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Wirtz MR, Revenson TA, Ford JS, Karas AN. Effective Interventions for Idiopathic Chronic Pelvic Pain: A Systematic Review. Int J Behav Med 2024:10.1007/s12529-024-10309-y. [PMID: 39048889 DOI: 10.1007/s12529-024-10309-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Chronic pelvic pain (CPP) in women is a debilitating condition with symptoms that affect both medical and psychological systems, yet for those with idiopathic CPP (i.e., those without a known physiologic cause), no consensus for intervention exists. AIM A systematic review was conducted to identify the effectiveness of current biomedical, psychosocial, and integrative interventions for idiopathic CPP (ICPP). METHOD Five databases (PubMed, CINAHL, Cochrane, PsycInfo, Web of Science) were systematically searched with multiple keywords for publications from 2008-2022. Articles were coded for sample characteristics, research design, type of intervention, and intervention outcomes. RESULTS Nineteen studies met criteria. The majority of the interventions (14 studies) were biomedical, either invasive (e.g., injections), or non-invasive (e.g., medications). Five studies evaluated integrative interventions that combined biomedical and psychosocial components (e.g., a multimodal pain treatment center). Invasive biomedical interventions were better at relieving short-term pain and non-invasive biomedical interventions were superior for long-term pain; integrated interventions reduced both short-term and long-term pain. Integrative interventions also improved mental health, sexual health, and QOL. CONCLUSION Although most interventions for ICPP have been biomedical, integrative interventions showed greater outcome effectiveness, suggesting a focus on integrative interventions in the future.
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Affiliation(s)
- Megan R Wirtz
- Program in Psychology, The Graduate Center, City University of New York, 365 5th Avenue, New York, NY, 10016, US.
- Department of Psychology, Hunter College, City University of New York, 695 Park Avenue, New York, NY10065, US.
| | - Tracey A Revenson
- Program in Psychology, The Graduate Center, City University of New York, 365 5th Avenue, New York, NY, 10016, US
- Department of Psychology, Hunter College, City University of New York, 695 Park Avenue, New York, NY10065, US
| | - Jennifer S Ford
- Program in Psychology, The Graduate Center, City University of New York, 365 5th Avenue, New York, NY, 10016, US
- Department of Psychology, Hunter College, City University of New York, 695 Park Avenue, New York, NY10065, US
| | - Alexandra N Karas
- Program in Psychology, The Graduate Center, City University of New York, 365 5th Avenue, New York, NY, 10016, US
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Wilson MV, Braithwaite FA, Arnold JB, Crouch SM, Moore E, Heil A, Cooper K, Stanton TR. The effectiveness of peer support interventions for community-dwelling adults with chronic musculoskeletal pain: a systematic review and meta-analysis of randomised trials. Pain 2024:00006396-990000000-00636. [PMID: 38916521 DOI: 10.1097/j.pain.0000000000003293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/20/2024] [Indexed: 06/26/2024]
Abstract
ABSTRACT This systematic review and meta-analysis critically examined the evidence for peer support interventions to reduce pain and improve health outcomes in community-dwelling adults with chronic musculoskeletal pain (PROSPERO CRD42022356850). A systematic search (inception-January 2023) of electronic databases and grey literature was undertaken to identify relevant randomised controlled trials, with risk of bias and GRADE assessments performed on included studies. Meta-analyses used a generic, inverse-variance, random-effects model, calculating mean difference (MD) or standardised mean difference (SMD). Of 16,445 records identified, 29 records reporting on 24 studies (n = 6202 participants) were included. All evidence had unclear/high risk of bias and low-very low certainty. Peer support interventions resulted in small improvements in pain (medium-term: MD -3.48, 95% CI -6.61, -0.35; long-term: MD -1.97, 95% CI -3.53, -0.42), self-efficacy (medium-term: SMD 0.26, 95% CI 0.16, 0.36; long-term: SMD 0.21, 95% CI 0.07, 0.36), and function (long-term: SMD -0.10, 95% CI -0.19, -0.00) relative to usual care and greater self-efficacy (medium-term: SMD 0.36, 95% CI 0.20, 0.51) relative to waitlist control. Peer support interventions resulted in similar improvement as active (health professional led) interventions bar long-term self-efficacy (MD -0.41, 95% CI -0.77, -0.05), which favoured active interventions. No point estimates reached minimal clinically important difference thresholds. Pooled health service utilisation outcomes showed unclear estimates. Self-management, quality of life, and social support outcomes had mixed evidence. Despite low-very low evidence certainty, peer support interventions demonstrated small improvements over usual care and waitlist controls for some clinical outcomes, suggesting that peer support may be useful as an adjunct to other treatments for musculoskeletal pain.
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Affiliation(s)
- Monique V Wilson
- Innovation, IMPlementation And Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, Australia
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Felicity A Braithwaite
- Innovation, IMPlementation And Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, Australia
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - John B Arnold
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Sophie M Crouch
- Innovation, IMPlementation And Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Kaurna Country, Adelaide, Australia
| | - Emily Moore
- Innovation, IMPlementation And Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Alrun Heil
- Department of Health Sciences, Bern University of Applied Sciences (BFH), Bern, Switzerland
| | - Kay Cooper
- School of Health Sciences, Robert Gordon University, Aberdeen, United Kingdom
- The Scottish Centre for Evidence-based, Multi-professional Practice: A JBI Centre of Excellence, Robert Gordon University, Aberdeen, Scotland
| | - Tasha R Stanton
- Innovation, IMPlementation And Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, Australia
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
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Calvi C, Sherman KA, Pham D. Loneliness and Perceived Social Support in Endometriosis: The Roles of Body Image Disturbance and Anticipated Stigma. Int J Behav Med 2024; 31:433-444. [PMID: 37884852 PMCID: PMC11106211 DOI: 10.1007/s12529-023-10230-w] [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] [Accepted: 10/04/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Research has identified that living with the chronic inflammatory disease endometriosis adversely impacts social functioning and interpersonal relationships, specifically, feelings of loneliness and a lack of perceived social support. Commonly experienced body image disturbance (BID), combined with the anticipation of endometriosis-related stigma from others, may result in further social withdrawal. This study aimed to quantitatively investigate the association between BID and social functioning (loneliness and diminished perceived social support), and the potential moderating effect of anticipated stigma on these associations. METHOD Participants (N = 212) with a self-reported endometriosis diagnosis completed an online questionnaire measuring social and emotional loneliness, perceived social support, BID, anticipated stigma and demographic and medical characteristics. RESULTS Mean scores indicated high levels of BID, emotional loneliness and diminished perceived social support. Bootstrapped multivariable regression analyses indicated that BID was significantly associated with greater emotional loneliness and lower perceived social support. BID was also associated bivariately with greater social loneliness. Anticipated stigma from healthcare workers moderated the association of BID with perceived social support, such that poorer perceived support was reported when anticipated stigma was high, despite the presence of minimal BID. CONCLUSION These findings highlight the psychological challenges of living with endometriosis in terms of highly prevalent BID, in the context of feeling lonely and poorly supported. The further negative impact of anticipated stigma suggests that psychosocial interventions may benefit from additionally targeting these perceptions of stigma.
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Affiliation(s)
- Catherine Calvi
- Lifespan Health and Wellbeing Research Centre, Macquarie University, 16 University Avenue, Sydney, NSW, 2109, Australia
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Kerry A Sherman
- Lifespan Health and Wellbeing Research Centre, Macquarie University, 16 University Avenue, Sydney, NSW, 2109, Australia.
- School of Psychological Sciences, Macquarie University, Sydney, Australia.
- Smart Green Cities Research Centre, Macquarie University, Sydney, Australia.
| | - Dione Pham
- School of Psychological Sciences, Macquarie University, Sydney, Australia
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Miazga E, Starkman H, Schroeder N, Nensi A, McCaffrey C. Virtual Mindfulness-Based Therapy for the Management of Endometriosis Chronic Pelvic Pain: A Novel Delivery Platform to Increase Access to Care. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102457. [PMID: 38614242 DOI: 10.1016/j.jogc.2024.102457] [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] [Received: 11/30/2023] [Revised: 03/12/2024] [Accepted: 03/19/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVES This study assessed the effectiveness of a virtual mindfulness-based stress reduction (MBSR) program to improve quality of life and pain in people with endometriosis. METHODS This was a multiple-method, before and after study design. Fifteen patients with a clinical or surgical diagnosis of endometriosis were recruited from a Canadian outpatient gynaecology clinic. Participants completed the Endometriosis Health Profile, a validated survey tool, and a pain medication use questionnaire before and after a virtual 8-week MBSR program run by an experienced social worker. A focus group was held upon completion of the program to assess participants' experiences using mindfulness for management of endometriosis symptoms. Quantitative data was analyzed with paired-samples t tests. Qualitative data was thematically analyzed. RESULTS A total of 67% of people enrolled completed the MBSR course (10/15). Following the MBSR program, participants had a statistically significant decrease in 4 components of the Endometriosis Health Profile: control and powerlessness (P = 0.012), emotional well-being (P = 0.048), social support (P = 0.030), and self-image (P = 0.014). There was no change in pain scores or medication use. Participants felt the program's benefits came from a sense of community, education about their condition, and application of mindfulness tools when approaching pain. Participants felt more comfortable with the virtual format over in-person sessions. CONCLUSIONS A virtual MBSR course can improve quality of life domains in people with endometriosis. The virtual format was effective and preferred by participants. Virtual MBSR programs may increase access to this type of care.
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Affiliation(s)
- Elizabeth Miazga
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON; Department of Obstetrics and Gynecology, Trillium Health Partners, Credit Valley Hospital, Mississauga, ON.
| | - Hava Starkman
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON
| | - Nicole Schroeder
- Department of Obstetrics and Gynecology, Unity Health, St. Michael's Hospital, Toronto, ON
| | - Alysha Nensi
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON; Department of Obstetrics and Gynecology, Unity Health, St. Michael's Hospital, Toronto, ON
| | - Carmen McCaffrey
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON; Department of Obstetrics and Gynecology, Unity Health, St. Michael's Hospital, Toronto, ON
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Si M, Chen J, Zhang X, Zhu L, Jiang Y. Pain and daily interference among reproductive-age women with myofascial pelvic pain: Serial mediation roles of kinesiophobia, self-efficacy and pain catastrophizing. PLoS One 2024; 19:e0301095. [PMID: 38739604 PMCID: PMC11090321 DOI: 10.1371/journal.pone.0301095] [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: 01/10/2024] [Accepted: 03/11/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Myofascial pelvic pain (MFPP), which is identified by tender points in the pelvic floor musculature, is a prevalent source of chronic pelvic pain in women. It may lead to physical and mental exhaustion, reproductive concerns, and coping difficulties in daily life and work than the disease itself. Pain-related cognitive processes can affect pain relief and quality of life. Kinesiophobia, self-efficacy and pain catastrophizing are frequently treated as mediators between pain and its related consequences. Greater kinesiophobia and pain catastrophizing have been shown to be associated with adverse functional outcomes, while higher self-efficacy has been related with improved quality of life. Regarding MFPP in females of childbearing age, it remains unclear whether the effects of kinesiophobia, self-efficacy and pain catastrophizing on daily interference are direct or indirect; the influence on each variable is, therefore, not entirely evident. AIM The present study aimed to evaluate the relationship between pain and daily interference in reproductive-age women with MFPP through kinesiophobia, self-efficacy and pain catastrophizing, as well as to identify areas for future investigation and intervention based on the data collected from this population. METHODS This is a multi-center cross-sectional study. The study was conducted from November 15, 2022 to November 10, 2023, 202 reproductive-age women with MFPP were recruited from 14 hospitals in ten provinces of China. The demographic variables, Brief Pain Inventory, Tampa Scale of Kinesiophobia, Pain Self-Efficacy Questionnaire, and Pain Catastrophizing Scale were used to measure the participants' related information. The data was described and analyzed using Descriptive analyses, Pearson correlation analysis, and Serial mediation modeling. RESULTS Pain not only had a direct positive impact (B = 0.575; SE = 0.081; 95%CI: LL = 0.415, UL = 0.735) on daily interference, but also had an indirect impact on daily interference through the independent mediating role of pain catastrophizing (B = 0.088; SE = 0.028; 95%CI: LL = 0.038, UL = 0.148), the chain mediating of kinesiophobia and catastrophizing (B = 0.057; SE = 0.019; 95%CI: LL = 0.024, UL = 0.098), and the four-stage serial mediating of kinesiophobia, self-efficacy and catastrophizing (B = 0.013; SE = 0.006; 95%CI: LL = 0.003, UL = 0.027). The proposed serial mediation model showed a good fit with the collected data. CONCLUSION The findings illustrate the significance of addressing pain catastrophizing and kinesiophobia (especially catastrophizing), and increasing self-efficacy in pain therapy, and suggest that functional recovery be integrated into pain therapy for reproductive-age women suffering from MFPP.
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Affiliation(s)
- Mingyu Si
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Juan Chen
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xue Zhang
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lan Zhu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yu Jiang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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de C Williams AC, McGrigor H. A thematic synthesis of qualitative studies and surveys of the psychological experience of painful endometriosis. BMC Womens Health 2024; 24:50. [PMID: 38238741 PMCID: PMC10795225 DOI: 10.1186/s12905-023-02874-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/28/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Endometriosis is a widespread problem in women of reproductive age, causing cyclical and non-cyclical pain in the pelvis and elsewhere, and associated with fatigue, fertility problems, and other symptoms. As a chronic pain problem, psychological variables are important in adjustment and quality of life, but have not been systematically studied. METHODS A systematic search of multiple databases was conducted to obtain surveys and qualitative studies of women's experience of pain from endometriosis. Surveys were combined narratively; qualitative studies were combined by thematic synthesis, and the latter rated for methodological quality. RESULTS Over 2000 records were screened on title and abstract, and provided 22 surveys and 33 qualitative studies from which accounts could be extracted of the psychological components of pain in endometriosis. Surveys mostly addressed quality of life in endometriosis, with poorer quality of life associated with higher levels of pain and of distress, but few referred to coherent psychological models. Qualitative studies focused rather on women's experience of living with endometriosis, including trajectories of diagnosis and treatment, with a few addressing meaning and identity. Thematic synthesis provided 10 themes, under the groupings of internal experience of endometriosis (impact on body, emotions, and life); interface with the external world (through self-regulation and social regulation); effects on interpersonal and social life, and encounters with medical care. CONCLUSIONS The psychological components of pain from endometriosis only partly corresponded with standard psychological models of pain, derived from musculoskeletal pain studies, with fewer fears about physical integrity and more about difficulties of managing pain and other symptoms in social settings, including work. Better understanding of the particular psychological threats of endometriosis, and integration of this understanding into medical care with opportunities for psychologically-based pain management, would substantially improve the experience and quality of life of women with painful endometriosis.
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Affiliation(s)
- Amanda C de C Williams
- Research Dept of Clinical, Educational & Health Psychology, University College London, Gower St, London, WC1E 6BT, UK.
| | - Honor McGrigor
- Research Dept of Clinical, Educational & Health Psychology, University College London, Gower St, London, WC1E 6BT, UK
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Kadah S, Soh SE, Morin M, Schneider M, Ang WC, McPhate L, Frawley H. Are pelvic pain and increased pelvic floor muscle tone associated in women with persistent noncancer pelvic pain? A systematic review and meta-analysis. J Sex Med 2023; 20:1206-1221. [PMID: 37507352 DOI: 10.1093/jsxmed/qdad089] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/23/2023] [Accepted: 06/14/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND The association between pelvic pain and pelvic floor muscle (PFM) tone in women with persistent noncancer pelvic pain (PNCPP) is unclear. AIM To synthesize the evidence of the association between pelvic pain and PFM tone in women with PNCPP. METHODS A systematic review was conducted via MEDLINE, Emcare, Embase, CINAHL, PsycINFO, and Scopus to identify relevant studies. Studies were eligible if pelvic pain and PFM tone outcome measures were reported among women aged >18 years. The National Heart, Lung, and Blood Institute's Quality Assessment Tool for Observational Cohort and Cross-sectional Studies was used to assess study quality. Studies were pooled by assessment of PFM tone via a random effects model. Associations between the presence of pelvic pain and PFM tone were assessed with odds ratio (OR), while linear associations were assessed with Pearson or Spearman correlation. OUTCOMES Pelvic pain measures (intensity, threshold, and frequency) and resting PFM tone in women with PNCPP, as evaluated by any clinical assessment method or tool. RESULTS Twenty-four studies were included in this review. The presence of pelvic pain was significantly associated with increased PFM tone as assessed by digital palpation (OR, 2.85; 95% CI, 1.66-4.89). Pelvic pain intensity was inversely but weakly associated with PFM flexibility when evaluated through dynamometry (r = -0.29; 95% CI, -0.42 to -0.17). However, no significant associations were found between pelvic pain and PFM tone when measured with other objective assessment methods. CLINICAL IMPLICATIONS Pelvic pain and increased PFM tone may not be directly associated; alternatively, a nonlinear association may exist. A range of biopsychosocial factors may mediate or moderate the association, and clinicians may need to consider these factors when assessing women with PNCPP. STRENGTHS AND LIMITATIONS This review was reported according to the PRISMA guidelines. All possible findings from relevant theses and conference abstracts were considered in our search. However, nonlinear associations between pelvic pain and increased PFM tone were not assessed as part of this review. CONCLUSION Pelvic pain may be linearly associated with increased PFM tone and decreased PFM flexibility when measured with digital palpation or dynamometry; however, this association was not observed when other aspects of PFM tone were assessed through objective methods. Future studies are required using robust assessment methods to measure PFM tone and analyses that account for other biopsychosocial factors that may influence the association.
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Affiliation(s)
- Shaza Kadah
- Department of Physiotherapy, Monash University, Melbourne, Victoria 3199, Australia
- Department of Physical Therapy, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Sze-Ee Soh
- Department of Physiotherapy, Monash University, Melbourne, Victoria 3199, Australia
| | - Melanie Morin
- School of Rehabilitation Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec J1K2R1, Canada
| | - Michal Schneider
- Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Victoria 3800, Australia
| | - W Catarina Ang
- Women's Health Services, Royal Women's Hospital, Melbourne, Victoria 3052 Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Lucy McPhate
- Department of General Medicine, The Royal Melbourne Hospital, Melbourne, Australia
| | - Helena Frawley
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria 3010, Australia
- Allied Health Research, The Royal Women's Hospital, Melbourne, Victoria 3052 Australia
- Allied Health Research, Mercy Hospital for Women, Melbourne, Victoria 3084, Australia
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Chandel PK, Maurya PK, Hussain S, Vashistha D, Sharma S. Endometriosis and Depression: A Double Agony for Women. Ann Neurosci 2023; 30:205-209. [PMID: 37779548 PMCID: PMC10540762 DOI: 10.1177/09727531231152022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/30/2022] [Indexed: 10/03/2023] Open
Abstract
Background Endometriosis is defined as a condition in which a formation of abnormal endometrial tissue outside the uterus takes place. Irrespective of any ethnic and socioeconomic class, the prevalence of the diseases has been seen among women of reproductive age. Endometriosis has been seen adversely affect the physical, psychological, social, and career of women. Summary This paper aims to identify and describe the experiences and outcomes of endometriosis healthcare by reviewing the existing literature on social and psychological effects of endometriosis. The study serves the purpose of providing insights on women's dual suffering (mental and social health) and critical comments on the present state of knowledge in order to make future recommendations for psycho-social research. The review included systematic search of the articles from various disciplines like, biology, psychology, sociology, anthropology, etc. A structured process of screening with specific inclusion and exclusion criteria was used to select the articles. The analysis of the articles resulted that woman diagnosed with endometriosis reported poor quality of life and the following symptoms such as anxiety, stress, Chronic Pelvic Pain (CPP), anxiety, dyspareunia, and dysmenorrhea. However, depression appears prominent among women diagnosed with endometriosis. There are few strategies mentioned that can be used to deal with endometriosis. Key Message The most promising causes of endometriosis include abnormality in immune functioning, atypical endometriotic growth, genetics, epigenetic, embryogenetic theory, and endocrine disruptors. The ill effects have been noted in the following domains of women's life such as work, close relationships, social well-being, and education, deteriorating their quality-of-life manifold. Psychological intervention is required to deal with the disorder as only medical treatment with pain may not be sufficient. Though, the condition can be improved by providing awareness regarding the severity of the disorder at the school and community levels.
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Affiliation(s)
- Payal Kanwar Chandel
- Department of Psychology, Central University of Haryana, Mahendragarh, Haryana, India
| | - Pawan Kumar Maurya
- Department of Biochemistry, Central University of Haryana, Mahendragarh, Haryana, India
| | | | - Divya Vashistha
- Department of Psychology, Central University of Haryana, Mahendragarh, Haryana, India
| | - Shreya Sharma
- Department of Psychology, Central University of Haryana, Mahendragarh, Haryana, India
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Barberis N, Cannavò M, Cuzzocrea F, Saladino V, Verrastro V. "Illness perceptions and factors of distress as mediators between trait emotional intelligence and quality of life in endometriosis". PSYCHOL HEALTH MED 2023; 28:1818-1830. [PMID: 36747368 DOI: 10.1080/13548506.2023.2175878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/22/2023] [Indexed: 02/08/2023]
Abstract
Past findings highlighted the presence of distress symptoms and poor quality of life in people with endometriosis. Several studies showed that trait Emotional Intelligence (trait EI) is a key component of one's wellbeing, whilst Illness Perceptions may play an important role in psychological distress and perceived quality of life. The current study sought to test the hypothesis that an association between trait EI and Quality of Life in individuals with endometriosis would be mediated by Illness Perceptions, examining also the relations with General Distress (depression, anxiety, and stress). 364 women with endometriosis aged between 18 and 58 years old (M = 33.87; SD = 8.64) filled a protocol to assess Trait EI, Illness Perceptions, General Distress, and Quality of Life. Structural Equation Modelling was used to assess the relationship between the observed variables. Illness Perception was a mediator in the relationship between Trait EI, General Distress, and Quality of Life. Moreover, General Distress was a mediator between Trait EI and Quality of Life, and between Illness Perceptions and Quality of Life. Results showed that both Trait EI and Illness perceptions are key components for levels of distress and quality of life in women with endometriosis.
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Affiliation(s)
- Nadia Barberis
- Dipartimento di Scienze della Salute, Università degli Studi MagnaGraecia di Catanzaro, viale Europa, Catanzaro (CZ), Italy
| | - Marco Cannavò
- Dipartimento di Scienze della Salute, Università degli Studi MagnaGraecia di Catanzaro, viale Europa, Catanzaro (CZ), Italy
| | - Francesca Cuzzocrea
- Dipartimento di Scienze della Salute, Università degli Studi MagnaGraecia di Catanzaro, viale Europa, Catanzaro (CZ), Italy
| | - Valeria Saladino
- Dipartimento di Scienze umane, sociali e della salute, Università degli studi di Cassino e del Lazio Meridionale, viale dell'Università, Cassino (FR), Italy
| | - Valeria Verrastro
- Dipartimento di Scienze della Salute, Università degli Studi MagnaGraecia di Catanzaro, viale Europa, Catanzaro (CZ), Italy
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10
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van Stein K, Schubert K, Ditzen B, Weise C. Understanding Psychological Symptoms of Endometriosis from a Research Domain Criteria Perspective. J Clin Med 2023; 12:4056. [PMID: 37373749 DOI: 10.3390/jcm12124056] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Endometriosis is currently the second most common gynecological disease and is associated with severe pain, vegetative impairment, and infertility. In association, there are considerable psychological symptoms that limit the quality of life of those affected. In this narrative review, the Research Domain Criteria (RDoC) framework was utilized to display the different transdiagnostic processes involved in disease progression and maintenance in regard to psychosocial functioning. Using the RDoC framework, it becomes clear that immune/endocrinological dysregulation is interlocked with (pelvic) pain chronification processes and psychological symptoms such as depressive mood, loss of control, higher vigilance toward the onset or worsening of symptoms, social isolation, and catastrophizing. This paper will discuss and identify promising treatment approaches, in addition to medical care, as well as further research implications. Endometriosis can come with substantial psychosomatic and social burden, requiring more research to understand the interdependence of different factors involved in its chronic development pathway. However, it is already clear that standard care should be extended with multifaceted treatments addressing pain, as well as the psychological and social burden, in order to halt the cycle of aggravation of symptoms and to improve quality of life for patients.
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Affiliation(s)
- Katharina van Stein
- Heidelberg University Hospital, Institute for Medical Psychology, 69115 Heidelberg, Germany
- Faculty of Behavioral and Cultural Studies, Ruprecht Karls-University, 69115 Heidelberg, Germany
| | - Kathrin Schubert
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, 35032 Marburg, Germany
| | - Beate Ditzen
- Heidelberg University Hospital, Institute for Medical Psychology, 69115 Heidelberg, Germany
- Faculty of Behavioral and Cultural Studies, Ruprecht Karls-University, 69115 Heidelberg, Germany
| | - Cornelia Weise
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, 35032 Marburg, Germany
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11
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Schreurs AMF, Dancet EAF, Apers S, Kuchenbecker WKH, van de Ven PM, Maas JWM, Lambalk CB, Nelen WLDM, van der Houwen LEE, Mijatovic V. The Relation between Patient-Centered Care and Quality of Life in Women with Endometriosis. Gynecol Obstet Invest 2023; 88:249-256. [PMID: 37231934 DOI: 10.1159/000531063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The objective of this study was to examine the hypothesis that experiences with patient-centered endometriosis care are related to the endometriosis-specific quality of life dimensions "emotional well-being" and "social support." DESIGN A secondary regression analysis of two cross-sectional studies was conducted. Participants/Materials: In total, data from 300 women were eligible for analysis. The participating women all had surgically proven endometriosis. SETTING The study was conducted in one secondary and two tertiary endometriosis clinics in the Netherlands. Questionnaires were disseminated between 2011 and 2016. METHODS Both included studies investigated patient-centeredness of endometriosis care and endometriosis-specific quality of life using, respectively, the ENDOCARE questionnaire (ECQ) and the Endometriosis Health Profile 30 (EHP-30). To increase power, the regression analysis focused on the previously found relation between the ten dimensions of the ECQ and the EHP-30 domains "emotional well-being" and "social support" rather than all five EHP-30 domains. After the Bonferroni correction to limit type 1 errors, the adjusted p value was 0.003 (0.05/20). RESULTS The participating women had a mean age of 35.7 years and had predominantly been diagnosed with moderate to severe endometriosis. None of the relations between patient-centered endometriosis care and the EHP-30 domain "emotional well-being" were significant. Three dimensions of patient-centered endometriosis care proved to be significantly related to the EHP-30 domain "social support": "information, communication, and education" (p < 0.001, beta = 0.436), "coordination and integration of care" (p = 0.001, beta = 0.307), and "emotional support and alleviation of fear and anxiety" (p = 0.002, beta = 0.259). LIMITATIONS This cross-sectional study identified relations rather than proving causality between experiencing less patient-centeredness of care and having lower quality of life. Nevertheless, it is very tangible that some causality exists, either directly or indirectly (e.g., through empowerment) and that by improving patient-centeredness, quality of life might be improved as well. CONCLUSION "Information, communication, and education"; "coordination and integration of care"; and "emotional support and alleviation of fear and anxiety" as dimensions of patient-centered endometriosis care are related to the quality of life domain "social support" of women with endometriosis. Improving the patient-centeredness of endometriosis care was already considered an important goal, but even more so given its relation with women's quality of life, which is increasingly considered the ultimate measure of health care quality. Quality improvement projects focusing on "information, communication, and education" are expected to impact women's quality of life the most.
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Affiliation(s)
- Anneke M F Schreurs
- Department of Reproductive Medicine, Endometriosis Center Amsterdam UMC, Research Institute Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eline A F Dancet
- Department of Development and Regeneration, KU Leuven, University of Leuven, Leuven, Belgium
| | - Silke Apers
- Department of Development and Regeneration, KU Leuven, University of Leuven, Leuven, Belgium
| | | | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universtiteit Amsterdam, Amsterdam, The Netherlands
| | - Jacques W M Maas
- Department of Obstetrics and Gynaecology, Maastricht UMC+ and Grow - School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Cornelis B Lambalk
- Department of Reproductive Medicine, Endometriosis Center Amsterdam UMC, Research Institute Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Willianne L D M Nelen
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lisette E E van der Houwen
- Department of Reproductive Medicine, Endometriosis Center Amsterdam UMC, Research Institute Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Velja Mijatovic
- Department of Reproductive Medicine, Endometriosis Center Amsterdam UMC, Research Institute Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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12
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Walsh EA, Chabria R, Vranceanu AM, Park ER, Post K, Peppercorn J, Temel JS, Greer JA, Jacobs JM. Understanding pain related to adjuvant endocrine therapy after breast cancer: A qualitative report. Eur J Cancer Care (Engl) 2022; 31:e13723. [PMID: 36196499 PMCID: PMC9701169 DOI: 10.1111/ecc.13723] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/06/2022] [Accepted: 09/22/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Most patients report pain while taking adjuvant endocrine therapy (AET) for the treatment of breast cancer. While studies have examined patients' experiences with side effects, none solely capture patients' experiences with AET-related pain, a troubling symptom that reduces quality of life and impairs treatment adherence. This study explored themes of AET-related pain to inform future intervention development. METHODS Between November 2017 and November 2018, female patients (n = 30) with early-stage breast cancer enrolled between 3 and 36 months post-initiation of AET. Purposeful sampling was stratified by adherence level, age, distress level and time taking AET. Study staff conducted, transcribed and coded semi-structured interviews via inductive thematic coding to identify pain-related themes and achieved high inter-coded reliability (Kappa = 0.96). RESULTS Several pain-related themes were observed. Attitudes around pain are generally negative, and management needs are largely unmet. Patients reported preferences for non-pharmacological management strategies and cited AET pain as a reason for medication breaks but not discontinuation. Patients within 19 months of starting AET and low adherers reported more intense and disruptive pain. CONCLUSIONS Patients' experiences varied by patient attributes and revealed modifiable factors that may be targeted through behavioural interventions. AET-related pain is a complex side effect for which psychosocial support may be beneficial.
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Affiliation(s)
| | | | - Ana-Maria Vranceanu
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Elyse R. Park
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Jeffrey Peppercorn
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jennifer S. Temel
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Joseph A. Greer
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jamie M. Jacobs
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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13
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Prevalence of chronic pelvic pain and primary dysmenorrhea in women of reproductive age in Ecuador. BMC Womens Health 2022; 22:363. [PMID: 36056424 PMCID: PMC9438184 DOI: 10.1186/s12905-022-01948-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 08/17/2022] [Indexed: 11/12/2022] Open
Abstract
Background Chronic pelvic pain (CPP) and primary dysmenorrhoea are debilitating conditions that can impair the quality of life of affected women. These conditions are frequently neglected, delaying proper diagnosis and healthcare provision. This study aimed to estimate the prevalence of CPP and primary dysmenorrhoea in Ecuador and identify potential variables associated with their occurrence.
Methods We conducted a cross-sectional survey in an urban neighbourhood of Quito, the capital of Ecuador. A total of 2397 participants of 14–49 years of age were included. The data were collected through questionnaires administered by trained interviewers.The crude and adjusted prevalence ratios were calculated using a log-binomial regression model. The correlation between pain intensity catastrophising of symptoms were statistically analysed. Results The prevalence of CPP and primary dysmenorrhoea was 9.8% and 8.9%, respectively. Irritative urinary symptoms, primary dysmenorrhoea, and underlying mental disorders were associated with CPP, while smoking, irritable bowel syndrome, sleep disturbance, dyspareunia, and mental disorders were associated with primary dysmenorrhoea.
Conclusions The prevalence of CPP and primary dysmenorrhoea in Ecuador was similar to that in other Latin American countries. Primary dysmenorrhoea is a risk factor of CPP, and less than a quarter of women are undergoing treatment for the condition. Our findings reinforce the importance of healthcare interventions in anticipating the diagnosis of these conditions in women of reproductive age. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01948-y.
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14
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Lackner JM, Jaccard J, Quigley BM, Ablove TS, Danforth TL, Firth RS, Gudleski GD, Krasner SS, Radziwon CD, Vargovich AM, Clemens JQ, Naliboff BD. Study protocol and methods for Easing Pelvic Pain Interventions Clinical Research Program (EPPIC): a randomized clinical trial of brief, low-intensity, transdiagnostic cognitive behavioral therapy vs education/support for urologic chronic pelvic pain syndrome (UCPPS). Trials 2022; 23:651. [PMID: 35964133 PMCID: PMC9375413 DOI: 10.1186/s13063-022-06554-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Urologic chronic pelvic pain syndrome (UCPPS) encompasses several common, costly, diagnoses including interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome that are poorly understood and inadequately treated with conventional medical therapies. Behavioral strategies, recommended as a first-line treatment for managing symptoms, are largely inaccessible, time and labor intensive, and technically complex. The Easing Pelvic Pain Interventions Clinical Research Program (EPPIC) is a clinical trial examining the efficacy of low-intensity cognitive behavioral therapy (Minimal Contact CBT or MC-CBT) for UCPPS and its durability 3 and 6 months post treatment. Additional aims include characterizing the operative processes (e.g., cognitive distancing, context sensitivity, coping flexibility, repetitive negative thought) that drive MC-CBT-induced symptom relief and pre-treatment patient variables that moderate differential response. Methods UCPPS patients (240) ages 18–70 years, any gender, ethnicity, and race, will be randomized to 4-session MC-CBT or a credible, non-specific education comparator (EDU) that controls for the generic effects from simply going to treatment. Efficacy assessments will be administered at pre-treatment, 2 weeks, and 3 and 6 months post treatment-week acute phase. A novel statistical approach applied to micro-analytic mediator assessment schedule will permit the specification of the most effective CBT component(s) that drive symptom relief. Discussion Empirical validation of a low-intensity self-management therapy transdiagnostic in scope has the potential to improve the health of chronic pelvic pain patients refractory to medical therapies, reduce social and economic costs, conserve health care resources, as well as inform evidence-based practice guidelines. Identification of change mechanisms and moderators of treatment effects can provide proactive patient-treatment matching fundamental to goals of personalized medicine. Trial Registration Clinicaltrials.gov NCT05127616. Registered on 9/19/21. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06554-9.
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Affiliation(s)
- Jeffrey M Lackner
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA.
| | - James Jaccard
- School of Social Work, New York University, New York, NY, USA.,Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Brian M Quigley
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Tova S Ablove
- Department of Obstetrics and Gynecology, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Teresa L Danforth
- Department of Urology, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Rebecca S Firth
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Gregory D Gudleski
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Susan S Krasner
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Christopher D Radziwon
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Alison M Vargovich
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | | | - Bruce D Naliboff
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
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15
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Slatman S, Mossink A, Jansen D, Broeks J, van der Lugt P, Prosman GJ, d'Hollosy WON. Factors used by general practitioners for referring patients with chronic musculoskeletal pain: a qualitative study. BMC PRIMARY CARE 2022; 23:126. [PMID: 35610564 PMCID: PMC9129062 DOI: 10.1186/s12875-022-01743-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/12/2022] [Indexed: 06/01/2023]
Abstract
Around 20% of the Dutch population is living with chronic musculoskeletal pain (CMP), which is a complex and multifactorial problem. This complexity makes it hard to define a classification system, which results in non-satisfactory referring from the general practitioner (GP). CMP is often explained using the biopsychosocial model in which biological, psychological and social factors cause and maintain the pain. The presented study investigated the factors related to the GPs' referral for patients with CMP to further treatment.Using convenience sampling, semi-structured interviews and a focus group were conducted among 14 GPs. The interviews were iteratively analyzed using inductive conventional content analysis.Analysis of the interviews demonstrated that there were 28 referral factors that were mentioned by more than 50% of the interviewed GPs. The results showed that the GPs were mostly focussing on the physical (e.g. pain location) and psychological (e.g. acceptation of pain) factors, indicating that they lack focus on the social factors. Furthermore, unfamiliarity of GPs with treatment options was a noteworthy finding.The referral of patients with CMP by GPs is complex and based on multiple factors. To improve referral, it is recommended to include social factors in the decision-making process and to increase the familiarity of the GPs with available treatments.
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Affiliation(s)
- Syl Slatman
- Department of Psychology Health & Technology, University of Twente, Faculty of Behavioral, Management & Social Sciences (BMS), De Zul 10, 7522NJ, Enschede, the Netherlands.
| | - Annemiek Mossink
- Department of Psychology Health & Technology, University of Twente, Faculty of Behavioral, Management & Social Sciences (BMS), De Zul 10, 7522NJ, Enschede, the Netherlands
| | - Duncan Jansen
- Department of EEMCS/BSS, University of Twente, Enschede, the Netherlands
| | - José Broeks
- Department of Rehabilitation, Zorggroep Twente, Almelo, the Netherlands
- Roessingh Rehabilitation Center (Department of Chronic Pain), Enschede, the Netherlands
| | - Peter van der Lugt
- Research Department General Practice, General Practitioner Cooperative Twente (THOON), Hengelo, the Netherlands
| | - Gert-Jan Prosman
- Department of Psychology Health & Technology, University of Twente, Faculty of Behavioral, Management & Social Sciences (BMS), De Zul 10, 7522NJ, Enschede, the Netherlands
- Roessingh Rehabilitation Center (Department of Chronic Pain), Enschede, the Netherlands
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Hawkey A, Chalmers KJ, Micheal S, Diezel H, Armour M. “A day-to-day struggle”: A comparative qualitative study on experiences of women with endometriosis and chronic pelvic pain. FEMINISM & PSYCHOLOGY 2022. [DOI: 10.1177/09593535221083846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Chronic pelvic pain (CPP) in women is a term that encompasses a range of conditions, including endometriosis, vulvodynia, painful bladder syndrome and adenomyosis. Given the impact on penetrative sex, fertility and potentially motherhood, CPP may also impact on women's identities as a wife or partner, a mother, and a woman. The aim of this study was to explore similarities and differences in experiences of women with endometriosis and non-endometriosis related CPP. A total of 17 participants aged between 21 and 48 years old participated in three focus groups. Using reflexive thematic analysis three main themes were found: the struggling woman, the unheard woman and the self-silenced woman. Women, regardless of the cause of their CPP, reported significant impacts on their intimate relationships, fertility, and parenting but those with non-endometriosis CPP often reported greater trouble communicating about pelvic pain in the workplace due to the “taboo” nature of discussing their vulval pain. Many participants described how a societal normalisation of pelvic pain resulted in women silencing their experiences, rendering their pain invisible. While women wanted to resist such silencing through information and support seeking, women with non-endometriosis CPP described fewer avenues to accessing credible informational resources or networks for support.
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17
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Medeiros P, Medeiros AC, Coimbra JPC, de Paiva Teixeira LEP, Salgado-Rohner CJ, da Silva JA, Coimbra NC, de Freitas RL. Physical, Emotional, and Social Pain During COVID-19 Pandemic-Related Social Isolation. TRENDS IN PSYCHOLOGY 2022. [PMCID: PMC8886700 DOI: 10.1007/s43076-022-00149-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The socio-emotional condition during the COVID-19 pandemic subsidises the (re)modulation of interactive neural circuits underlying risk assessment behaviour at the physical, emotional, and social levels. Experiences of social isolation, exclusion, or affective loss are generally considered some of the most “painful” things that people endure. The threats of social disconnection are processed by some of the same neural structures that process basic threats to survival. The lack of social connection can be “painful” due to an overlap in the neural circuitry responsible for both physical and emotional pain related to feelings of social rejection. Indeed, many of us go to great lengths to avoid situations that may engender these experiences. Accordingly, this work focuses on pandemic times; the somatisation mentioned above seeks the interconnection and/or interdependence between neural systems related to emotional and cognitive processes such that a person involved in an aversive social environment becomes aware of himself, others, and the threatening situation experienced and takes steps to avoid daily psychological and neuropsychiatric effects. Social distancing during isolation evokes the formation of social distress, increasing the intensity of learned fear that people acquire, consequently enhancing emotional and social pain.
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Affiliation(s)
- Priscila Medeiros
- Laboratory of Neuroanatomy and Neuropsychobiology, Department of Pharmacology, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Av. Bandeirantes, 3900, São Paulo, Ribeirão Preto 14049-900 Brazil
- Laboratory of Neurosciences of Pain & Emotions and Multi-User Centre of Neuroelectrophysiology, Department of Surgery and Anatomy, Ribeirão Preto Medical School of the University of São Paulo, Av. Bandeirantes, 3900, São Paulo, Ribeirão Preto 14049-900 Brazil
| | - Ana Carolina Medeiros
- Laboratory of Neuroanatomy and Neuropsychobiology, Department of Pharmacology, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Av. Bandeirantes, 3900, São Paulo, Ribeirão Preto 14049-900 Brazil
- Laboratory of Neurosciences of Pain & Emotions and Multi-User Centre of Neuroelectrophysiology, Department of Surgery and Anatomy, Ribeirão Preto Medical School of the University of São Paulo, Av. Bandeirantes, 3900, São Paulo, Ribeirão Preto 14049-900 Brazil
- Behavioural Neurosciences Institute (INeC), Av. do Café, 2450, São Paulo, Ribeirão Preto 14050-220 Brazil
| | - Jade Pisssamiglio Cysne Coimbra
- Pontificial Catholic University of Campinas (PUC-Campinas), Prof Dr Euryclides de Jesus Zerbini Str., 1516, Parque Rural Fazenda Santa Cândida, Campinas, São Paulo, 13087-571 Brazil
| | | | - Carlos José Salgado-Rohner
- NeuroSmart Lab, International School of Economics and Administrative Sciences, Universidad de La Sabana, Chia, Colombia
| | - José Aparecido da Silva
- Laboratory of Psychophysics, Perception, Psychometrics, and Pain, Department of Psychology, Ribeirão Preto School of Philosophy, Sciences and Literature of the University of São Paulo (FFCLRP-USP), São Paulo, Ribeirão Preto 14049-901 Brazil
| | - Norberto Cysne Coimbra
- Laboratory of Neuroanatomy and Neuropsychobiology, Department of Pharmacology, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Av. Bandeirantes, 3900, São Paulo, Ribeirão Preto 14049-900 Brazil
- Behavioural Neurosciences Institute (INeC), Av. do Café, 2450, São Paulo, Ribeirão Preto 14050-220 Brazil
| | - Renato Leonardo de Freitas
- Laboratory of Neurosciences of Pain & Emotions and Multi-User Centre of Neuroelectrophysiology, Department of Surgery and Anatomy, Ribeirão Preto Medical School of the University of São Paulo, Av. Bandeirantes, 3900, São Paulo, Ribeirão Preto 14049-900 Brazil
- Behavioural Neurosciences Institute (INeC), Av. do Café, 2450, São Paulo, Ribeirão Preto 14050-220 Brazil
- Biomedical Sciences Institute, Federal University of Alfenas (UNIFAL-MG), Gabriel Monteiro da Silva Str., 700, Alfenas, Minas Gerais 37130-000 Brazil
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Riffin C, Patrick K, Lin SL, Carrington Reid M, Herr K, Pillemer KA. Caregiver-provider communication about pain in persons with dementia. DEMENTIA 2022; 21:270-286. [PMID: 34340587 PMCID: PMC9158475 DOI: 10.1177/14713012211036868] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Pain in older persons with dementia is both under-detected and under-managed. Family caregivers can play an important role in addressing these deficiencies by communicating their care recipient's symptoms and behaviors to medical providers, but little is known about how caregivers and providers approach pain-related discussions in the context of dementia. The goal of this study was to explore how ambulatory care providers and family caregivers of persons with dementia view pain communication. METHODS In-depth, semi-structured interviews were conducted with family caregivers (n = 18) and healthcare providers involved in dementia care (n = 16). Interviews focused on three specific content areas: (1) caregivers' roles in communicating about pain in persons with dementia, (2) challenges experienced when communicating about pain in persons with dementia, and (3) strategies and recommendations for optimizing communication in this context. All interviews were audio-recorded, transcribed, and analyzed using the constant comparative method of data analysis. RESULTS Caregivers and providers described various roles that caregivers assumed in communication processes, such as serving as historians, interpreters, and advocates. They identified two key features of problematic communication-receipt of inadequate information and interpersonal conflict about the care recipient's pain-and articulated how ambiguity around pain and dementia, as well as preexisting beliefs and emotions, contributed to communication challenges. They also offered several suggestions to improve caregiver-provider communication processes, including the use of (1) written records to enhance the accuracy of caregivers' reports and ensure that providers had specific information to inform symptom management and treatment plans, (2) pain scales and follow-up discussions to establish baseline data and clarify treatment recommendations, and (3) collaboration and rapport-building strategies to validate the caregivers' contributions and maximize a team-based decision-making. CONCLUSION Receipt of inadequate information and interpersonal conflict are key challenges to caregiver-provider communication regarding pain in persons with dementia. Written records, pain scales, and rapport-building strategies may help to address these challenges.
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Affiliation(s)
- Catherine Riffin
- Department of Medicine, 12295Weill Cornell Medicine, New York, NY, USA
| | - Karlee Patrick
- Department of Psychological Sciences, 4229Kent State University, Kent, OH, USA
| | - Sylvia L Lin
- 546065New York University Long Island School of Medicine, Long Island, NY, USA
| | - M Carrington Reid
- Department of Medicine, 12295Weill Cornell Medicine, New York, NY, USA
| | - Keela Herr
- College of Nursing, 16102University of Iowa, Iowa City, IA, USA
| | - Karl A Pillemer
- College of Human Ecology, 12295Cornell University, Ithaca, NY, USA
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Miró J, Sánchez-Rodríguez E, Ferreira-Valente A, Pais-Ribeiro J, Ciaramella A. Effects of COVID-19 Social Distancing Measures in Individuals with Chronic Pain Living in Spain in the Late Stages of the Lockdown. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11732. [PMID: 34831489 PMCID: PMC8624638 DOI: 10.3390/ijerph182211732] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 01/05/2023]
Abstract
Social distancing measures during the lockdown have had a negative impact on chronic pain patients' function. Research, however, has only focused on the early stages of the first lockdowns. The aim of this study was to improve the understanding of the effects of COVID-19 social distancing measures on individuals with chronic pain living in Spain during the late stages of the lockdown. A group of 361 adults with pain participated in this study. They responded to an online survey and provided information on sociodemographic issues, pain, fatigue, perceived health, and quality of life. The data showed that most participants suffered moderate to severe pain and interferences with pain treatment and an increase in pain intensity during the lockdown. Most participants also informed us that fatigue had worsened during the lockdown (62%). Importantly, females with lower monthly family income and lower education have been found to be associated with greater levels of pain and fatigue. Despite this, participants perceived themselves as having good health and good quality of life. The findings from this study can be used to inform policy and specific responses for future COVID-19 waves and future pandemics where social distancing measures must be implemented.
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Affiliation(s)
- Jordi Miró
- Research Center for Behavior Assessment (CRAMC), Unit for the Study and Treatment of Pain—ALGOS, Department of Psychology, Universitat Rovira i Virgili, 43007 Catalonia, Spain;
- Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43003 Catalonia, Spain
| | - Elisabet Sánchez-Rodríguez
- Research Center for Behavior Assessment (CRAMC), Unit for the Study and Treatment of Pain—ALGOS, Department of Psychology, Universitat Rovira i Virgili, 43007 Catalonia, Spain;
- Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43003 Catalonia, Spain
| | - Alexandra Ferreira-Valente
- William James Center for Research, ISPA—University Institute, 1100-304 Lisbon, Portugal; (A.F.-V.); (J.P.-R.)
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - José Pais-Ribeiro
- William James Center for Research, ISPA—University Institute, 1100-304 Lisbon, Portugal; (A.F.-V.); (J.P.-R.)
- Faculty of Psychology and Education Sciences, University of Porto, 4099-002 Porto, Portugal
| | - Antonella Ciaramella
- Lab. of Psychosomatic, GIFT Institute of Integrative Medicine, 56126 Pisa, Italy;
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20
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Abstract
OBJECTIVES The primary aim of this study was to better understand the role that social factors (ie, social support, satisfaction in participation with social roles, social isolation, and self-perceived ability to perform social roles and activities) play in pain-related interference and depressive symptoms in adults with chronic pain. Moreover, this study also examined if sex exerts a moderating role in these associations. MATERIALS AND METHODS In this cross-sectional study, 364 adults with chronic pain participated: 133 were university students and 231 were individuals from the community. University students completed a paper-and-pencil survey and individuals from the community responded to a web-based survey. Both surveys included the same questions assessing sociodemographic, pain characteristics, pain-related interference, depressive symptoms, and social factors. RESULTS Only satisfaction in participation in usual social roles and self-perceived ability for participating in such social roles contributed independently, significantly, and negatively to the prediction of pain interference, whereas all 4 social factors made independent and significant contributions to the prediction of depressive symptoms. Satisfaction with participation in usual social roles, self-perceived social ability, and social support were negatively related to depressive symptoms, whereas social isolation was positively related. The results also indicated that sex moderated the associations between social factors and depressive symptoms, but not between social factors and pain interference. DISCUSSION The study provides important new findings regarding the associations between social factors and physical and psychological functioning of individuals with chronic pain, supporting biopsychosocial models.
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Poli-Neto OB, Oliveira AMZ, Salata MC, Cesar Rosa-E-Silva J, Machado DRL, Candido-Dos-Reis FJ, Nogueira AA. Strength Exercise Has Different Effects on Pressure Pain Thresholds in Women with Endometriosis-Related Symptoms and Healthy Controls: A Quasi-experimental Study. PAIN MEDICINE 2021; 21:2280-2287. [PMID: 31800061 DOI: 10.1093/pm/pnz310] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate the influence of strength exercises on remote pain sensitivity in women with endometriosis-related symptoms. DESIGN A quasi-experimental study. SETTING University Hospital, a tertiary health unit. SUBJECTS Twenty-one women with endometriosis-related symptoms and 21 healthy women provided written informed consent. METHODS The participants performed weekly exercise sessions on an extensor chair for four consecutive weeks. An electronic algometer was used to measure the pressure pain thresholds on the nondominant forearm. Heart rate and blood pressure were measured using a digital device. All measurements were taken before, immediately after, and 10 and 20 minutes after the exercise series. RESULTS Women with endometriosis-related symptoms had lower pain thresholds. Pressure pain thresholds increased immediately after exercise in healthy women, returning to baseline level 20 minutes after exercise. Women with endometriosis-related symptoms did not present significant pressure pain threshold alterations after exercise. However, they had a higher heart rate and systolic, diastolic, and average blood pressure than healthy women at all the timepoints. There were no consistent correlations between pressure pain thresholds and heart rate or blood pressure. CONCLUSIONS The strength exercise regimen used in this study increased pain thresholds in healthy women but not in women with endometriosis-related painful symptoms. The maintenance or even worsening of pain perception after exercise in women with persistent pain, such as those with endometriosis, may limit their adherence to a physical training program, which in turn could prevent them from experiencing the long-term beneficial effects of exercise.
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Affiliation(s)
- Omero Benedicto Poli-Neto
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Arthur Marques Zecchin Oliveira
- Sport Science, School of Physical Education and Sport, Ribeirão Preto Medical School, University of the São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Mariana Cecchi Salata
- Physiotherapy, Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Julio Cesar Rosa-E-Silva
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Dalmo Roberto Lopes Machado
- Sport Science, School of Physical Education and Sport, Ribeirão Preto Medical School, University of the São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Francisco Jose Candido-Dos-Reis
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Antonio Alberto Nogueira
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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22
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Estes SJ, Huisingh CE, Chiuve SE, Petruski-Ivleva N, Missmer SA. Depression, Anxiety, and Self-Directed Violence in Women With Endometriosis: A Retrospective Matched-Cohort Study. Am J Epidemiol 2021; 190:843-852. [PMID: 33184648 PMCID: PMC8247611 DOI: 10.1093/aje/kwaa249] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/04/2020] [Accepted: 11/04/2020] [Indexed: 12/19/2022] Open
Abstract
The purpose of this study was to compare the incidence of mental health outcomes in women in the United States with and without documented endometriosis. In a retrospective matched-cohort study using administrative health claims data from Optum's Clinformatics DataMart from May 1, 2000, through March 31, 2019, women aged 18-50 years with endometriosis (n = 72,677), identified by International Classification of Disease diagnosis codes (revisions 9 or 10), were matched 1:2 on age and calendar time to women without endometriosis (n = 147,251), with a median follow-up of 529 days (interquartile range, 195, 1,164). The rate per 1,000 person-years of anxiety, depression, and self-directed violence among women with endometriosis was 57.1, 47.7, and 0.9, respectively. Comparing women with endometriosis to those without, the adjusted hazard ratios and 95% confidence intervals were 1.38 (1.34, 1.42) for anxiety, 1.48 (1.44, 1.53) for depression, and 2.03 (1.60, 2.58) for self-directed violence. The association with depression was stronger among women younger than 35 years (P for heterogeneity < 0.01). Risk factors for incident depression, anxiety, and self-directed violence among women with endometriosis included endometriosis-related pain symptoms and prevalence of other chronic conditions associated with pain. The identification of risk factors for mental health conditions among women with endometriosis may improve patient-centered disease management.
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Affiliation(s)
| | - Carrie E Huisingh
- Correspondence to Dr. Carrie E. Huisingh, Pharmacovigilance
& Patient Safety, AbbVie, Inc., 1 North Waukegan Road, North Chicago, IL
60064 (e-mail: )
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23
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Towne J, Suliman Y, Russell KA, Stuparich MA, Nahas S, Behbehani S. Health Information in the Era of Social Media: An Analysis of the Nature and Accuracy of Posts Made by Public Facebook Pages for Patients with Endometriosis. J Minim Invasive Gynecol 2021; 28:1637-1642. [PMID: 33582381 DOI: 10.1016/j.jmig.2021.02.005] [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: 12/11/2020] [Revised: 02/05/2021] [Accepted: 02/06/2021] [Indexed: 10/22/2022]
Abstract
STUDY OBJECTIVE To analyze the nature and accuracy of social media (Facebook) content related to endometriosis. DESIGN Retrospective content analysis. SETTING Social media platform, Facebook. PARTICIPANTS Social media posts on Facebook endometriosis pages. INTERVENTIONS A search of public Facebook pages was performed using the key word "endometriosis." Posts from the month-long study period were categorized and analyzed for accuracy. Two independent researchers used thematic evaluation to place posts into the following 11 categories: educational, emotional support, advocacy, discussion, events, humor, promotional, recipes, resources, surveys, and other. Posts categorized as educational were further subcategorized and reviewed. Each posted fact was cross-referenced in peer-reviewed scientific journals to determine whether the claim made was evidence-based. Engagement in a post was calculated by taking the sum of comments, shares, and reactions. MEASUREMENTS AND MAIN RESULTS A total of 53 Facebook pages meeting inclusion criteria were identified and 1464 posts from the study period were evaluated. Emotional support posts comprised the largest category of posts (48%) followed by educational posts (21%). Within the educational category, the epidemiology and pathophysiology subcategory comprised the largest group (42.0%) followed by the symptom's subcategory (19.6%). