1
|
Green I, Briggs M, Encalada Soto D, Cole K, Wygant J, Burnett T, Zhu X, Chen I, Sangaralingam LR, Thao V. Health Care Utilization by Patients With Chronic Pelvic Pain. Obstet Gynecol 2024:00006250-990000000-01065. [PMID: 38696811 DOI: 10.1097/aog.0000000000005595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/21/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVE To describe the patterns of health care utilization among patients with chronic pelvic pain. METHODS Deidentified administrative claims data from the OptumLabs Data Warehouse were used. Adult female patients who had their first medical claim for chronic pelvic pain between January 1, 2016, and December 31, 2019, were included. Utilization was examined for 12 months after the index diagnosis. The greedy nearest neighbor matching method was used to identify a control group of individuals without chronic pelvic pain. Comparisons were made between those with and those without chronic pelvic pain using χ2 tests for categorical data and Wilcoxon rank-sum tests for continuous data. RESULTS In total, 18,400 patients were analyzed in the chronic pelvic pain cohort. Patients with chronic pelvic pain had a higher rate of chronic overlapping pain conditions. Patients with chronic pelvic pain had higher rates of health care utilization across all queried indices. They had more outpatient office visits; 55.5% had 10 or more office visits. Patients with chronic pelvic pain showed higher utilization of the emergency department (ED) (6.3 visits vs 1.9 visits; P<.001). Urine culture and pelvic ultrasonography were the most utilized tests. One-third of patients with chronic pelvic pain utilized physical therapy (PT), and 13% utilized psychological or behavioral therapy. Patients with chronic pelvic pain had higher rates of hysterectomy (8.9% vs 0.6%). The average total health care costs per patient with chronic pelvic pain per year was $12,254. CONCLUSION Patients with chronic pelvic pain have higher rates of chronic overlapping pain conditions and undergo more ED visits, imaging tests, and hysterectomies than patients without chronic pelvic pain. Improving access to multidisciplinary care, increasing utilization of interventions such as PT and psychological or behavioral therapy, and reducing ED utilization may be possible targets to help reduce overall health care costs and improve patient care.
Collapse
Affiliation(s)
- Isabel Green
- Department of Obstetrics and Gynecology, Mayo Clinic, and Health Care Policy and Research and the Center for the Science of Health Care Delivery, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; the Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin; Minimally Invasive Gynecologic Surgery, University of South Florida, Tampa, Florida; and the University of Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Cromeens MG, Knafl K, Robinson WR, Carey ET, Haji-Noor Z, Thoyre S. Endometriosis and Disability: Analysis of Federal Court Appeals of Social Security Disability Insurance and Supplemental Security Income Claims by Individuals Suffering From Endometriosis. Womens Health Issues 2024; 34:221-231. [PMID: 38418360 PMCID: PMC11129848 DOI: 10.1016/j.whi.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND Endometriosis, a chronic noncancerous gynecologic condition commonly characterized by disruptive physical and psychosocial symptoms, can be disabling. Individuals in the United States with endometriosis who are unable to work before retirement age can apply for Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI). Given the multi-step process of disability review, it is important to better understand how disability decisions are made. This study aimed to examine approaches and rationales of U.S. federal appeals courts reviewing SSDI and/or SSI claims involving endometriosis-related issues of appeal. METHODS We searched Westlaw and Nexis Uni records, available as of January 2021, for federal appeals of SSDI and SSI claims including endometriosis as an impairment. Two independent reviewers screened full-text cases and extracted data. Framework Analysis was applied to courts' rationales regarding endometriosis-related issues of appeal. RESULTS Eighty-seven appeals addressed an endometriosis-related issue. Three themes-evidence, treatment, and time-were identified across the decisions. The courts' discussions across themes exposed rationales and evidentiary requirements that posed challenges for claimants with endometriosis. The courts found subjective reports of symptoms insufficient evidence of impairment and positive responses to treatments to indicate cures or prevent claimants from demonstrating the necessary continuous 12 months of impairment. Some courts expected claimants to use treatments such as contraception or hysterectomy without addressing the risks of such treatments or the fact that they might have been counter to claimants' needs and preferences. CONCLUSIONS Individuals with endometriosis face evidentiary obstacles and common misconceptions about disease, diagnosis, and treatment in disability claims. SSDI and SSI endometriosis claims are systematically disadvantaged, particularly among those without access to care. The health care, policy, and legal systems can leverage the findings in this study to create a more equitable disability application and review system for those with chronic pain conditions such as endometriosis.
Collapse
Affiliation(s)
- Martha Grace Cromeens
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina; Indiana University School of Nursing, Indianapolis, Indiana; School of Nursing, University of Washington, Seattle, Washington.
| | - Kathleen Knafl
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina
| | - Whitney R Robinson
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; Division of Women's Community and Population Health, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina
| | - Erin T Carey
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Zakiya Haji-Noor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Suzanne Thoyre
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina
| |
Collapse
|
3
|
Sultana S, Chowdhury TA, Chowdhury TS, Mahmud N, Sultana R, Mahtab NT, Sharker Y, Ahmed F. Migraine among women with endometriosis: a hospital-based case-control study in Bangladesh. AJOG GLOBAL REPORTS 2024; 4:100344. [PMID: 38655567 PMCID: PMC11036091 DOI: 10.1016/j.xagr.2024.100344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Endometriosis is a disease among women of reproductive age, which causes several health problems, such as dysmenorrhea, dyspareunia, and subfertility. In addition, it increases psychological stress and often results in marital disharmony. Similarly, migraine is more frequent among this group of women. Several studies have shown an association between endometriosis and migraine among groups of populations completely different from Bangladesh. OBJECTIVE This study aimed to identify the association between endometriosis and migraine among the Bangladeshi population. STUDY DESIGN This nonrandomized case-control study was conducted with cases of endometriosis and controls without endometriosis who were confirmed by laparoscopy or laparotomy. Among the study participants, cases of migraine in 1 group of respondents who were already diagnosed as patients of migraine were identified, and the others with complaints of headaches were further confirmed by a medicine specialist. Patients were recruited from the Department of Obstetrics and Gynecology at the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders General Hospital and Ibrahim Medical College. The study was approved by the ethical review committee of the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders General Hospital. Multivariate logistic regression was used to identify the association between endometriosis and migraine using odds ratios and 95% confidence intervals. RESULTS Of 1496 patients who underwent laparoscopy or laparotomy during the study period, the frequency of endometriosis was found to be 12.7%. A total of 190 patients with confirmed endometriosis cases and an equal number of controls without endometriosis were enrolled, maintaining the age distribution of the controls similar to that of the cases. Compared with controls, the distribution of age, body mass index, education, and marital status of the patients with endometriosis were similar. The average ages of respondents were 30.6 years in both the case and control groups. Regarding occupation, cases included more students than controls (12% vs 0%, respectively). The odds of suffering from dysmenorrhea and dyspareunia among the cases were 3.3 (95% confidence interval, 2.66-4.15; P<.001) and 9.5 (95% confidence interval, 5.3-17.9; P<.001) times higher than that of controls, respectively. In addition, the odds of menstrual irregularity was 60% lower among the cases than among controls (odds ratio, 0.4; 95% confidence interval, 0.24-0.64; P<.001). No significant difference was observed in having primary subfertility and secondary subfertility among the 2 groups of respondents. Univariate regression analysis showed that patients with endometriosis have 6.13 times higher odds (95% confidence interval, 2.50-18.40; P<.001) of having a migraine and 2.00 times higher odds (95% confidence interval, 1.2-3.2; P=.01) of having a headache than controls. Furthermore, the age- and body mass index-adjusted multivariate model showed that patients with endometriosis have 5.4 times higher odds of having migraine than patients without endometriosis (95% confidence interval, 2.11-16.4; P<.001). In addition, the higher the age of reproductive-age women, the higher the odds of having migraine. A 1-year increase in age increases the odds of having migraine by 23% (odds ratio, 1.23; 95% confidence interval, 1.13-1.16; P<.001). CONCLUSION Our results support the association between endometriosis and migraine among the Bangladeshi population, which is similar to relevant studies conducted in other geographic locations. The groups of physicians who treat patients suffering from the 2 diseases, endometriosis and migraine, should keep this interrelationship in mind to ensure a better quality of life for the patient.
