométriose. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102451. [PMID: 38555045 DOI: 10.1016/j.jogc.2024.102451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
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Allaire C, Yong PJ, Bajzak K, Jarrell J, Lemos N, Miller C, Morin M, Nasr-Esfahani M, Singh SS, Chen I. Directive clinique n o445 : Gestion de la douleur pelvienne chronique. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102284. [PMID: 38341222 DOI: 10.1016/j.jogc.2023.102284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
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Allaire C, Yong PJ, Bajzak K, Jarrell J, Lemos N, Miller C, Morin M, Nasr-Esfahani M, Singh SS, Chen I. Guideline No. 445: Management of Chronic Pelvic Pain. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102283. [PMID: 38341225 DOI: 10.1016/j.jogc.2023.102283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To provide evidence-based recommendations for the management of chronic pelvic pain in females. TARGET POPULATION This guideline is specific to pelvic pain in adolescent and adult females and excluded literature that looked at pelvic pain in males. It also did not address genital pain. BENEFITS, HARMS, AND COSTS The intent is to benefit patients with chronic pelvic pain by providing an evidence-based approach to management. Access to certain interventions such as physiotherapy and psychological treatments, and to interdisciplinary care overall, may be limited by costs and service availability. EVIDENCE Medline and the Cochrane Database from 1990 to 2020 were searched for articles in English on subjects related to chronic pelvic pain, including diagnosis, overlapping pain conditions, central sensitization, management, medications, surgery, physiotherapy, psychological therapies, alternative and complementary therapies, and multidisciplinary and interdisciplinary care. The committee reviewed the literature and available data and used a consensus approach to develop recommendations. Only articles in English and pertaining to female subjects were included. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE Family physicians, gynaecologists, urologists, pain specialists, physiotherapists, and mental health professionals. TWEETABLE ABSTRACT Management of chronic pelvic pain should consider multifactorial contributors, including underlying central sensitization/nociplastic pain, and employ an interdisciplinary biopsychosocial approach that includes pain education, physiotherapy, and psychological & medical treatments. SUMMARY STATEMENTS RECOMMENDATIONS.
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Prillaman G, Zillioux J, Beller H, Yeaman C, Rapp D. Predictors of pelvic pain in a general urology clinic population. BJUI COMPASS 2023; 4:668-672. [PMID: 37818032 PMCID: PMC10560618 DOI: 10.1002/bco2.262] [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: 01/06/2023] [Revised: 04/14/2023] [Accepted: 05/21/2023] [Indexed: 10/12/2023] Open
Abstract
Objectives To assess the prevalence and predictors of chronic pelvic pain in a general urology population presenting for evaluation of unrelated non-painful complaints.Generalized pelvic pain is estimated to afflict between 6% and 26% of women and is often multifactorial in aetiology. A paucity of prospective research exists to characterize chronic pelvic pain patterns and to understand related predictors. Materials and Methods This is a prospective, cross-sectional survey-based study of female patients presenting to a general urology clinic over a 10-month period (7/2018-5/2019). Patients completed a 32-item survey with questions pertaining to demographics, comorbidities and chronic pelvic pain characteristics. Comparison tests (chi-squared, Fisher's exact) and stepwise multivariable logistic modelling were performed to assess for predictors of chronic pelvic pain. Results A total of 181 women completed the survey, with a mean age of 56 years. Overall, 75 (41%) women reported chronic pelvic pain. Those with chronic pelvic pain were younger compared to those without (52 vs 59 years, p = 0.001). Univariable logistic regression analysis identified BMI, depression, fibromyalgia, overactive bladder and any bowel symptoms as possible positive predictors of chronic pelvic pain. Final best-fit multivariable model found overactive bladder, fibromyalgia and presence of bowel symptoms as independent positive predictors of chronic pelvic pain. Conclusions Our study is one of the few studies that has prospectively analysed chronic pelvic pain and its predictors. The present study identified significant associations with overactive bladder, fibromyalgia and bowel symptoms. Further research is needed to better understand the aetiologies of chronic pelvic pain and the possible relationship with identified clinical predictors.
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Affiliation(s)
- Grace Prillaman
- University of Virginia School of MedicineCharlottesvilleVirginiaUSA
| | | | - Haerin Beller
- Department UrologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Clinton Yeaman
- Department UrologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - David Rapp
- Department UrologyUniversity of VirginiaCharlottesvilleVirginiaUSA
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Complementary therapy for endometriosis related pelvic pain. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2023. [DOI: 10.1177/22840265231159704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
In the setting of a global pandemic, it is vastly important now more than ever that patients have agency and control over pain management when living with a debilitating chronic pain disease such as endometriosis. We present a review of the available literature on the most popular and easily accessible complementary pain management therapies for endometriosis including Transcutaneous Electrical Nerve stimulator (TENS) units, diets, Cannabidiol (CBD), turmeric, meditation, yoga, and acupuncture. These are worthwhile recommendations; however, the data for each is limited and more research is needed to further support each of its use.
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Shoukat S, Tasneem M, Zahid T, Goolamnobee JMB. Incidence of Chronic Pelvic Pain in Females Attending a Gynaecology Outpatient Department. EUROPEAN MEDICAL JOURNAL 2023. [DOI: 10.33590/emj/10302260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Background and Aims: Chronic pelvic pain (CPP) is a persistent pelvic pain that
leads to reduced work performance and impaired quality of life in females. Nearly
15% of females report time off from paid work and around 45% report reduced
work productivity. There is a paucity of studies to address the issue, especially
with a multidisciplinary and multifactorial view. Various gynaecological disorders
are associated with CPP such as endometriosis, adenomyosis, adhesions, chronic
pelvic inflammatory disease, and pelvic congestion syndrome. The objective is
to determine the frequency of CPP in females attending gynaecologic outpatient
departments.
Materials and Methods: A total of 201 patients aged 14–48 years attending the
gynaecologic outpatient department for gynaecological disorders with complaints
of lower abdominal pain were included in this study. Patients enrolled in the study
were assessed by a detailed history and pelvic examination, and a structured
questionnaire was filled out. Data were analysed using the statistical package for
social sciences version 23.0 (International Business Machines Corporation, Armonk,
New York, USA).
Results: The mean age of the patients was 32.39±6.98 years. The frequency of CPP
in females was observed as 95.52% (95% confidence interval: 91.67–97.93%) The
rate of CPP was significantly high in females with parity ≤5 and those who had a
duration of pain lower than 36 months. In multivariate analysis, adjusted odds ratio
by stepwise logistic regression model showed that parity (parity 0–1) and duration of
pain (≤36 months) were significantly associated with CPP in females.
Conclusion: The study indicates that the most common gynaecological causes of
CPP in females attending the outpatient department were those with endometriosis
followed by adenomyosis. The management of CPP needs patient-centred care with
a multidisciplinary approach. This will lead to early and effective management.
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Affiliation(s)
| | - Maria Tasneem
- Jinnah Medical and Dental College, Karachi, Pakistan
| | - Tehreem Zahid
- Shifa International Hospitals Ltd., Islamabad, Pakistan
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Baldiotti ALP, Amaral-Freitas G, Barbosa MCF, Moreira PR, Machado RA, Coletta RD, Meger MN, Paiva SM, Scariot R, Ferreira FDM. Associations between Anxiety, Depression, Chronic Pain and Oral Health-Related Quality of Life, Happiness, and Polymorphisms in Adolescents' Genes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3321. [PMID: 36834016 PMCID: PMC9967116 DOI: 10.3390/ijerph20043321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
Adolescence is marked by changes and vulnerability to the emergence of psychological problems. This study aimed to investigate associations between anxiety/depression/chronic pain and oral health-related quality of life (OHRQoL)/happiness/polymorphisms in the COMT, HTR2A and FKBP5 genes in Brazilian adolescents. A cross-sectional study was conducted with ninety adolescents 13 to 18 years. Anxiety, depression and chronic pain were evaluated using the RDC/TMD. The Oral Health Impact Profile was used to assess oral OHRQoL. The Subjective Happiness Scale was used to assess happiness. Single-nucleotide polymorphisms in COMT (rs165656, rs174675), HTR2A (rs6313, rs4941573) and FKBP5 (rs1360780, rs3800373) were genotyped using the Taqman® method. Bivariate and multivariate logistic regression analyses were performed (p < 0.05). Chronic pain and depression were associated with feelings of happiness (p < 0.05). A significant inverse association was found between anxiety and OHRQoL (p = 0.004). The presence of minor allele C of COMT rs174675 was significantly associated with depression (p = 0.040). Brazilian adolescents with depression and chronic pain considers themselves to be less happy than others and those with anxiety are more likely to have a negative impact on OHRQoL. Moreover, the rs174675 variant allele in the COMT gene was associated with depressive symptoms in Brazilian adolescents.
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Affiliation(s)
- Ana Luiza Peres Baldiotti
- Department of Pediatric Dentistry, Federal University of Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Gabrielle Amaral-Freitas
- Department of Pediatric Dentistry, Federal University of Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | | | - Paula Rocha Moreira
- Department of Morphology, Institute of Biological Sciences (ICB), Federal University of Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Renato Assis Machado
- Department of Oral Diagnosis and Graduate Program in Oral Biology, School of Dentistry, University of Campinas, Piracicaba 13414-903, SP, Brazil
| | - Ricardo Della Coletta
- Department of Oral Diagnosis and Graduate Program in Oral Biology, School of Dentistry, University of Campinas, Piracicaba 13414-903, SP, Brazil
| | | | - Saul Martins Paiva
- Department of Pediatric Dentistry, Federal University of Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Rafaela Scariot
- Departament of Oral Surgery and Maxilofacial, Federal University of Paraná, Curitiba 81530-000, PR, Brazil
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Thomas EB, Stegall MS, Farley KE, Pawlak SA. A Multidisciplinary Pelvic Pain Clinic: Integrated Health Psychology in a Specialty Care Setting. J Womens Health (Larchmt) 2022; 31:1639-1644. [PMID: 35704283 PMCID: PMC9836695 DOI: 10.1089/jwh.2022.0072] [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] [Indexed: 01/22/2023] Open
Abstract
Purpose: Chronic pelvic pain (CPP) is a relatively common health problem, impacting around 25 million women globally. This study details the development of a multidisciplinary women's CPP clinic at a major U.S. academic medical center, and examines associations between mood, pain symptoms, and trauma history. Materials and Methods: Data were collected from 96 subjects, including self-report measures (Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Brief Trauma Questionnaire), pain intensity ratings, psychiatric diagnoses, and relevant medical history. Results: Most subjects reported at least one traumatic experience. Nearly half of subjects met criteria for an anxiety disorder and/or a depressive disorder. Most subjects were diagnosed with pelvic floor dysfunction, and more than half were referred to physical therapy. Women with abdominal/pelvic surgery history reported more traumatic experiences than women without surgical history. Women with a history of sexual abuse reported trying more medications and seeking care from a greater number of providers. Many reported pain duration of >2 years. Conclusions: Study findings related to mental health and trauma support a multidisciplinary CPP approach that includes a clinical health psychology component. Future research may investigate the therapeutic processes that apply to this population to identify targeted efficacious interventions.
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Affiliation(s)
- Emily B.K. Thomas
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Manny S. Stegall
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Kathryn E. Farley
- Department of Physical Medicine and Rehabilitation, UnityPoint Health, St. Luke's Hospital, Cedar Rapids, Iowa, USA
| | - Stacey A. Pawlak
- Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Till SR, Nakamura R, Schrepf A, As-Sanie S. Approach to Diagnosis and Management of Chronic Pelvic Pain in Women. Obstet Gynecol Clin North Am 2022; 49:219-239. [DOI: 10.1016/j.ogc.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Siqueira-Campos VM, de Deus MSC, Poli-Neto OB, Rosa-E-Silva JC, de Deus JM, Conde DM. Current Challenges in the Management of Chronic Pelvic Pain in Women: From Bench to Bedside. Int J Womens Health 2022; 14:225-244. [PMID: 35210869 PMCID: PMC8863341 DOI: 10.2147/ijwh.s224891] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/04/2022] [Indexed: 12/11/2022] Open
Abstract
Chronic pelvic pain (CPP) affects a significant proportion of women worldwide And has a negative impact on several aspects of these women’s lives including mental health, work, relationships and sexual function, among others. This set of factors ultimately reflects negatively on quality Of life. The physiopathology of CPP is complex and remains to be fully clarified; however, recent advances have increased understanding of the mechanisms involved in chronic pain in general, and more specifically, CPP. Nonetheless, even when a detailed clinical history is obtained, meticulous physical examination is performed and imaging resources are appropriately used, the organic cause of the pain may still fail to be identified in a substantial number of women with CPP. Management of CPP may therefore be challenging. This narrative review was aimed at adding to the available literature on the subject, presenting and discussing the principal characteristics of CPP in women. The paper highlights gaps in the literature while providing the most up-to-date evidence associated with the physiopathology and classification of pain, its diagnosis and treatment. In addition, current challenges in the management of women with CPP are discussed.
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Affiliation(s)
- Vânia Meira Siqueira-Campos
- Department of Obstetrics and Gynecology, School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | - Omero Benedicto Poli-Neto
- Laboratory for Translational Data Science, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.,Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Julio Cesar Rosa-E-Silva
- Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - José Miguel de Deus
- Department of Obstetrics and Gynecology, School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Délio Marques Conde
- Department of Obstetrics and Gynecology, School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
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Mardon AK, Leake HB, Szeto K, Astill T, Hilton S, Moseley GL, Chalmers KJ. Treatment recommendations for the management of persistent pelvic pain: A systematic review of international clinical practice guidelines. BJOG 2021; 129:1248-1260. [PMID: 34919325 DOI: 10.1111/1471-0528.17064] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/30/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Females with persistent pelvic pain (PPP) report great variability in treatments they are recommended despite the availability of clinical practice guidelines (CPGs) that aim to standardise care. A clear consensus for the best practice care for PPP is required. OBJECTIVE Identify and summarise treatment recommendations across CPGs for the management of PPP, and appraise their quality. SEARCH STRATEGY MEDLINE, CENTRAL, EMBASE, EmCare, SCOPUS, the Cochrane Database of Systematic Reviews, Web of Science Core Collection, and relevant guideline databases were searched from their inception to June 2021. SELECTION CRITERIA Included CPGs were those for the management of urogynaecological conditions in adult females published in English, of any publication date, and endorsed by a professional organisation or society. DATA COLLECTION AND ANALYSIS We screened 1,379 records and included 20 CPGs. CPG quality was assessed using The Appraisal of Guidelines for Research and Evaluation II (AGREE-II) tool. Descriptive synthesis compiled treatment recommendations across CPGs. MAIN RESULTS CPGs for seven conditions provided 281 individual recommendations. On quality appraisal, guidelines on average scored 'excellent' for the domains 'scope and purpose' (80.6%, SD=13.3) and 'clarity and presentation' (74.4%, SD=12.0); for other domains, average scores were satisfactory or poor. Four guidelines (Endometriosis, NICE, RANZCOG, ESHRE; PCOS, Teede et al. 2018) were deemed recommended for use. Recommendations were most frequent for pharmaceutical and surgical interventions. Recommendations were variable for psychological, physiotherapy, and other conservative interventions. CONCLUSIONS The quality of CPGs for PPP is generally poor. Several CPGs endorse the consideration of biopsychosocial elements of PPP. Yet most recommend pharmaceutical, surgical, and other biomedical interventions.
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Affiliation(s)
- Amelia K Mardon
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Hayley B Leake
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia.,Centre for IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Kimberley Szeto
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia.,Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, SA, Australia
| | - Thomas Astill
- Brain Stimulation and Rehabilitation (BrainSTAR) Lab, Western Sydney University, Campbelltown, NSW, Australia
| | | | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - K Jane Chalmers
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia.,Western Sydney University, Campbelltown, NSW, Australia
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Koechlin H, Kharko A, Probst T, Pradela J, Buechi S, Locher C. Placebo Responses and Their Clinical Implications in Fibromyalgia: A Meta-Analysis Using SSRI and SNRI Trials. FRONTIERS IN PAIN RESEARCH 2021; 2:750523. [PMID: 35295427 PMCID: PMC8915657 DOI: 10.3389/fpain.2021.750523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/11/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Fibromyalgia (FM) is a chronic primary pain condition, associated with widespread musculoskeletal pain, disturbed sleep, fatigue, cognitive dysfunction, and a range of comorbid conditions such as irritable bowel syndrome, and depression. Despite its high prevalence of 2% in the general population, FM continues to pose scientific and clinical challenges in definition, etiology, and day-to-day management. In terms of treatment, FM can be treated with selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs). Objective: Patients with FM and other chronic primary pain syndromes are known to experience substantial and clinically relevant placebo effects. An update of the placebo responses for various outcomes in the FM population and especially a discussion about clinical implications is therefore needed. Methods: We used data from a large data pool that includes randomized controlled trials (RCTs) examining within-placebo mean change scores of baseline vs. follow-up assessments in FM trials of SSRIs and SNRIs. The primary outcomes were pain, functional disability, and depression and using different scales. We assessed heterogeneity of included trials. Results: A total of 29 RCTs with N = 8,453 patients suffering from FM were included in our analysis. Within-placebo mean change scores of baseline vs. follow-up assessments were large for pain (mean change = 2.31, 95% CI: 0.42-4.21, p = 0.017), functional disability (mean change = 3.31, 95% CI: 2.37-4.26, p < 0.000), and depression (mean change = 1.55, 95% CI: 0.92-2.18, p < 0.000). Heterogeneity was found to be large for all outcomes. Impact: Our results provide preliminary evidence that placebo responses, which also consist of non-specific effects, might play a role in the treatment of FM. Furthermore, we highlight limitations of our analyses and make suggestions for future studies.
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Affiliation(s)
- Helen Koechlin
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Anna Kharko
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Tamara Probst
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Julia Pradela
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Stefan Buechi
- Clinic for Psychotherapy and Psychosomatics “Hohenegg”, Meilen, Switzerland
| | - Cosima Locher
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
- Clinic for Psychotherapy and Psychosomatics “Hohenegg”, Meilen, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
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15
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Aboussouan AB, Mandell D, Johnson J, Thompson N, Huffman KL. An interdisciplinary chronic pain rehabilitation program effectively treats impairment in sexual function, depression, alexithymia, and pain in women with chronic pelvic pain. J Psychosom Obstet Gynaecol 2021; 42:261-271. [PMID: 32141387 DOI: 10.1080/0167482x.2020.1735341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Chronic pelvic pain (CPP) in women is often associated with marked emotional distress and disability, with particular impairments in sexual functioning. Research supports the efficacy of interdisciplinary chronic pain rehabilitation programs (ICPRPs) in treating chronic pain, however less is known about their utility in CPP. METHODS This retrospective study examined pain-related sexual impairment, emotional symptoms, and pain severity in CPP patients before and after completing a 3-4 week ICPRP. Predictors of post-treatment sexual impairment were also investigated. Participants included 58 female CPP patients and 58 age-matched females with non-pelvic chronic pain (NPCP). RESULTS All participants reported robust improvements across outcome measures. Women with CPP reported greater pre- and post-treatment impairment in sexual function than NPCP patients, despite significant treatment-related improvements. In contrast, CPP patients also reported higher levels of depression at baseline but showed greater treatment related-improvements. In participants with CPP, treatment-related improvements in depression, alexithymia, and pain severity significantly explained decreases in pain-related sexual impairment following treatment, whereas none of these variables explained sexual impairment outcomes in women with NPCP. CONCLUSION Results demonstrate that ICPRPs can effectively treat CPP, particularly through changes in depression and alexithymia. Future research should examine whether specific interventions can be added in ICPRPS to address CPP-related sexual impairment.
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Affiliation(s)
- Alix B Aboussouan
- Department of Clinical Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Darcy Mandell
- Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph Johnson
- Center for Comprehensive Pain Recovery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nicolas Thompson
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
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16
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Application of Bioinformatics Methods to Identify Key Genes and Functions in Chronic Pelvic Pain. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:7257405. [PMID: 34381521 PMCID: PMC8352682 DOI: 10.1155/2021/7257405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/19/2021] [Indexed: 11/17/2022]
Abstract
Neuropathologic pain (NPP) occurs in most patients with chronic pelvic pain (CPP), and the unique physiological characteristics of visceral sensory neurons make the current analgesic effect of CPP patients not optimistic. Therefore, this study explored the possible biological characteristics of key genes in CPP through the bioinformatics method. CPP-related dataset GSE131619 was downloaded from Gene Expression Omnibus to investigate the differentially expressed genes (DEGs) between lumbar dorsal root ganglia (DRG) and sacral DRG, and the functional enrichment analysis was performed. A protein-protein interaction (PPI) network was constructed to search subnet modules of specific biological processes, and then, the genes in the subnet were enriched by single gene set analysis. A CPP mouse model was established, and the expression of key genes were identified by qPCR. The results showed that 127 upregulated DEGs and 103 downregulated DEGs are identified. Functional enrichment analysis showed that most of the genes involved in signal transduction were involved in the pathway of receptor interaction. A subnet module related to neural signal regulation was identified in PPI, including CHRNB4, CHRNA3, and CHRNB2. All three genes were associated with neurological or inflammatory activity and are downregulated in the sacral spinal cord of CPP mice. This study provided three key candidate genes for CPP: CHRNB4, CHRNA3, and CHRNB2, which may be involved in the occurrence and development of CPP, and provided a powerful molecular target for the clinical diagnosis and treatment of CPP.
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17
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Torres-Cueco R, Nohales-Alfonso F. Vulvodynia-It Is Time to Accept a New Understanding from a Neurobiological Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126639. [PMID: 34205495 PMCID: PMC8296499 DOI: 10.3390/ijerph18126639] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/13/2021] [Accepted: 06/16/2021] [Indexed: 12/12/2022]
Abstract
Vulvodynia is one the most common causes of pain during sexual intercourse in premenopausal women. The burden of vulvodynia in a woman's life can be devastating due to its consequences in the couple's sexuality and intimacy, in activities of daily living, and psychological well-being. In recent decades, there has been considerable progress in the understanding of vulvar pain. The most significant change has been the differentiation of vulvar pain secondary to pathology or disease from vulvodynia. However, although it is currently proposed that vulvodynia should be considered as a primary chronic pain condition and, therefore, without an obvious identifiable cause, it is still believed that different inflammatory, genetic, hormonal, muscular factors, etc. may be involved in its development. Advances in pain neuroscience and the central sensitization paradigm have led to a new approach to vulvodynia from a neurobiological perspective. It is proposed that vulvodynia should be understood as complex pain without relevant nociception. Different clinical identifiers of vulvodynia are presented from a neurobiological and psychosocial perspective. In this case, strategies to modulate altered central pain processing is necessary, changing the patient's erroneous cognitions about their pain, and also reducing fear avoidance-behaviors and the disability of the patient.
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Affiliation(s)
- Rafael Torres-Cueco
- Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Correspondence:
| | - Francisco Nohales-Alfonso
- Gynecology Section, Clinical Area of Women’s Diseases, La Fe University Hospital, 46010 Valencia, Spain;
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18
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Carralero-Martínez A, Muñoz Pérez MA, Pané-Alemany R, Blanco-Ratto L, Kauffmann S, Ramírez-García I. Efficacy of capacitive resistive monopolar radiofrequency in the physiotherapeutic treatment of chronic pelvic pain syndrome: study protocol for a randomized controlled trial. Trials 2021; 22:356. [PMID: 34016168 PMCID: PMC8136758 DOI: 10.1186/s13063-021-05321-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/08/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Chronic pelvic pain syndrome (CPPS) is a multifactorial disorder that affects 5.7% to 26.6% of women and 2.2% to 9.7% of men, characterized by hypersensitivity of the central and peripheral nervous system affecting bladder and genital function. People with CPPS have much higher rates of psychological disorders (anxiety, depression, and catastrophizing) that increase the severity of chronic pain and worsen quality of life. Myofascial therapy, manual therapy, and treatment of trigger points are proven therapeutic options for this syndrome. This study aims to evaluate the efficacy of capacitive resistive monopolar radiofrequency (CRMRF) at 448 kHz as an adjunct treatment to other physiotherapeutic techniques for reducing pain and improving the quality of life of patients with CPPS. METHODS This triple-blind (1:1) randomized controlled trial will include 80 women and men with CPPS. Participants will be randomized into a CRMRF activated group or a CRMRF deactivated group and receive physiotherapeutic techniques and pain education. The groups will undergo treatment for 10 consecutive weeks. At the beginning of the trial there will be an evaluation of pain intensity (using VAS), quality of life (using the SF-12), kinesiophobia (using the TSK-11), and catastrophism (using the PCS), as well as at the sixth and tenth sessions. DISCUSSION The results of this study will show that CRMRF benefits the treatment of patients with CPPS, together with physiotherapeutic techniques and pain education. These results could offer an alternative conservative treatment option for these patients. TRIAL REGISTRATION ClinicalTrials.gov NCT03797911 . Registered on 8 January 2019.
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Affiliation(s)
- A Carralero-Martínez
- Rehabilitación Abdomino-Pelviana (RAPbarcelona SL), Barcelona, Spain
- Servicio de Ginecología, Instituto Clínic de Ginecología, Obstetricia y Neonatología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - M A Muñoz Pérez
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP-Jordi Gol), Barcelona, Spain
- Institut Català de la Salut (ICS), Barcelona, Spain
- Departament de Pediatria, Obstetricia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - R Pané-Alemany
- Rehabilitación Abdomino-Pelviana (RAPbarcelona SL), Barcelona, Spain
| | - L Blanco-Ratto
- Rehabilitación Abdomino-Pelviana (RAPbarcelona SL), Barcelona, Spain
- Fundació Universitària del Bages (FUB), Barcelona, Spain
| | - S Kauffmann
- Rehabilitación Abdomino-Pelviana (RAPbarcelona SL), Barcelona, Spain
- Fundació Universitària del Bages (FUB), Barcelona, Spain
- Servicio de Fisioterapia, Womens Salud y Bienestar de la Mujer SL, Barcelona, Spain
| | - I Ramírez-García
- Rehabilitación Abdomino-Pelviana (RAPbarcelona SL), Barcelona, Spain.
- Servicio de Fisioterapia, Instituto Médico Tecnológico SL, Barcelona, Spain.
- Blanquerna School of Health Science-Universitat Ramon Llull, Barcelona, Spain.
- Universidad Internacional de Catalunya (UIC), Barcelona, Spain.
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19
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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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20
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Ross V, Detterman C, Hallisey A. Myofascial Pelvic Pain: An Overlooked and Treatable Cause of Chronic Pelvic Pain. J Midwifery Womens Health 2021; 66:148-160. [PMID: 33788379 DOI: 10.1111/jmwh.13224] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 12/10/2020] [Accepted: 01/26/2021] [Indexed: 12/13/2022]
Abstract
Myofascial pelvic pain is a common, nonarticular musculoskeletal disorder characterized by the presence of myofascial trigger points in the lower abdominal wall and/or pelvic floor muscles. Myofascial pelvic pain is involved in an estimated 22% to 94% of cases of chronic pelvic pain, which is one of the most common gynecologic conditions in the United States. Myofascial pelvic pain may exist independently or in conjunction with disorders such as vaginismus, dysmenorrhea, and endometriosis and is frequently a causative factor in sexual pain or dyspareunia. This article reviews the pathophysiology, assessment, and treatment options for myofascial pelvic pain, with a particular focus on trigger point injections. Increased recognition and treatment of this commonly overlooked diagnosis has the potential to improve care and outcomes for many patients suffering from chronic pelvic pain.
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Affiliation(s)
- Vanessa Ross
- Baystate Midwifery and Women's Health, Baystate Medical Center, Springfield, Massachusetts.,Pioneer Women's Health, Baystate Franklin Medical Center, Greenfield, Massachusetts.,Brigham and Women's Midwifery Group, Brigham and Women's Hospital, Boston, Massachusetts
| | - Carly Detterman
- Baystate Midwifery Education Program, Baystate Medical Center, Springfield, Massachusetts
| | - Anastasia Hallisey
- Baystate Midwifery Education Program, Baystate Medical Center, Springfield, Massachusetts
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21
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Vincent K, Evans E. An update on the management of chronic pelvic pain in women. Anaesthesia 2021; 76 Suppl 4:96-107. [PMID: 33682093 DOI: 10.1111/anae.15421] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 12/19/2022]
Abstract
Chronic pelvic pain represents a major public health problem for women and impacts significantly on their quality of life. Yet it is under-researched and a challenge to manage. Women who suffer from chronic pelvic pain frequently describe their healthcare journey as long, via a variety of specialists and frustrating, with their pain often dismissed. Aetiological factors and associations are best conceptualised using the 'three P's' model of predisposing, precipitating and perpetuating factors. This integrates the numerous biological, psychological and social contributors to the complex, multifactorial nature of chronic pelvic pain. Overall management involves analgesia, hormonal therapies, physiotherapy, psychological approaches and lifestyle advice, which like other chronic pain conditions relies on a multidisciplinary team approach delivered by professionals experienced and trained in managing chronic pelvic pain.
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Affiliation(s)
- K Vincent
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - E Evans
- Department of Gynaecology, Oxford University Foundation Hospitals Trust, Oxford, UK
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22
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Srinivasan M, Torres JE, McGeary D, Nagpal AS. Complementary and Alternative (CAM) Treatment Options for Women with Pelvic pain. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021; 8:240-248. [PMID: 33585075 DOI: 10.1007/s40141-020-00264-6] [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] [Indexed: 01/03/2023]
Abstract
Purpose of review I.To provide an overview of the current complementary and alternative (CAM) treatment options for women with chronic pelvic pain (CPP). Recent findings II.Recent studies on chronic pain at cellular, molecular and network level and their interaction with the immune system has unfolded several mechanisms for pain making it promising to explore the alternative paradigm to manage the incredibly complex chronic pelvic pain condition where multifactorial etiology often limits successful outcomes. Summary III.The multifactorial nature and complexity in establishing the underlying diagnosis in CPP limits predictable response to traditional medical and interventional options. Complementary and alternative options have been studied to improve outcomes. Incorporation of exercise-based CAM, pelvic floor physical therapy, acupuncture and cognitive behavioral therapy are suggested to show promising results but well powered randomized studies are needed to draw conclusions on their efficacy. Evidence for non-opioid alternatives such as oral cannabinoids are preliminary and may emerge to be safe and effective.
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Affiliation(s)
- Malathy Srinivasan
- Department of Physical Medicine and Rehabilitation, Sidney Kimmel Medical College at Thomas Jefferson University
| | | | - Donald McGeary
- Associate Professor and Vice Chair for Research, Rehabilitation Medicine; Associate Professor, Psychiatry, UT Health San Antonio
| | - Ameet S Nagpal
- UT Health San Antonio, Department of Anesthesiology, Associate Professor, Department of Anesthesiology, Medical Director, UT Health San Antonio Pain Consultants, Associate Program Director, UT Health San Antonio Pain Medicine Fellowship
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23
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Ali A, Andrzejowski P, Kanakaris NK, Giannoudis PV. Pelvic Girdle Pain, Hypermobility Spectrum Disorder and Hypermobility-Type Ehlers-Danlos Syndrome: A Narrative Literature Review. J Clin Med 2020; 9:jcm9123992. [PMID: 33317183 PMCID: PMC7764306 DOI: 10.3390/jcm9123992] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/27/2020] [Accepted: 12/04/2020] [Indexed: 01/04/2023] Open
Abstract
Pelvic girdle pain (PGP) refers specifically to musculoskeletal pain localised to the pelvic ring and can be present at its anterior and/or posterior aspects. Causes such as trauma, infection and pregnancy have been well-established, while patients with hypermobile joints are at greater risk of developing PGP. Research exploring this association is limited and of varying quality. In the present study we report on the incidence, pathophysiology, diagnostic and treatment modalities for PGP in patients suffering from Hypermobility Spectrum Disorder (HSD) and Hypermobility-Type Ehlers-Danlos Syndrome (hEDS). Recommendations are made for clinical practice by elaborating on screening, diagnosis and management of such patients to provide a holistic approach to their care. It appears that this cohort of patients are at greater risk particularly of mental health issues. Moreover over, they may require a multidisciplinary approach for their management. Ongoing research is still required to expand our understanding of the relationship between PGP, HSD and hEDS by appropriately diagnosing patients using the latest updated terminologies and by conducting randomised control trials to compare outcomes of interventions using standardised patient reported outcome measures.
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Affiliation(s)
- Ahmed Ali
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Floor D, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
| | - Paul Andrzejowski
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Floor D, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
| | - Nikolaos K Kanakaris
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Floor D, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Floor D, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
- NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds LS7 4SA, UK
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24
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Nunes-Reis AR, Da Luz RA, de Deus JM, Martinez EZ, Conde DM. Association of religiosity with mental health and quality of life in women with chronic pelvic pain. Int J Psychiatry Med 2020; 55:408-420. [PMID: 32064976 DOI: 10.1177/0091217420906979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study evaluated religiosity and its association with mental health, quality of life, and the intensity of pelvic pain in women with chronic pelvic pain. METHODS A cross-sectional study was conducted with 100 women with chronic pelvic pain. Religiosity was investigated using the Duke University Religion Index. Quality of life was evaluated using the abbreviated version of the World Health Organization's quality of life instrument. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale, while pain intensity was evaluated using a visual analog scale. RESULTS Almost half the participants attended religious services at least once a week and 62% prayed, meditated, or studied the Bible at least once a day. There was no association between religiosity and anxiety or depression. The intrinsic religiosity score was lower for women with mixed anxiety-depressive disorder compared to those without mixed anxiety-depressive disorder. There was a positive association between intrinsic religiosity and the psychological health domain of the quality of life instrument. There was no association between religiosity and pain intensity. CONCLUSIONS Women with chronic pelvic pain were strongly religious. Women with mixed anxiety-depressive disorder had lower levels of intrinsic religiosity. On the other hand, intrinsic religiosity was positively associated with quality of life in women with chronic pelvic pain. Religiosity was not associated with the intensity of pelvic pain. These data suggest that health-care professionals should take religiosity into account when treating women with chronic pelvic pain.
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Affiliation(s)
- Aline R Nunes-Reis
- Department of Gynecology and Obstetrics, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Rosa A Da Luz
- Women's Health Unit, Teaching Hospital, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - José M de Deus
- Department of Gynecology and Obstetrics, Federal University of Goiás, Goiânia, Goiás, Brazil.,Women's Health Unit, Teaching Hospital, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Edson Z Martinez
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Délio M Conde
- Department of Gynecology and Obstetrics, Federal University of Goiás, Goiânia, Goiás, Brazil
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25
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Abstract
Chronic pelvic pain is a common, burdensome, and costly condition that disproportionately affects women. Diagnosis and initial management of chronic pelvic pain in women are within the scope of practice of specialists in obstetrics and gynecology. The challenging complexity of chronic pelvic pain care can be addressed by increased visit time using appropriate coding modifiers, as well as identification of multidisciplinary team members within the practice or by facilitated referral. This Practice Bulletin addresses the diagnosis and management of chronic pelvic pain that is not completely explained by identifiable pathology of the gynecologic, urologic, or gastrointestinal organ systems. When evidence on chronic pelvic pain treatment is limited, recommendations are extrapolated from treatment of other chronic pain conditions to help guide management. The evaluation and management of potential gynecologic etiologies of pelvic pain (ie, endometriosis, adenomyosis, leiomyomas, adnexal pathology, vulvar disorders) are discussed in other publications of the American College of Obstetricians and Gynecologists ().
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26
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Ariza-Mateos MJ, Cabrera-Martos I, López-López L, Rodríguez-Torres J, Torres-Sánchez I, Valenza MC. Effects of a patient-centered program including the cumulative-complexity model in women with chronic pelvic pain: a randomized controlled trial. Maturitas 2020; 137:18-23. [PMID: 32498932 DOI: 10.1016/j.maturitas.2020.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/08/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To evaluate the effects of a patient-centered intervention including the cumulative-complexity model on quality of life related to health, coping behaviors, pain, self-perceived occupational performance and activity levels. STUDY DESIGN Randomized controlled trial. Forty-four women with a clinical diagnosis of chronic pelvic pain were randomized into two groups. Patients in the experimental group (n = 22) were included in a patient-centered intervention that involved relevant activities proposed by participants. Patients in the control group (n = 22) received a leaflet with information about chronic pelvic pain, physical activity, fear of movement, false beliefs, active lifestyle and behavioral advice. MAIN OUTCOME MEASURES The primary outcome measures were health-related quality of life assessed with the EuroQol-5D and coping behavior using the Coping Strategies Questionnaires. Secondary outcomes included severity of pain using a Visual Analogue Scale, self-perception of occupational performance using the Canadian Occupational Performance Measure and physical activity levels assessed by the International Physical Activity Questionnaire. RESULTS An analysis of variance with repeated measures showed, in the experimental group compared with the control group, significantly greater improvement from baseline to post-intervention in health-related quality of life (EuroQol-5D Visual Analog Scale values of 70.06 ± 16.44 vs. 57.38 ± 16.40, p = 0.026) and coping behavior (adaptive coping 113.00 ± 31.89 vs. 83.24 ± 16.69, p = 0.002). Pain, self-perception of performance and physical activity levels also significantly improved. CONCLUSIONS A patient-centered intervention considering the workload of patients and their capacity for performing health behaviors provides benefits regarding quality of life and coping behavior. Additionally, pain, self-perceived performance of relevant tasks and physical activity levels improved.
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Affiliation(s)
| | | | - Laura López-López
- Department of Physical Therapy, University of Granada, Granada, Spain
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27
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Grinberg K, Sela Y, Nissanholtz-Gannot R. New Insights about Chronic Pelvic Pain Syndrome (CPPS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3005. [PMID: 32357440 PMCID: PMC7246747 DOI: 10.3390/ijerph17093005] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Chronic pelvic pain syndrome (CPPS) is one of the common diseases in urology and gynecology. CPPS is a multifactorial disorder where pain may originate in any of the urogynecological, gastrointestinal, pelvic musculoskeletal, or nervous systems. The symptoms of CPPS appear to result from an interplay between psychological factors and dysfunction in the immune, neurological, and endocrine systems. The aim of this article was to present new insight about CPPS in order to raise awareness of nursing and medical staff in the identification and diagnosis of the syndrome and to promote an appropriate treatment for each woman who suffers from CPPS. METHODS A literature review about the factors associated with CPPS and therapeutic interventions for CPPS was conducted. RESULTS CPPS represents a chronic pain syndrome that combines anatomic malfunction of the pelvic floor muscles with malfunction of pain perception linked with psychological and cognitive factors. CONCLUSIONS The therapeutic interventions in CPPS cases should, consequently, follow a multidisciplinary approach.
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Affiliation(s)
- Keren Grinberg
- Department of Nursing, Faculty of Social and Community Science, Ruppin Academic Center, 40250 Emek-Hefer, Israel
| | - Yael Sela
- Department of Nursing, Faculty of Social and Community Science, Ruppin Academic Center, 40250 Emek-Hefer, Israel
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28
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Brooks T, Sharp R, Evans S, Baranoff J, Esterman A. Predictors of Depression, Anxiety and Stress Indicators in a Cohort of Women with Chronic Pelvic Pain. J Pain Res 2020; 13:527-536. [PMID: 32210608 PMCID: PMC7071858 DOI: 10.2147/jpr.s223177] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 01/17/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Establishing predictors of mental health outcomes is a crucial precursor to the development and assessment of psychological interventions for women with chronic pelvic pain (CPP). The objective of this study was to identify predictors of depression, anxiety and stress in a cohort of women with CPP. DESIGN Cross-sectional analytic study. METHODS Pre-treatment questionnaires were collected from 212 women with CPP, who had attended a private specialist pelvic pain clinic over a period of 18 months. Multivariate linear regression with backwards elimination was used to determine the best joint predictors of depression, anxiety and stress scores on the Depression, Anxiety and Stress Scale-21 item (DASS 21). RESULTS Of 19 potential predictor variables, seven key predictors of depression, anxiety and stress indicators were identified. Higher depression scores were associated with higher current pain severity, a history of stabbing pains, prior experience of a sexually distressing event, having experienced pain as a child, and never having been pregnant before. Higher anxiety scores were associated with higher current pain severity, a history of stabbing pains, prior experience of a sexually distressing event, younger age of menarche, and younger age. Predictors of high-stress scores were higher current pain severity, a history of stabbing pains, prior experience of a sexually distressing event, and being younger. CONCLUSION We have identified several important predictors of mental health in women with CPP. Using this information, psychological assessment and treatment for these women may be better tailored to client needs.
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Affiliation(s)
- Tiffany Brooks
- School of Nursing and Midwifery, The University of South Australia, Adelaide, South Australia, Australia
- Aware Women’s Health, Adelaide, South Australia, Australia
| | - Rebecca Sharp
- School of Nursing and Midwifery, The University of South Australia, Adelaide, South Australia, Australia
| | - Susan Evans
- Discipline of Obstetrics and Gynaecology, University of Adelaide, Adelaide, South Australia, Australia
| | - John Baranoff
- Discipline of Obstetrics and Gynaecology, University of Adelaide, Adelaide, South Australia, Australia
- Centre for Treatment of Anxiety and Depression, Adelaide, South Australia, Australia
| | - Adrian Esterman
- School of Nursing and Midwifery, The University of South Australia, Adelaide, South Australia, Australia
- Health and Medicine, James Cook University, Cairns, Queensland, Australia
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Sieberg CB, Lunde CE, Borsook D. Endometriosis and pain in the adolescent- striking early to limit suffering: A narrative review. Neurosci Biobehav Rev 2019; 108:866-876. [PMID: 31862211 DOI: 10.1016/j.neubiorev.2019.12.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 12/17/2022]
Abstract
Endometriosis, a condition in which uterine tissue grows outside the uterus, is a debilitating disease, affecting millions of women and costing the United States approximately $78 billion annually in pain- related disability. It is also the leading cause of chronic pelvic pain (CPP), which is often unresponsive to existing treatments. Adolescent women with the disease are at particular risk as there are often significant diagnostic delays, which in turn can exacerbate pain. Research and treatment guidelines for adolescents with endometriosis are largely based on studies for adult women due to the limited number of studies focusing on adolescents. The current paper critically reviews the literature as it pertains to endometriosis pathophysiology, mechanisms contributing to CPP, and treatment implications and recommendations with a focus on gaps related to adolescents.
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Affiliation(s)
- Christine B Sieberg
- Center for Pain and the Brain (P.A.I.N. Group), Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, USA; Biobehavioral Pediatric Pain Lab, Department of Psychiatry, Boston Children's Hospital, USA; Department of Psychiatry, Harvard Medical School, USA; Department of Anesthesiology, Harvard Medical School, USA.
| | - Claire E Lunde
- Center for Pain and the Brain (P.A.I.N. Group), Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, USA; Biobehavioral Pediatric Pain Lab, Department of Psychiatry, Boston Children's Hospital, USA; Nuffield Department of Women's and Reproductive Health, Medical Sciences Division, University of Oxford, UK
| | - David Borsook
- Center for Pain and the Brain (P.A.I.N. Group), Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, USA; Department of Anesthesiology, Harvard Medical School, USA
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30
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Grinberg K, Weissman-Fogel I, Lowenstein L, Abramov L, Granot M. How Does Myofascial Physical Therapy Attenuate Pain in Chronic Pelvic Pain Syndrome? Pain Res Manag 2019; 2019:6091257. [PMID: 31915499 PMCID: PMC6930783 DOI: 10.1155/2019/6091257] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/05/2019] [Accepted: 11/12/2019] [Indexed: 12/16/2022]
Abstract
Background Chronic pelvic pain syndrome (CPPS) is a multifactorial disorder comprising structural and functional muscular abnormalities, a dysfunctional pain system, and psychological distress. Myofascial physical Therapy (MPT) that is targeted at improving pelvic muscle functioning is considered a first line nonpharmacological treatment for CPPS, although the precise mechanisms that lead to symptoms alleviation have not yet been elucidated. Purpose This longitudinal study aimed to examine the local and systemic effects of MPT intervention, including biopsychophysiological processes, among CPPS patients. Methods The study included 50 CPPS women. Morphologic assessment of the levator ani and quantitative sensory testing of the pain system were applied alongside with evaluation of pain-related psychological factors using designated questionnaires. All measures were evaluated both before and after MPT in 39 patients. The long-term effects of MPT were evaluated by clinical pain reports obtained at 3 and 9 months following MPT that were compared with a nontreated group of 11 untreated CPPS women. Results Along with an improvement in the clinical pain intensity (p = 0.001) and sensitivity to experimental pain tests (p = 0.001) following MPT, the results also indicate that MPT has anatomical, psychological, and social therapeutic effects (p = 0.04; p = 0.001; p = 0.01, respectively). Furthermore, clinical pain evaluation at 3 and 9 months after MPT revealed a significant improvement in women who received treatment (p = 0.001). Conclusions The findings of this pilot study suggest multisystemic (direct and indirect anatomical, neurophysiological, and psychological) effects of MPT on the multifactorial pain disorder of CPPS and therefore place MPT as a mechanism-based intervention.
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Affiliation(s)
- Keren Grinberg
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- The Department of Nursing, Ruppin Academic Center, Emek Hefer, Israel
| | - Irit Weissman-Fogel
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Lior Lowenstein
- The Department of Obstetrics and Gynecology, Rambam Medical Center and Faculty of Medicine, Technion, Haifa, Israel
| | - Liora Abramov
- Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, The Sex Therapy Clinic, Tel Aviv, Israel
| | - Michal Granot
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- The Laboratory of Clinical Neurophysiology, Faculty of Medicine, Technion, Haifa, Israel
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31
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A Practical Guide to the Clinical Evaluation of Endometriosis-Associated Pelvic Pain. J Minim Invasive Gynecol 2019; 27:270-279. [PMID: 31669551 DOI: 10.1016/j.jmig.2019.10.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 02/07/2023]
Abstract
Endometriosis-associated pain (EAP) has a significant impact on the quality of life of those affected and their families. Recognizing that endometriosis is a chronic condition associated with an impairment in function and negative social impact, there is a shift toward reducing diagnostic delays and initiating timely management. This article provides a comprehensive and practical approach to the clinical diagnosis of EAP, which can subsequently facilitate prompt and directed treatment. The key components of the history, physical examination, and high-quality imaging to evaluate suspected EAP and related pain conditions are presented. Currently, biomarkers have limited utility in the diagnosis of endometriosis, but research in this area continues; development of a reliable noninvasive test for endometriosis may further improve early identification of this condition.
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32
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Psychology of Chronic Pelvic Pain: Prevalence, Neurobiological Vulnerabilities, and Treatment. Clin Obstet Gynecol 2019; 62:22-36. [PMID: 30383545 DOI: 10.1097/grf.0000000000000412] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Patients with pelvic pain suffer from psychological conditions at a disproportionately high rate compared with their peers. We review environmental, genetic, inflammatory, and neurobiological factors that increase vulnerability to developing both of these conditions. We review treatment strategies for chronic pelvic pain in patients who have comorbid psychological conditions, including both nonpharmacologic and pharmacologic options.
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Siqueira-Campos VME, Da Luz RA, de Deus JM, Martinez EZ, Conde DM. Anxiety and depression in women with and without chronic pelvic pain: prevalence and associated factors. J Pain Res 2019; 12:1223-1233. [PMID: 31114304 PMCID: PMC6490234 DOI: 10.2147/jpr.s195317] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/14/2019] [Indexed: 12/13/2022] Open
Abstract
Objectives: To investigate the prevalence of anxiety, depression and mixed anxiety and depressive disorder (MADD) and factors associated with these conditions in women with chronic pelvic pain (CPP) compared to a pain-free control group. Methods: A cross-sectional study was conducted with 100 women with CPP and 100 without CPP. The Hospital Anxiety and Depression Scale (HADS) was used to evaluate the presence of anxiety and depression. Sociodemographic, behavioral and clinical characteristics were investigated. Fisher’s exact test was used to compare characteristics between groups. A log-binomial regression model was used, with adjustment for age, skin color, schooling, body mass index and pain. Prevalence ratios (PR), together with their 95% confidence intervals (CI), were calculated to investigate factors associated with anxiety, depression and MADD. Results: The prevalence of anxiety was 66% in the CPP group and 49% in the controls (p=0.02). Depression was identified in 63% of the women with CPP and in 38% of the controls (p<0.01). MADD was present in 54% of the CPP group and in 28% of the controls (p<0.01). In the adjusted analysis, CPP (PR=1.3; 95%CI: 1.1–1.6), physical abuse (PR=1.5; 95%CI: 1.2–1.8) and sexual abuse (PR=1.5; 95%CI: 1.1–1.8) were independently associated with anxiety. Women of 25 to 34 years of age were less likely to have anxiety (PR=0.6; 95%CI: 0.4–0.8). CPP (PR=1.6; 95%CI: 1.2–2.2), physical abuse (PR=1.3; 95%CI: 1.1–1.7) and sexual abuse (PR=1.7; 95%CI: 1.3–2.2) were independently associated with depression. CPP (PR=1.9; 95%CI: 1.3–2.7), smoking (PR=1.5; 95%CI: 1.1–2.1), physical abuse (PR=1.4; 95%CI: 1.1–1.9) and sexual abuse (PR=1.4; 95%CI: 1.1–1.8) were independently associated with MADD. Conclusions: The prevalence of anxiety, depression and MADD was higher in women with CPP compared to the pain-free controls. Factors associated with mental disorders were identified. The independent association between CPP and anxiety, depression and MADD was noteworthy. These findings suggest that systematic management of psychological factors could contribute towards improving the mental health of these women.
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Affiliation(s)
| | - Rosa Azevedo Da Luz
- Teaching Hospital, Women's Health Unit, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - José Miguel de Deus
- Teaching Hospital, Women's Health Unit, Federal University of Goiás, Goiânia, Goiás, Brazil.,Department of Gynecology and Obstetrics, Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | - Délio Marques Conde
- Postgraduate Program in Health Sciences, Federal University of Goiás, Goiânia, Goiás, Brazil.,Department of Gynecology and Obstetrics, Federal University of Goiás, Goiânia, Goiás, Brazil
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Nygaard AS, Stedenfeldt M, Øian P, Haugstad GK. Characteristics of women with chronic pelvic pain referred to physiotherapy treatment after multidisciplinary assessment: a cross-sectional study. Scand J Pain 2019; 19:355-364. [DOI: 10.1515/sjpain-2018-0308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/18/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Background and aims
Chronic pelvic pain (CPP) in women is a complex condition that can seriously impact health and quality of life. Clinical guidelines for CPP place great demands on healthcare professionals, as they require both specialized knowledge about the pelvic area and knowledge of the mechanisms of chronic pain. To ensure best possible assessment and treatment of these women it is important to bring about more knowledge of the special CPP features. The purpose of this paper is to describe the characteristics of women with CPP evaluated at the University Hospital of North Norway, and further referred to physiotherapy. The frequency of having a history of abuse or previous pelvic surgery will also be reported, and analyses performed to investigate if subjective health status differs between women with and without these experiences.
Methods
We collected cross-sectional data from 62 women with CPP aged 20–65 (mean age 38.0), referred to physiotherapy after assessment by medical specialists. Data were collected by semi-structured interviews for demographic variables and medical history, and self-administered questionnaires on pain intensity, sexual function, urinary incontinence (UI), anal incontinence (AI), obstructed defecation syndrome (ODS), subjective health complaints (SHC) and symptoms of anxiety and depression.
Results
Pain duration of more than 10 years was reported by 42%, mean pain score was 4.7/10, and analgesics were used weekly by 48%. Previous pelvic or abdominal surgery was reported by 71%, and sick leave >12 weeks the last year by 34%. Reduced sexual desire was reported by 78%, dyspareunia by 73%, UI by 54%, AI by 23%, and obstructed defecation syndrome (ODS) by 34%. More than 90% reported musculoskeletal or pseudoneurologic complaints. Anxiety and depression scores defined as requiring treatment were reported by 40%. Abuse was reported by 50%, and associated with significantly more reports of ODS (p=0.02), more SHC (p=0.02) and higher anxiety scores (p=0.009). Analgesic use and sick leave were significantly higher both among women with a history of abuse (p=0.04 and p=0.005) and among those with previous surgery (p=0.04 and p=0.02). Women with previous surgery reported significantly lower pain intensity during intercourse than those without previous surgery (p=0.008).
Conclusions
Women with CPP have complex symptoms and high scores for both physical and psychological complaints. Women exposed to abuse have especially high scores related to analgesic use, sick leave, ODS, anxiety and SHC. Women with previous surgery report more analgesic use and sick leave, and lower pain intensity during intercourse, than those without previous surgery.
Implications
This study illustrates the complexity of CPP and highlights the need for health professionals to have specialized knowledge of the possible features of the condition. Previous abuse seems to be more associated with poor scores on several health outcomes than surgery, but this needs to be investigated further.
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Affiliation(s)
- Ane Sigrid Nygaard
- Norwegian National Advisory Unit on Incontinence and Pelvic Floor Health, University Hospital of North Norway , Pb. 96 , 9038 Tromsø , Norway
- Women’s Health and Perinatology Research Group, Institute of Clinical Medicine, University of Tromsø , Tromsø , Norway , Phone: 0047 – 92258582
| | - Mona Stedenfeldt
- Norwegian National Advisory Unit on Incontinence and Pelvic Floor Health, University Hospital of North Norway , Tromsø , Norway
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs Hospital, Trondheim University Hospital , Trondheim , Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway
| | - Pål Øian
- Women’s Health and Perinatology Research Group, Institute of Clinical Medicine, University of Tromsø , Tromsø , Norway
- Department of Obstetrics and Gynecology , University Hospital of North Norway , Tromsø , Norway
| | - Gro Killi Haugstad
- Institute of Physiotherapy, OsloMet – Oslo Metropolitan University , Oslo , Norway
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van den Beukel BAW, Stommel MWJ, van Leuven S, Strik C, IJsseldijk MA, Joosten F, van Goor H, Ten Broek RPG. A Shared Decision Approach to Chronic Abdominal Pain Based on Cine-MRI: A Prospective Cohort Study. Am J Gastroenterol 2018; 113:1229-1237. [PMID: 29946174 DOI: 10.1038/s41395-018-0158-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 05/11/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Chronic abdominal pain develops in 11-20% of patients undergoing abdominal surgery, partly owing to post-operative adhesions. In this study we evaluate results of a novel diagnostic and therapeutic approach for pain associated with adhesions. METHODS Prospective cohort study including patients with a history of abdominal surgery referred to the outpatient clinic of a tertiary referral center for the evaluation of chronic abdominal pain. Subgroups were made based on outcome of adhesion mapping with cine-MRI and shared decision making. In operatively managed cases, anti-adhesion barriers were applied after adhesiolysis. Long-term results for pain were evaluated by a questionnaire. RESULTS A total of 106 patients were recruited. Seventy-nine patients had adhesions on cine-MRI, 45 of whom underwent an operation. Response rate to follow-up questionnaire was 86.8%. In the operative group (Group 1), the number of negative laparoscopies was 3 (6%). After a median of 19 (range 6-47) months follow-up, 80.0% of patients in group 1 reported improvement of pain, compared with 42.9% in patients with adhesions on cine-MRI who declined surgery (group 2), and 26.3% in patients with no adhesions on cine-MRI (group 3), P = 0.002. Consultation of medical specialists was significantly lower in group 1 compared with groups 2 and 3 (35.7 vs. 65.2 vs. 58.8%; P = 0.023). CONCLUSION We demonstrate long-term pain relief in two-thirds of patients with chronic pain likely caused by adhesions, using cine-MRI and a shared decision-making process. Long-term improvement of pain was achieved in 80% of patients who underwent surgery with concurrent application of an anti-adhesion barrier.
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Affiliation(s)
- Barend Arend Willem van den Beukel
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands. Rijnstate Hospital Department of Radiology, Arnhem, The Netherlands. These authors jointly supervised: Harry van Goor H, Richard PG ten Broek
| | - Martijn Willem Jan Stommel
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands. Rijnstate Hospital Department of Radiology, Arnhem, The Netherlands. These authors jointly supervised: Harry van Goor H, Richard PG ten Broek
| | - Suzanne van Leuven
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands. Rijnstate Hospital Department of Radiology, Arnhem, The Netherlands. These authors jointly supervised: Harry van Goor H, Richard PG ten Broek
| | - Chema Strik
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands. Rijnstate Hospital Department of Radiology, Arnhem, The Netherlands. These authors jointly supervised: Harry van Goor H, Richard PG ten Broek
| | - Michiel Andreas IJsseldijk
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands. Rijnstate Hospital Department of Radiology, Arnhem, The Netherlands. These authors jointly supervised: Harry van Goor H, Richard PG ten Broek
| | - Frank Joosten
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands. Rijnstate Hospital Department of Radiology, Arnhem, The Netherlands. These authors jointly supervised: Harry van Goor H, Richard PG ten Broek
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands. Rijnstate Hospital Department of Radiology, Arnhem, The Netherlands. These authors jointly supervised: Harry van Goor H, Richard PG ten Broek
| | - Richard Peter Gerardus Ten Broek
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands. Rijnstate Hospital Department of Radiology, Arnhem, The Netherlands. These authors jointly supervised: Harry van Goor H, Richard PG ten Broek
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Da Luz RA, de Deus JM, Conde DM. Quality of life and associated factors in Brazilian women with chronic pelvic pain. J Pain Res 2018; 11:1367-1374. [PMID: 30100751 PMCID: PMC6064161 DOI: 10.2147/jpr.s168402] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Chronic pelvic pain (CPP) is a common and debilitating clinical condition in women. Objectives The aim of this study was to compare the quality of life (QoL) of women with and without CPP and to investigate factors associated with the QoL of women with CPP. Patients and methods A cross-sectional study was conducted with 100 women with CPP and 100 women without CPP. QoL was evaluated using the abbreviated version of the World Health Organization QoL instrument (WHOQOL-BREF). Depression and anxiety were evaluated using the Hospital Anxiety and Depression Scale, and sexual function was evaluated using the Female Sexual Function Index. Generalized linear models were used to analyze the data, permitting comparison of QoL scores and identification of the factors affecting QoL. Results Mean age (± SD) was 37.8±8.0 and 37.2±9.6 years for women with and without CPP, respectively (P=0.648). Following adjustment, women with CPP had significantly lower QoL scores in the physical health (P<0.001) and social relationships’ (P=0.025) domains. Anxiety, depression, sexual dysfunction, hypertension, diabetes mellitus, pain intensity, lower family income, and not having a partner were factors negatively associated with QoL, while being postmenopausal, being employed, and having a child were positively associated with QoL in women with CPP. Conclusion Women with CPP had poorer QoL than those without CPP. Factors affecting the QoL of women with CPP were identified, some for the first time in this population of women. Interventions targeting these factors may prove effective in minimizing the negative repercussion of CPP on QoL.
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Affiliation(s)
| | - José Miguel de Deus
- Teaching Hospital, Federal University of Goiás, Goiânia, Goiás, Brazil.,Department of Obstetrics and Gynecology, Federal University of Goiás, Goiânia, Goiás, Brazil,
| | - Délio Marques Conde
- Department of Obstetrics and Gynecology, Federal University of Goiás, Goiânia, Goiás, Brazil,
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A common pronociceptive pain modulation profile typifying subgroups of chronic pelvic pain syndromes is interrelated with enhanced clinical pain. Pain 2018; 158:1021-1029. [PMID: 28178074 DOI: 10.1097/j.pain.0000000000000869] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Provoked vestibulodynia (PVD) and painful bladder syndrome (PBS), subgroups of chronic pelvic pain syndromes (CPPS), are considered to share common biophysiological peripheral mechanisms. In addition, indications of a pronociceptive pain profile coexisting with psychological vulnerability suggest common dysfunctional pain processing and pain modulation in these 2 subgroups of CPPS. We therefore aimed at comparing the pain profile and psychological traits of patients with PVD and PBS to see whether the pain profile contributes to intersubject variability of clinical pain symptoms. Patients with PVD (n = 18) and PBS (n = 21) were compared with healthy controls (n = 20) in their responses to (1) pain psychophysical tests applied to both referred (suprapubis) and remote (hand) body areas and (2) pain-related psychological factors (pain catastrophizing, depression, anxiety, and somatization). We found a similar pronociceptive pain profile in the 2 subgroups of CPPS-enhanced facilitation (ie, hyperalgesia in the referred body area [P < 0.001]) and inefficient inhibition (ie, reduced conditioned pain modulation [P < 0.001] that were associated with both enhanced pain ratings evoked during trigger point examination [P < 0.037]) and higher Brief Pain Inventory ratings (P = 0.002). The latter was also correlated with pain catastrophizing (r = 0.504, P = 0.001) and depression symptoms (r = 0.361, P = 0.024). The findings suggest common mechanisms underlying a dysfunctional nociceptive system in both PVD and PBS. The intersubject variability in the level of dysfunction and its association with disease severity recommends a personalized pain treatment that may alleviate daily pain and dysfunction in patients with CPPS.
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Abstract
This article addresses the common women's health concerns of menopause-related symptoms, premenstrual syndrome, and chronic pelvic pain. Each can be effectively addressed with an integrative approach that incorporates interventions such as pharmaceuticals, nutraceuticals, mind-body approaches, acupuncture, and lifestyle modification.
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Affiliation(s)
- Delia Chiaramonte
- Department of Family and Community Medicine, Center for Integrative Medicine, University of Maryland School of Medicine, 520 West Lombard Street, East Hall, Baltimore, MD 21201, USA; Department of Epidemiology and Public Health, Center for Integrative Medicine, University of Maryland School of Medicine, 520 West Lombard Street, East Hall, Baltimore, MD 21201, USA.
| | - Melinda Ring
- Osher Center for Integrative Medicine at Northwestern University, Northwestern University Feinberg School of Medicine, 150 East Huron Avenue, Suite 1100, Chicago, IL 60611, USA
| | - Amy B Locke
- Co-Director Resiliency Center, Office of Wellness and Integrative Health, Department of Family and Preventive Medicine, University of Utah, 555 Foothill Boulevard, Salt Lake City, UT 84112, USA
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Obedin-Maliver J, de Haan G. Gynecologic Care for Transgender Adults. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0204-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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40
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Carey ET, Till SR, As-Sanie S. Pharmacological Management of Chronic Pelvic Pain in Women. Drugs 2017; 77:285-301. [DOI: 10.1007/s40265-016-0687-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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41
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Bryant C, Cockburn R, Plante AF, Chia A. The psychological profile of women presenting to a multidisciplinary clinic for chronic pelvic pain: high levels of psychological dysfunction and implications for practice. J Pain Res 2016; 9:1049-1056. [PMID: 27895510 PMCID: PMC5118022 DOI: 10.2147/jpr.s115065] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective Chronic pelvic pain (CPP) is widely acknowledged as a common problem with significant consequences for those diagnosed with this condition. There is a lack of studies with good sample size that provide a comprehensive psychological profile of women presenting to specialist chronic pain clinics. Therefore, the objective of this study was to describe the psychological profile of a representative sample of women presenting with CPP at a tertiary referral center. Design This was a cross-sectional study. Women were asked to complete a questionnaire assessing symptoms of anxiety and depression, pain severity and interference, pain self-efficacy and catastrophizing beliefs, and sexual functioning. Methods One-hundred and seventy-five women with CPP were recruited when they attended their initial assessment at a specialist CPP clinic of the Royal Women’s Hospital, a public hospital in Melbourne, Australia. Results Over 75% of the participants had experienced pain for longer than 2 years. Fifty-three percent of women experienced either moderate or severe anxiety, and 26.7% experienced moderate-to-severe depression. There were strong correlations between depressive symptoms and pain interference, pain catastrophizing and self-efficacy beliefs. Conclusion Our findings confirm previous evidence for high levels of psychological distress and functional impairment associated with this condition, and extend these findings by including measures that are highly relevant to treatment planning, such as thinking styles and pain self-efficacy. Therefore, treatment of this complex condition needs to be holistic, and a multidisciplinary approach is likely to be the best way to achieve this.
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Affiliation(s)
- Christina Bryant
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville; Melbourne School of Psychological Sciences, University of Melbourne
| | - Rebecca Cockburn
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville
| | | | - Angela Chia
- Department of Anaesthesia, Royal Women's Hospital, Parkville, VIC, Australia
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