Collapse
Affiliation(s)
- Samina Sultana
- Department of Obstetrics and Gynecology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders General Hospital and Ibrahim Medical College, Shahabagh, Dhaka, Bangladesh (Ms S Sultana, Drs TA Chowdhury, TS Chowdhury, Ms Mahmud, and Drs R Sultana and Mahtab)
- Department of Obstetrics and Gynecology, President Abdul Hamid Medical College and Hospital, Karimganj, Kishoreganj, Bangladesh (Ms S Sultana)
| | - Touhidul A. Chowdhury
- Department of Obstetrics and Gynecology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders General Hospital and Ibrahim Medical College, Shahabagh, Dhaka, Bangladesh (Ms S Sultana, Drs TA Chowdhury, TS Chowdhury, Ms Mahmud, and Drs R Sultana and Mahtab)
| | - Tanzeem S. Chowdhury
- Department of Obstetrics and Gynecology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders General Hospital and Ibrahim Medical College, Shahabagh, Dhaka, Bangladesh (Ms S Sultana, Drs TA Chowdhury, TS Chowdhury, Ms Mahmud, and Drs R Sultana and Mahtab)
| | - Nusrat Mahmud
- Department of Obstetrics and Gynecology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders General Hospital and Ibrahim Medical College, Shahabagh, Dhaka, Bangladesh (Ms S Sultana, Drs TA Chowdhury, TS Chowdhury, Ms Mahmud, and Drs R Sultana and Mahtab)
| | - Rebeka Sultana
- Department of Obstetrics and Gynecology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders General Hospital and Ibrahim Medical College, Shahabagh, Dhaka, Bangladesh (Ms S Sultana, Drs TA Chowdhury, TS Chowdhury, Ms Mahmud, and Drs R Sultana and Mahtab)
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh (Dr R Sultana)
| | - Naushaba T. Mahtab
- Department of Obstetrics and Gynecology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders General Hospital and Ibrahim Medical College, Shahabagh, Dhaka, Bangladesh (Ms S Sultana, Drs TA Chowdhury, TS Chowdhury, Ms Mahmud, and Drs R Sultana and Mahtab)
| | - Yushuf Sharker
- Center for Data Research and Analytics, Bethesda, MD (Dr Sharker)
| | - Firoz Ahmed
- Clinical Laboratory Services, icddr,b diagnostic laboratory Dhanmondi, Dhaka, Bangladesh (Dr Ahmed)
- Department of Microbiology, Noakhali Science and Technology University, Noakhali, Bangladesh (Dr Ahmed)
| |
Collapse
|
4
|
Ghiasi M, Chang C, Shafrir AL, Vitonis AF, Sasamoto N, Vazquez AI, DiVasta AD, Upson K, Sieberg CB, Terry KL, Holzman CB, Missmer SA. Subgroups of pelvic pain are differentially associated with endometriosis and inflammatory comorbidities: a latent class analysis. Pain 2024:00006396-990000000-00563. [PMID: 38563996 DOI: 10.1097/j.pain.0000000000003218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 01/15/2024] [Indexed: 04/04/2024]
Abstract
ABSTRACT Chronic pelvic pain is heterogeneous with potentially clinically informative subgroups. We aimed to identify subgroups of pelvic pain based on symptom patterns and investigate their associations with inflammatory and chronic pain-related comorbidities. Latent class analysis (LCA) identified subgroups of participants (n = 1255) from the Adolescence to Adulthood (A2A) cohort. Six participant characteristics were included in the LCA: severity, frequency, and impact on daily activities of both menstruation-associated (cyclic) and non-menstruation-associated (acyclic) pelvic pain. Three-step LCA quantified associations between LC subgroups, demographic and clinical variables, and 18 comorbidities (10 with prevalence ≥10%). Five subgroups were identified: none or minimal (23%), moderate cyclic only (28%), severe cyclic only (20%), moderate or severe acyclic plus moderate cyclic (9%), and severe acyclic plus severe cyclic (21%). Endometriosis prevalence within these 5 LCA-pelvic pain-defined subgroups ranged in size from 4% in "none or minimal pelvic pain" to 24%, 72%, 70%, and 94%, respectively, in the 4 pain subgroups, with statistically significant odds of membership only for the latter 3 subgroups. Migraines were associated with significant odds of membership in all 4 pelvic pain subgroups relative to those with no pelvic pain (adjusted odds ratios = 2.92-7.78), whereas back, joint, or leg pain each had significantly greater odds of membership in the latter 3 subgroups. Asthma or allergies had three times the odds of membership in the most severe pain group. Subgroups with elevated levels of cyclic or acyclic pain are associated with greater frequency of chronic overlapping pain conditions, suggesting an important role for central inflammatory and immunological mechanisms.
Collapse
Affiliation(s)
- Marzieh Ghiasi
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, United States
| | - Chi Chang
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, United States
- Office of Medical Education Research and Development, Michigan State University, East Lansing, MI, United States
| | - Amy L Shafrir
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
- Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, MA, United States
| | - Allison F Vitonis
- Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, MA, United States
- Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Naoko Sasamoto
- Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Ana I Vazquez
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, United States
- Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, United States
| | - Amy D DiVasta
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
- Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, MA, United States
| | - Kristen Upson
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, United States
| | - Christine B Sieberg
- Biobehavioral Pain Innovations Lab, Department of Psychiatry & Behavioral Sciences, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
- Pain & Affective Neuroscience Center, Department of Anesthesiology, Critical Care, & Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Kathryn L Terry
- Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Claudia B Holzman
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, United States
| | - Stacey A Missmer
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
- Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, MA, United States
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
| |
Collapse
|
5
|
Importance of internal vaginal pelvic floor muscle exams for women with external lumbar/hip/pelvic girdle pain. Int Urogynecol J 2022:10.1007/s00192-022-05390-4. [DOI: 10.1007/s00192-022-05390-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/26/2022] [Indexed: 11/26/2022]
|
6
|
Doggweiler R, Bschleipfer T. [Physical and psychological comorbidities of interstitial cystitis/bladder pain syndrome]. Aktuelle Urol 2021; 52:569-574. [PMID: 34734395 DOI: 10.1055/a-1665-9615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Compared with the healthy population, patients diagnosed with IC/BPS have a higher risk of developing further pain syndromes. Common comorbidities include endometriosis, irritable bowel syndrome, fibromyalgia, chronic fatigue, migraine, anxiety, multiple chemical sensitivity and autoimmune diseases. Chronic pain may lead to depression, which often results in social isolation. Chronic pain can only be explained and treated successfully if a person is seen as a biopsychosocial entity. Interrelations between a person and their environment are of central importance for the maintenance of health and the development of disease. The fact that the pain is located in the urogenital area makes the situation even more delicate. In this location, we find the functions of excretion, reproduction und sexual desire - a constellation that predisposes to a high incidence of psychosomatic events. This means that urogenital pain not only involves an unpleasant sensory experience but also feelings of fear, guilt, shame and impotence.
Collapse
Affiliation(s)
| | - Thomas Bschleipfer
- Klinik für Urologie, Kinderurologie und Andrologie, Kliniken Nordoberpfalz AG, Weiden, Germany
| |
Collapse
|
7
|
Wang Y, Li B, Zhou Y, Wang Y, Han X, Zhang S, He Z, Ouyang L. Does Endometriosis Disturb Mental Health and Quality of Life? A Systematic Review and Meta-Analysis. Gynecol Obstet Invest 2021; 86:315-335. [PMID: 34352799 DOI: 10.1159/000516517] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 04/04/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study aimed to evaluate whether endometriosis could disturb the mental health and health-related quality of life (HRQoL) of patients and to provide a new prospective for further treatment of endometriosis. METHODS A comprehensive literature review was conducted among 4 international databases (PubMed, Embase, Web of Science, and Cochrane Library) and 2 of the largest Chinese databases (the China National Knowledge Infrastructure and Wangfang). The Newcastle-Ottawa Scale was used to assess the quality of the included articles. Six effect sizes were synthesized through a meta-analysis, and a subgroup analysis was performed to identify potential moderating factors, including types of control groups, methods of assessment, number of study groups, and origin of the study. Potential publication bias was examined using a funnel plot. RESULTS This meta-analysis pooled 44 articles from 4 continents and 13 countries and compared 6 types of main effect sizes (the odds ratio [OR] for depression, the OR for anxiety, the standardized mean difference [SMD] for depression, the SMD for anxiety, the SMD for the physical component summary [PCS] and the SMD for the mental component summary [MCS]) between endometriosis patients and controls. Except for the SMD for depression, all other effect sizes revealed statistically significant differences between the study group and the controls. The main effect size outcomes of the subgroup analysis were also similar. The type of control group (I2 = 35% in non-endometriosis control groups for the SMD of anxiety; I2 = 47% in non-endometriosis control groups for the MCS of the 36-Item Short Form Health Survey) and the continent of origin (I2 = 0% in studies from South America for the OR of depression; I2 = 47% in studies from Europe for the SMD of anxiety) may influence heterogeneity in this analysis. Additionally, depression and anxiety symptoms in patients seemed to be more apparent compared with healthy controls when the sample was smaller and when a questionnaire was used. The publication bias of the articles was acceptable. CONCLUSION Endometriosis can disturb mental health (specifically depression and anxiety) and decrease both the mental and physical HRQoL of patients. There may be some moderating factors that we were unable to identify in the subgroup analysis, but more research is necessary to develop proper management and improve the prognosis of endometriosis patients.
Collapse
Affiliation(s)
- Yuehan Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China,
| | - Bo Li
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yang Zhou
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yizi Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xue Han
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shitai Zhang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zheng He
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ling Ouyang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| |
Collapse
|
8
|
Wu Y, Wang H, Chen S, Lin Y, Xie X, Zhong G, Zhang Q. Migraine Is More Prevalent in Advanced-Stage Endometriosis, Especially When Co-Occuring with Adenomoysis. Front Endocrinol (Lausanne) 2021; 12:814474. [PMID: 35140688 PMCID: PMC8818695 DOI: 10.3389/fendo.2021.814474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Emerging data suggest a significant association between migraine and endometriosis, however the relationship between migraine and endometriosis severity or adenomyosis is unclear. Our objectives were to explore the relationship between migraine and endometriosis, according to the endometriosis severity and co-exist with adenomyosis or not. METHODS This case-control study of 167 endometriosis patients verified by surgery and 190 patients for other benign gynecological conditions (control subjects) was performed from September 2017 and January 2021. There is 49 adenomyosis detected by transvaginal ultrasound or histologic diagnosis among the endometriosis patients. Besides, we also included 41 adenomyosis but without endometriosis patients as a subgroup. All women completed a self-administered headache questionnaire and diagnosed as migraine according to the International Headache Society classification. The severity and stage of endometriosis was evaluated with revised American Society of Reproductive Medicine (rASRM) score. We used logistic regression to estimate the association between the presence of migraine and endometriosis severity while accounting for important confounders, including age, body mass index (BMI) and family history of migraine. We also estimate the risk of adenomyosis alone and adenomyosis with co-occurring endometriosis in migrainous women. RESULTS Migraine was significantly more prevalent in endometriosis patients compared with controls (29.9% vs. 12.1%, p<0.05), but the prevalence was similar between isolated adenomyosis patients and controls (9.8% vs.12.1%, p>0.05). For all endometriosis and control participants, migraineurs were 4.6-times (OR=4.6; 95% CI 2.7-8.1) more likely to have severe endometriosis. However, the strength of the association decreased when the analysis examined in moderate stage (OR=3.6, 95% CI 2.1-6.2). The risk of mild and minimal endometriosis was not significant (OR=1.9, 95%CI 0.9-4.0; OR=1.6, 95% CI 0.8-3.4; respectively). When we divided the endometriosis patients according to whether co-occurring with adenomyosis. We found in migrainous women, the risk of endometriosis co-exist with adenomyosis increased, with nearly fivefold greater odds compared with control (OR=5.4;95% CI 3.0-9.5), and nearly two times higher than the risk of endometriosis without co-exist adenomyosis patients (OR=2.2; 95% CI 1.2-3.8). CONCLUSION Our study supports the strong association between migraine and endometriosis. We found migrainous women suffer more frequently from sever endometriosis, especially endometriosis with co-occurring adenomyosis. It is advisable to heighten suspicion for patients who presenting with either these conditions in order to optimize therapy.
Collapse
Affiliation(s)
- Yingchen Wu
- Department of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hao Wang
- Department of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shengfu Chen
- Department of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yueming Lin
- Department of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoqian Xie
- Department of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Guangzheng Zhong
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- *Correspondence: Guangzheng Zhong, ; Qingxue Zhang,
| | - Qingxue Zhang
- Department of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- *Correspondence: Guangzheng Zhong, ; Qingxue Zhang,
| |
Collapse
|
9
|
Evans S, Mikocka-Walus A, Olive L, Seidman LC, Druitt M, Payne LA. Phenotypes of Women with and Without Endometriosis and Relationship with Functional Pain Disability. PAIN MEDICINE 2020; 22:1511-1521. [DOI: 10.1093/pm/pnaa362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Objective
Primary dysmenorrhea and secondary dysmenorrhea due to endometriosis share overlapping symptoms and likely demonstrate aspects of central sensitization. The present study aimed to identify distinct phenotypes of women who have dysmenorrhea with and without endometriosis to shed light on the unique mechanisms contributing to the pathogenesis of each condition.
Methods
An online survey was used to investigate the relationship between ratings of menstrual pain severity, menstrual symptoms (abdominal cramps, abdominal discomfort, low back pain, headache, body aches, bloating, nausea, diarrhea, increased bowel movements), widespread pain, and functional pain disability in a community sample of 1,354 women (aged 18–50) with menstrual pain in Australia.
Results
Compared with women without endometriosis, those with endometriosis had statistically significant higher menstrual pain severity (P<0.01), symptom severity and fatigue (all symptoms P<0.001, although only cramps and bloating were clinically significant), widespread pain sites (P<0.001), and functional pain disability (P<0.001, although this difference was not clinically significant). When examining symptoms by pain severity, women with severe menstrual pain were more likely to experience symptoms than women with less severe pain, regardless of the presence of endometriosis. Similar predictors of functional pain disability emerged for women with and without endometriosis, such as body aches, nausea, fatigue, and widespread pain, respectively, suggesting the presence of central sensitization in both groups. Logistic regression revealed that after accounting for menstrual pain severity (odds ratio [OR], 1.61) and duration (OR, 1.04), symptoms of bloating (OR, 1.12), nausea (OR, 1.07), and widespread pain sites (OR, 1.06) significantly predicted the presence of endometriosis.
Conclusions
The findings suggest that phenotypes specific to endometriosis can be identified.
Collapse
Affiliation(s)
- Subhadra Evans
- School of Psychology, Deakin University, Geelong, Australia
| | | | - Lisa Olive
- School of Psychology, Deakin University, Geelong, Australia
- Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Institute, School of Medicine, Deakin University, Geelong, Australia
| | | | | | - Laura A Payne
- McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
10
|
Affiliation(s)
- Ensiyeh Jenabi
- Pediatric Developmental Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Salman Khazaei
- Autism Spectrum disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| |
Collapse
|
11
|
Alshehre SM, Duffy S, Jones G, Ledger WL, Metwally M. A prospective, single-centre, single-arm, open label study of the long term use of a gonadotropin releasing hormone agonist (Triptorelin SR, 11.25 mg) in combination with Tibolone add-back therapy in the management of chronic cyclical pelvic pain. Reprod Biol Endocrinol 2020; 18:28. [PMID: 32290838 PMCID: PMC7155249 DOI: 10.1186/s12958-020-00586-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 04/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic cyclic pelvic pain (CCPP) affects women's quality of life and pituitary downregulation is often used for symptomatic relief. However, prolonged suppression of ovarian function is associated with menopausal side effects and can lead to osteoporosis. Currently, the use of gonadotropin releasing hormone agonists (GnRHa) for treatment of CCPP is usually restricted to 6-9 months, limiting their efficacy. There is limited information regarding safety and efficacy with longer-term use. The aim of this study is to examine the safety and efficacy of long-term (24 months) pituitary down-regulation with the GnRHa (Triptorelin SR) with add-back therapy (ABT) using Tibolone for symptom relief in women with CCPP. METHODS A single-arm, prospective clinical trial at a Tertiary University Teaching Hospital of 27 patients receiving Triptorelin SR (11.25 mg) and Tibolone (2.5 mg). Outcomes measures were the safety of treatment assessed by clinical examination, haematological markers, liver and renal function tests and bone mineral density (BMD) at 12, 18 and 24 months as well as at 6 months post-treatment. Pain and health-related quality of life (HR-QoL) assessed using the endometriosis health profile (EHP-30) and chronic pain grade (CPG) questionnaires. RESULTS There was no evidence for any significant harmful effects on any of the measured haematological, renal or liver function tests. Although results regarding the effect on BMD are not conclusive there is an increased risk of development of osteopaenia after 12 months of treatment. Pain and HRQoL assessments showed significant improvement during medication, but with deterioration after treatment cessation. CONCLUSION Long- term Triptorelin plus Tibolone add-back therapy in women suffering from CCPP does not appear to be associated with significant serious adverse events apart from the possibility of deterioration in the BMD that needs to be monitored. This mode of therapy appears to be effective in pain relief and in improving quality of life over a 24-month period. TRIAL REGISTRATION Clinical trials database NCT00735852.
Collapse
Affiliation(s)
- Sallwa M Alshehre
- Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield, The Jessop Wing, Tree Root Walk, Sheffield, S10 3HY, Sheffield, UK
| | - Sheila Duffy
- Department of Obstetrics and Gynaecology, The Jessop Wing, Tree Root Walk, Sheffield, S10 3HY, UK
| | - Georgina Jones
- School of Social Sciences, Leeds Beckett University, City Campus, Leeds, LS1 3HE, UK
| | - William L Ledger
- The University of New South Wales, Royal Hospital for Women, Barker Street, Randwick NSW, Sydney, 2031, Australia
| | - Mostafa Metwally
- Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield, The Jessop Wing, Tree Root Walk, Sheffield, S10 3HY, Sheffield, UK.
| |
Collapse
|
12
|
Bourdel N, Chauvet P, Billone V, Douridas G, Fauconnier A, Gerbaud L, Canis M. Systematic review of quality of life measures in patients with endometriosis. PLoS One 2019; 14:e0208464. [PMID: 30629598 PMCID: PMC6328109 DOI: 10.1371/journal.pone.0208464] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/16/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Endometriosis and quality of life has been the subject of much research, however, there is little consensus on how best to evaluate quality of life in endometriosis, resulting in many and diverse scales being used. In our study, we aim to identify quality of life scales used in endometriosis, to review their strengths and weaknesses and to establish what would define an ideal scale in the evaluation of endometriosis-related quality of life. MATERIALS AND METHODS A search of the MEDLINE and EMBASE databases was carried out for publications in English and French for the period from 1980 to February 2017, using the words 'endometriosis' and 'quality of life'. Publications were selected if they reported on quality of life in patients with endometriosis and specified use of a quality of life scale. A quantitative and a qualitative analysis of each scale was performed in order to establish the strengths and weaknesses for each scale (systematic registration number: PROSPERO 2014: CRD42014014210). RESULTS A total of 1538 articles publications were initially identified. After exclusion of duplicates and application of inclusion criteria, 201 studies were selected for analysis. The SF-36, a generic HRQoL measure, was found to be the most frequently used scale, followed by the EHP-30, a measure specific to endometriosis. Both perform well, when compared with other scales, with scale weaknesses offset by strengths. EHP-5 and EQ-5D also showed to be of good quality. All four were the only scales to report on MCID studied in endometriosis patients. CONCLUSION For clinical practice, routine evaluation of HRQOL in women with endometriosis is essential both for health-care providers and patients. Both SF-36 and EHP-30 perform better overall with regard to their strengths and weaknesses when compared to other scales.
Collapse
Affiliation(s)
- Nicolas Bourdel
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
| | - Pauline Chauvet
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
| | - Valentina Billone
- Department of Mother and Child, University Hospital P. Giaccone, Palermo, Italy
| | - Giannis Douridas
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Arnaud Fauconnier
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, EA 7285 Research Unit ‘Risk and Safety in Clinical Medicine for Women and Perinatal Health’, Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France
| | - Laurent Gerbaud
- Dept of Public Health, PEPRADE, Université Clermont Auvergne, CHU Clermont-Ferrand, France, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Michel Canis
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
| |
Collapse
|
13
|
Karamustafaoglu Balci B, Kabakci Z, Guzey DY, Avci B, Guler M, Attar E. Association between endometriosis, headache, and migraine. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2019. [DOI: 10.1177/2284026518818975] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction: Available data suggest that there is an association between endometriosis and a group of disorders including autonomic nervous system irregularities. A deeper understanding of relationship between endometriosis and autonomic nervous system is needed as it may lead to novel discoveries on the causes or consequences of endometriosis. In this study, we analyzed the prevalence of migraine in patients with endometriosis. Methods: In this cross-sectional study, medical records of women were reviewed through January 2013 to December 2017. Women with laparoscopically proven endometriosis (n = 185) were compared with those without endometriosis (n = 168). The 3-item screening questions (ID Migraine™) test was used to screen migraine. Data were analyzed using SPSS v25 (IBM Corporation). The χ2 test was used for analyzing the nominal parameters and group comparisons. Pearson χ2 was used to study the association between endometriosis and migraine. Results: The mean age was 31.86 ± 4.49 years of the endometriosis group and 28.95 ± 5.11 years of the controls (p = 0.408). The two pre-screening questions of ID Migraine test were answered positively by 86 patients of the endometriosis group (75.4%) and by 53 patients of the control group (54.6%) (p = 0.001). Of these patients, 51 (44.7% of endometriosis group) and 26 (26.8% of control group) were diagnosed as having migraine using 3-item Migraine questionnaire (p = 0.007). Conclusion: This study showed that the prevalence of migraine was significantly higher in patients with endometriosis. Because there is a strong correlation, patients with endometriosis should be screened for headache and migraine to increase the benefits of care.
Collapse
Affiliation(s)
| | - Zehra Kabakci
- Department of Obstetrics and Gynecology, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Damla Y Guzey
- Department of Obstetrics and Gynecology, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Bartu Avci
- Department of Obstetrics and Gynecology, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Murathan Guler
- Department of Obstetrics and Gynecology, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Erkut Attar
- Department of Obstetrics and Gynecology, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| |
Collapse
|
14
|
Zhu Y, Liu Y, Zhao J, Han Q, Liu L, Shen X. The efficacy and safety of calcitonin gene-related peptide monoclonal antibody for episodic migraine: a meta-analysis. Neurol Sci 2018; 39:2097-2106. [PMID: 30182284 DOI: 10.1007/s10072-018-3547-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/21/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This meta-analysis was performed to evaluate the efficacy and safety of monoclonal antibodies against calcitonin gene-related peptide (CGRP) for episodic migraine prevention. METHODS MEDLINE, EMBASE, Web of Science, and the Cochrane Library were searched from inception to April 2018. Studies considered to be eligible were randomized controlled trials about efficacy and safety of calcitonin gene-related peptide monoclonal antibody for episodic migraine prevention. RESULTS Eight randomized controlled trials involving 2292 patients were included. The outcomes of this meta-analysis presented that CGRP monoclonal antibodies for preventive treatment of episodic migraine significantly reduced the monthly migraine days from baseline [weighted mean difference (WMD) = - 1.52; 95%CI, - 1.92 to - 1.11; Z = 7.40; P < 0.001] and monthly acute migraine-specific medication consumption from baseline [WMD = - 1.45; 95%CI, - 2.17 to - 0.72; Z = 3.93; P < 0.001], as compared with placebo group. CGRP monoclonal antibodies for preventive treatment of episodic migraine significantly increased the ≥ 50% reduction from baseline in migraine days per month [RR = 1.54; 95%CI, 1.38 to1.71; Z = 7.88; P < 0.001]. The adverse events were similar between the CGRP monoclonal antibody group and placebo group (P = 0.998). The outcomes of subgroup analysis showed that erenumab, galcanezumab, and fremanezumab significantly reduced the monthly migraine days from baseline and increased the ≥ 50% reduction from baseline in migraine days per month. Both erenumab and fremanezumab significantly reduced from baseline. CONCLUSIONS Based on the results of this meta-analysis, CGRP monoclonal antibodies significantly reduced the monthly migraine days and acute migraine-specific medication. CGRP monoclonal antibodies were effective and safe for preventive treatment of episodic migraine.
Collapse
Affiliation(s)
- Yuhan Zhu
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | | | - Jing Zhao
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Qingqing Han
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Lei Liu
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Xiaoxu Shen
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China.
| |
Collapse
|
15
|
Miller JA, Missmer SA, Vitonis AF, Sarda V, Laufer MR, DiVasta AD. Prevalence of migraines in adolescents with endometriosis. Fertil Steril 2018; 109:685-690. [DOI: 10.1016/j.fertnstert.2017.12.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/25/2017] [Accepted: 12/13/2017] [Indexed: 10/17/2022]
|
16
|
Marinho MC, Magalhaes TF, Fernandes LFC, Augusto KL, Brilhante AV, Bezerra LR. Quality of Life in Women with Endometriosis: An Integrative Review. J Womens Health (Larchmt) 2018; 27:399-408. [DOI: 10.1089/jwh.2017.6397] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Manuela C.P. Marinho
- Department of Surgery and Maternidade Escola Assis Chateaubriand of Federal University of Ceará (UFC), Fortaleza, Brazil
| | - Thais F. Magalhaes
- Department of Surgery and Maternidade Escola Assis Chateaubriand of Federal University of Ceará (UFC), Fortaleza, Brazil
| | | | - Kathiane L. Augusto
- Department of Surgery and Maternidade Escola Assis Chateaubriand of Federal University of Ceará (UFC), Fortaleza, Brazil
- Medicine Course of University of Fortaleza (UNIFOR), Fortaleza, Brazil
| | - Aline V.M. Brilhante
- Post-Graduate Program in Public Health, University of Fortaleza (UNIFOR), Fortaleza, Brazil
- Medicine Course of University of Fortaleza (UNIFOR), Fortaleza, Brazil
| | - Leonardo R.P.S. Bezerra
- Department of Surgery and Maternidade Escola Assis Chateaubriand of Federal University of Ceará (UFC), Fortaleza, Brazil
| |
Collapse
|
17
|
|
18
|
Zhang X, Li M, Guan J, Wang H, Li S, Guo Y, Liu M. Evaluation of the sacral nerve plexus in pelvic endometriosis by three-dimensional MR neurography. J Magn Reson Imaging 2016; 45:1225-1231. [PMID: 27666420 DOI: 10.1002/jmri.25435] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 08/08/2016] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To investigate the feasibility of three-dimensional MR neurography (3D MRN) for the sacral plexus using sampling perfection with application-optimized contrasts using different flip angle evolution (SPACE) sequences, and to demonstrate structural abnormalities in the pelvic nerve of women with pelvic endometriosis. MATERIALS AND METHODS Twenty patients with pelvic endometriosis and 20 healthy controls were examined by contrast-enhanced 3D short time inversion recovery T2-weighted imaging (CE 3D STIR T2WI) SPACE sequences on 3 Tesla MRI. Image quality and diagnostic confidence of the sequences in identifying abnormalities of the sacral plexus were analyzed and compared with conventional three-plane images of 2D turbo-spin echo T2-weighted images (2D TSE T2WI). The changes in the sacral plexus caused by endometrial lesions were evaluated. RESULTS The sacral plexus was clearly revealed in both healthy controls and patients with endometriosis on 3D STIR SPACE images. A good agreement was reached in the evaluation of both imaging quality (Kappa value [κ] = 0.73-1.00) and diagnostic confidence (κ = 0.66-0.81) when compared between the two independent readers. Abnormalities caused by endometriosis were identified in 17 patients, unilaterally in 10 patients, and bilaterally in 7 patients. Nerve fiber abnormalities of lumbar 5 (L5) were detected in 11 patients, of sacral 1 (S1) in 14 patients and of sacral 2 (S2) in 9 patients. CONCLUSION CE 3D STIR SPACE sequences demonstrate its significant capacity to investigate and map the sacral plexus, and reveal the compression and adhesion of the sacral plexus nerve as a result of ectopic lesions. LEVEL OF EVIDENCE 3 J. Magn. Reson. Imaging 2017;45:1225-1231.
Collapse
Affiliation(s)
- Xiaoling Zhang
- Department of Radiology, First affiliated hospital of Sun Yat-sen University, Guangzhou, China
| | - Meizhi Li
- Department of Radiology, First affiliated hospital of Sun Yat-sen University, Guangzhou, China
| | - Jian Guan
- Department of Radiology, First affiliated hospital of Sun Yat-sen University, Guangzhou, China
| | - Huanjun Wang
- Department of Radiology, First affiliated hospital of Sun Yat-sen University, Guangzhou, China
| | - Shurong Li
- Department of Radiology, First affiliated hospital of Sun Yat-sen University, Guangzhou, China
| | - Yan Guo
- Department of Radiology, First affiliated hospital of Sun Yat-sen University, Guangzhou, China
| | - Mingjuan Liu
- Department of Radiology, First affiliated hospital of Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
19
|
|
20
|
Allais G, Chiarle G, Bergandi F, Benedetto C. The use of progestogen-only pill in migraine patients. Expert Rev Neurother 2015; 16:71-82. [PMID: 26630354 DOI: 10.1586/14737175.2016.1127161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Migraine is a debilitating neurovascular disorder which is estimated to affect 18% of women and 6% of men. Two main forms of this neurological disorder must be considered: Migraine without Aura and Migraine with Aura. Migraine without aura often has a strict menstrual relationship: the International Headache Society classification gives criteria for Pure Menstrual Migraine and Menstrually Related Migraine. The higher prevalence of migraine among women suggests that this sex difference probably results from the trigger of fluctuating hormones during the menstrual cycle. Safe and effective contraception is essential for all women of childbearing age, but Combined Oral Contraceptives have been associated with worsening of attacks and cardiovascular risk in these patients. We analyzed characteristics, effects and benefits of progestogen-only pill, a possible alternative for contraception in women with migraine.
Collapse
Affiliation(s)
- Gianni Allais
- a Department of Surgical Sciences, Women's Headache Center , University of Turin , Turin , Italy
| | - Giulia Chiarle
- a Department of Surgical Sciences, Women's Headache Center , University of Turin , Turin , Italy
| | - Fabiola Bergandi
- a Department of Surgical Sciences, Women's Headache Center , University of Turin , Turin , Italy
| | - Chiara Benedetto
- a Department of Surgical Sciences, Women's Headache Center , University of Turin , Turin , Italy
| |
Collapse
|
21
|
Standardizing data exchange for clinical research protocols and case report forms: An assessment of the suitability of the Clinical Data Interchange Standards Consortium (CDISC) Operational Data Model (ODM). J Biomed Inform 2015; 57:88-99. [PMID: 26188274 DOI: 10.1016/j.jbi.2015.06.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 03/27/2015] [Accepted: 06/26/2015] [Indexed: 01/27/2023]
Abstract
Efficient communication of a clinical study protocol and case report forms during all stages of a human clinical study is important for many stakeholders. An electronic and structured study representation format that can be used throughout the whole study life-span can improve such communication and potentially lower total study costs. The most relevant standard for representing clinical study data, applicable to unregulated as well as regulated studies, is the Operational Data Model (ODM) in development since 1999 by the Clinical Data Interchange Standards Consortium (CDISC). ODM's initial objective was exchange of case report forms data but it is increasingly utilized in other contexts. An ODM extension called Study Design Model, introduced in 2011, provides additional protocol representation elements. Using a case study approach, we evaluated ODM's ability to capture all necessary protocol elements during a complete clinical study lifecycle in the Intramural Research Program of the National Institutes of Health. ODM offers the advantage of a single format for institutions that deal with hundreds or thousands of concurrent clinical studies and maintain a data warehouse for these studies. For each study stage, we present a list of gaps in the ODM standard and identify necessary vendor or institutional extensions that can compensate for such gaps. The current version of ODM (1.3.2) has only partial support for study protocol and study registration data mainly because it is outside the original development goal. ODM provides comprehensive support for representation of case report forms (in both the design stage and with patient level data). Inclusion of requirements of observational, non-regulated or investigator-initiated studies (outside Food and Drug Administration (FDA) regulation) can further improve future revisions of the standard.
Collapse
|
22
|
Bourdel N, Alves J, Pickering G, Ramilo I, Roman H, Canis M. Systematic review of endometriosis pain assessment: how to choose a scale? Hum Reprod Update 2014; 21:136-52. [PMID: 25180023 DOI: 10.1093/humupd/dmu046] [Citation(s) in RCA: 209] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Numerous studies concerning endometriosis and pain have been reported. However, there is no consensus on the best method to evaluate pain in endometriosis and many scales have been used. Moreover, there are only a few descriptions of minimal clinically important differences after treatment (MCID) to evaluate variations in pain. In our study, we aim to identify pain scales used in endometriosis pain treatment, to address their strong and weak points and to define which would be the ideal scale to help clinicians and researchers to evaluate endometriosis-related pain. METHODS A search of the MEDLINE and EMBASE databases was carried out for publications in English, French or Portuguese from 1980 to December 2012, for the words: endometriosis, treatment, pain. Studies were selected if they studied an endometriosis treatment and a pain scale was specified. A quantitative and a qualitative analysis of each scale was performed to define strong and weak points of each scale (systematic registration number: CRD42013005336). RESULTS A total of 736 publications were identified. After excluding duplications and applying inclusion criteria 258 studies remained. We found that the visual analog scale (VAS) is the most frequently used scale. Both VAS and the numerical rating scale (NRS) show a good balance between strong and weak points in comparison with others such as the Biberoglu and Behrman scale. Concerning MCID, only VAS, NRS and Brief Pain Inventory scales have reported MCID and, among these, only VAS MCID has been studied in endometriosis patients (VAS MCID = 10 mm). Adding the Clinical Global Impression score (CGI) to the pain scale allows calculation of the MCID. CONCLUSIONS When using pain scales their strengths and weaknesses must be known and included in the analysis. VAS is the most frequently used pain scale and, together with NRS, seems the best adapted for endometriosis pain measurement. The use of VAS or NRS for each type of typical pain related to endometriosis (dysmenorrhea, deep dyspareunia and non-menstrual chronic pelvic pain), combined with the CGI and a quality-of-life scale will provide both clinicians and researchers with tools to evaluate treatment response.
Collapse
Affiliation(s)
- Nicolas Bourdel
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France Faculté de medicine, ISIT - Université d'Auvergne, Place Henri Dunant, 63000 Clermont-Ferrand, France
| | - João Alves
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France
| | - Gisele Pickering
- Centre de Pharmacologie Clinique, CHU Clermont Ferrand, Inserm CIC 501, Inserm, U1107 Neuro-Dol, F-63003 Clermont-Ferrand, France
| | - Irina Ramilo
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France
| | - Horace Roman
- Department of Gynecology and Obstetrics, Rouen University Hospital-Charles Nicolle, 1 rue de Germont, 76031 Rouen, France
| | - Michel Canis
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France Faculté de medicine, ISIT - Université d'Auvergne, Place Henri Dunant, 63000 Clermont-Ferrand, France
| |
Collapse
|
23
|
Morotti M, Remorgida V, Buccelli E, Venturini PL, Ferrero S. Comparing treatments for endometriosis-related pain symptoms in patients with migraine without aura. J Comp Eff Res 2014; 1:347-57. [PMID: 24237468 DOI: 10.2217/cer.12.38] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Endometriosis is a gynecological disorder defined by the presence of endometrial-like tissue outside the uterus. Several studies have found an epidemiological correlation between endometriosis and migraine, probably due to the association of both diseases with female hormones. Progestins or combined oral contraceptives are the first-line medical therapy in women with endometriosis; however, it is well known that in some women the use of combined oral contraceptives could exacerbate migraine. This observation poses a challenge to clinicians who must concomitantly treat endometriosis-related symptoms and migraine. This review summarizes the available literature on the medical treatment of endometriosis in women suffering concomitant migraine without aura until March 2012. Due to the lack of available studies on this topic, it is difficult to draw definitive conclusions. Further studies evaluating hormonal therapies are needed; in particular, progestin therapy should be reconsidered in women with migraine and concomitant endometriosis.
Collapse
Affiliation(s)
- Matteo Morotti
- Department of Obstetrics & Gynecology, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | | | | | | | | |
Collapse
|
24
|
Incidence and risk factors for chronic pelvic pain after hysteroscopic sterilization. J Minim Invasive Gynecol 2014; 22:390-4. [PMID: 24952343 DOI: 10.1016/j.jmig.2014.06.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 06/10/2014] [Accepted: 06/12/2014] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVE To investigate the incidence of and preoperative risk factors for developing pelvic pain after hysteroscopic sterilization using the Essure microinserts. DESIGN Retrospective cohort study (Canadian Task Force classification II-2). SETTING University medical center. PATIENTS A total of 458 patients who underwent hysteroscopic sterilization using Essure between January 1, 2005, and June 30, 2012. INTERVENTION Hysteroscopic sterilization using Essure. MEASUREMENTS AND MAIN RESULTS The incidence of acute pelvic pain after hysteroscopic sterilization was 8.1%, and of persistent pain at 3 months after the procedure was 4.2%. The range of presence of pain was 1 to 469 days (mean, 56 days). Of patients who developed chronic pelvic pain after the procedure, 75% reported it within 130 days of the procedure. Patients with previous diagnoses of any chronic pain (chronic pelvic pain, chronic low back pain, chronic headache, and fibromyalgia) were more likely to report both acute pain (odds ratio, 6.81; 95% confidence interval, 2.95-15.73) and chronic pain (odds ratio, 6.15; 95% confidence interval, 2.10-18.10) after hysteroscopic sterilization. CONCLUSIONS Pelvic pain may develop after hysteroscopic sterilization. Patients with a diagnosis of preexisting chronic pain may be at increased risk of developing pelvic pain after the procedure. Fifty percent of new pelvic pain after Essure placement will resolve within 3 months.
Collapse
|
25
|
Brawn J, Morotti M, Zondervan KT, Becker CM, Vincent K. Central changes associated with chronic pelvic pain and endometriosis. Hum Reprod Update 2014; 20:737-47. [PMID: 24920437 DOI: 10.1093/humupd/dmu025] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chronic pelvic pain (CPP) is a significant public health problem with 1 million affected women in the UK. Although many pathologies are associated with CPP, the pain experienced is often disproportionate to the extent of disease identified and frequently no pathology is found (chronic pelvic pain syndrome). The central nervous system (CNS) is central to the experience of pain and chronic pain conditions in general are associated with alterations in both the structure and function of the CNS. This review describes the available evidence for central changes in association with conditions presenting with CPP. METHODS A detailed literature search was performed to identify relevant papers, however, this is not a systematic review. RESULTS CPP is associated with central changes similar to those identified in other pain conditions. Specifically these include, alterations in the behavioural and central response to noxious stimulation, changes in brain structure (both increases and decreases in the volume of specific brain regions), altered activity of both the hypothalamic-pituitary-adrenal axis and the autonomic nervous system (ANS) and psychological distress. CONCLUSIONS The evidence reviewed in this paper demonstrates that CPP is associated with significant central changes when compared with healthy pain-free women. Moreover, the presence of these changes has the potential to both exacerbate symptoms and to predispose these women to the development of additional chronic conditions. These findings support the use of adjunctive medication targeting the CNS in these women.
Collapse
Affiliation(s)
- Jennifer Brawn
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Matteo Morotti
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK Department of Obstetrics and Gynaecology, University of Genoa, Genoa 16100, Italy
| | - Krina T Zondervan
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - Christian M Becker
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - Katy Vincent
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK
| |
Collapse
|
26
|
Morotti M, Remorgida V, Venturini PL, Ferrero S. Progestogen-only contraceptive pill compared with combined oral contraceptive in the treatment of pain symptoms caused by endometriosis in patients with migraine without aura. Eur J Obstet Gynecol Reprod Biol 2014; 179:63-8. [PMID: 24965982 DOI: 10.1016/j.ejogrb.2014.05.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 05/07/2014] [Accepted: 05/20/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Evaluate patient satisfaction at 6-month treatment in women with symptomatic rectovaginal endometriosis and migraine without aura with (progestogen-only contraceptive pill, POP versus sequential combined oral contraceptives, COC) STUDY DESIGN: A patient preference trial including 144 women (82 in the group COC and 62 in the group POP). Main outcome measure was the degree of patient satisfaction by using a Likert scale. Secondary objectives were to evaluate differences in endometriosis-related pain and changes in migraine features during the treatment. RESULTS In group POP, 38/62 women (61.2%) were satisfied or very satisfied after treatment, compared to 31/82 women (37.8%) in group COC (p=0.005). The intensity of chronic pelvic pain and dyspareunia significantly decreased at 6-month treatment in both the groups. At 6-month treatment, the number of migraine attacks was lower than at baseline in group POP (p=0.002), while it was not reduced in group COC (p=0.521). The intensity of migraine attacks was significantly different between baseline and 6-month treatment in group POP (p<0.001) but not in group COC (p=0.078). CONCLUSIONS POP is better tolerated than COC and it seems to ameliorate migraine attacks compared to COC in symptomatic patients with rectovaginal endometriosis and migraine without aura. Both drugs efficaciously relieve endometriosis-related pain symptoms. This study supports the use of the POP in women with rectovaginal endometriosis and coexisting migraine without aura.
Collapse
Affiliation(s)
- Matteo Morotti
- Department of Obstetrics and Gynaecology, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Largo R. Benzi 1 16132 Genoa, Italy.
| | - Valentino Remorgida
- Department of Obstetrics and Gynaecology, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Largo R. Benzi 1 16132 Genoa, Italy
| | - Pier Luigi Venturini
- Department of Obstetrics and Gynaecology, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Largo R. Benzi 1 16132 Genoa, Italy
| | - Simone Ferrero
- Department of Obstetrics and Gynaecology, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Largo R. Benzi 1 16132 Genoa, Italy
| |
Collapse
|
27
|
Gordon A, Paneduro D, Pink L, Lawler V, Lay C. Evaluation of the frequency and the association of sexual pain and chronic headaches. Headache 2013; 54:109-15. [PMID: 24261411 DOI: 10.1111/head.12271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND Sexual pain and chronic headaches are both complex conditions with associated high disability. Little research has examined whether there is a relationship between the 2. The aim of this survey-based study was to explore the frequency of sexual pain in a population of women being treated for chronic headache. Peripheral aims included exploring the number of patients receiving treatment for sexual pain and the association between sexual pain and libido, and history of abuse. METHODS Patients presenting to an ambulatory chronic headache clinic were administered a short 10-item survey. RESULTS Forty-four percent of patients reported that they had pelvic region or genital pain brought on by sexual activity. Only half of these patients had ever discussed their pelvic pain with a health care provider, and 31% of these patients had not received treatment. Almost all patients would be interested in treatment if available. Seventy-five percent of patients indicated a change in libido. CONCLUSION Chronic headaches and sexual pain are both conditions that have a significant impact on patients and the health care system, and they do coexist. More research is needed to look at the relationship between these conditions in addition to epidemiology, symptomatology, evaluation, and treatments.
Collapse
Affiliation(s)
- Allan Gordon
- Wasser Pain Management Centre, Mount Sinai Hospital, Toronto, ON, Canada
| | | | | | | | | |
Collapse
|
28
|
Triolo O, Laganà AS, Sturlese E. Chronic pelvic pain in endometriosis: an overview. J Clin Med Res 2013; 5:153-63. [PMID: 23671540 PMCID: PMC3651065 DOI: 10.4021/jocmr1288w] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2013] [Indexed: 12/14/2022] Open
Abstract
Chronic pelvic pain (CPP) could be considered nowadays a deep health problem that challenges physicians all over the world. This because its aetiology is still unclear, the course of the disease could vary a lot among different patients and through time in the same patient, and the response to treatments is not every time successful. Among women who underwent laparoscopy for CPP, endometriosis is found in about 1/3 of the cases, while only 25% of women with histological confirmed endometriosis are asymptomatic. A wide range of variables may exert their influence on the resulting pain syndrome in endometriosis; for example, score according to American society for reproductive medicine (rASRM), size of the sub-peritoneal and pelvic wall implants, Douglas obliteration, previous surgery. It is widely accepted nowadays that central nervous system (CNS) and peripheral nervous system (PNS) seems to influence each other and this interconnection play a key role in pain modulation. Moreover, the phenomena induced by endometriosis in the pelvis, including the breakdown of peritoneal homeostasis and the induction of the production of proinflammatory and proangiogenic cytokines, are responsible of altered innervations and modulation of pain pathways in these patients. There are many proposed medical and surgical approach to treat this painful syndrome, although there is necessity of more efforts to create new non-invasive strategies that set a more accurate diagnosis of the causes of endometriotic-related CPP, and therefore facilitate its eradication.
Collapse
Affiliation(s)
- Onofrio Triolo
- Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, University of Messina - Messina, Italy
| | - Antonio Simone Laganà
- Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, University of Messina - Messina, Italy
| | - Emanuele Sturlese
- Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, University of Messina - Messina, Italy
| |
Collapse
|
29
|
Abstract
The association of pain and endometriosis was recognized with the first definitive published reports of this disorder. Unfortunately, the precise etiologies and pathways leading to nociception and pain symptoms in endometriosis remain poorly understood, and as a result, effective therapeutic interventions are lacking with consequent profound effects on affected women's quality of life. In this opinion paper we summarize selected proceedings presented at the 28th Annual Meeting of the European Society of Human Reproduction and Embryology (ESHRE) in Istanbul, Turkey, and review the clinical and translational evidence of chronic pain, neurogenesis, and the pernicious impact of dyspareunia on women with symptomatic endometriosis. The effectiveness of medical treatments is critically assessed and the findings indicate that good therapeutic options are available with extant medications effective in some sub-groups of women with endometriosis, many of which are affordable globally. Nevertheless, new management strategies and drugs need to be developed to increase the options of all afflicted women to minimize and ideally eradicate painful symptoms of endometriosis. However, only by elucidating distinctions among sub-groups with specific symptoms, suggesting different mechanisms, are we likely to derive truly successful therapeutic strategies.
Collapse
|
30
|
|
31
|
Women with endometriosis are more likely to suffer from migraines: a population-based study. PLoS One 2012; 7:e33941. [PMID: 22442736 PMCID: PMC3307779 DOI: 10.1371/journal.pone.0033941] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 02/21/2012] [Indexed: 11/19/2022] Open
Abstract
Previous research suggests that a co-morbid relationship exists between migraine and endometriosis; however, results have been inconsistent. In addition, female hormones, which are important in the pathogenesis and management of endometriosis, have been reported to precipitate migraine attacks and may confound the results. The aim of this population-based cohort study was to explore the relationship between migraine and endometriosis in women of reproductive age (18-51 years). Data were derived from the National Health Insurance Research Database of Taiwan, which contains outpatient and inpatient records from 2000 to 2007. Our study cohort included 20,220 endometriosis patients and 263,767 controls without endometriosis. We analyzed the prevalence of migraine in these women as recorded during the eight years of the database. Our results found that patients with endometriosis were more likely to suffer migraine headaches compared to controls (odds ratio [OR], 1.70; 95% confidence interval [CI] [1.59, 1.82]; p<0.001). In addition, the co-morbid association between migraine and endometriosis remained significant after the data were controlled for age and frequently utilized hormone therapies (OR, 1.37; 95% CI, [1.27, 1.47]; p<0.001). The results of this cohort study support the existence of a co-morbid relationship between migraine and endometriosis, even after adjusting for the possible effects of female hormone therapies on migraine attacks.
Collapse
|
32
|
Abstract
Headache and endometriosis show some similarities in their clinical and epidemiological features that are probably due to the influence of female sexual hormones on both disorders. Epidemiological studies indicate that they are comorbid disorders. However, the nature of the comorbidity is not known with certainty, but a likely explanation may be common susceptibility genes. Another possibility is that, because they both are related to pain, increased pain sensitivity induced by one of the disorders may lead to a higher likelihood of developing the other, possibly mediated by nitrogen oxide or prostaglandins. A common link to the widespread use of estroprogestins may seem less probable. For physicians dealing with women with either of these disorders, awareness of the comorbidity may be helpful in the treatment of the patient.
Collapse
Affiliation(s)
- Lars Jacob Stovner
- Norwegian National Headache Centre, Department of Neuroscience, Norwegian University of Science and Technology, Trondheim University Hospital, 7006 Trondheim, Norway.
| | | | | |
Collapse
|
33
|
Hsu AL, Sinaii N, Segars J, Nieman LK, Stratton P. Relating pelvic pain location to surgical findings of endometriosis. Obstet Gynecol 2011; 118:223-230. [PMID: 21775836 PMCID: PMC3155822 DOI: 10.1097/aog.0b013e318223fed0] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study whether pain location is related to lesion location in women with chronic pelvic pain and biopsy-proven endometriosis. METHODS A secondary analysis was performed to compare self-reported pain location with recorded laparoscopy findings for location and characteristics of all visible lesions. All lesions were excised. Endometriosis was diagnosed using histopathology criteria. The pelvic area was divided into three anterior and two posterior regions. Lesion depth, number of lesions or endometriomas, and disease burden (defined as sum of lesion sizes, or single compared with multiple lesions) were determined for each region. Data were analyzed using t tests, Fisher exact tests, and logistic regression modeling, with P values corrected for multiple comparisons using the step-down Bonferroni method. RESULTS Women with endometriosis (n = 96) had lower body mass indexes, were more likely to be white, had more previous surgeries, and had more frequent menstrual pain and incapacitation than did chronic pain patients without endometriosis (n = 37). Overall, few patients had deeply infiltrating lesions (n = 38). Dysuria was associated with superficial bladder peritoneal lesions. Other lesions or endometriomas were not associated with pain in the same anatomic locations. Lesion depth, disease burden, and number of lesions or endometriomas were not associated with pain. CONCLUSION In this group of women with biopsy-proven endometriosis, few had deeply infiltrating lesions or endometriomas. Dysuria and midline anterior pain were the only symptoms associated with the location of superficial endometriosis lesions. The lack of relationship between pain and superficial lesion location raises questions about how these lesions relate to pain. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT00001848. LEVEL OF EVIDENCE : II.
Collapse
Affiliation(s)
- Albert L. Hsu
- Program in Reproductive and Adult Endocrinology, NICHD, NIH, Bethesda, MD
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Ninet Sinaii
- Biostatistics and Clinical Epidemiology Service, Clinical Center, NIH, Bethesda, MD
| | - James Segars
- Program in Reproductive and Adult Endocrinology, NICHD, NIH, Bethesda, MD
| | - Lynnette K Nieman
- Program in Reproductive and Adult Endocrinology, NICHD, NIH, Bethesda, MD
| | - Pamela Stratton
- Program in Reproductive and Adult Endocrinology, NICHD, NIH, Bethesda, MD
| |
Collapse
|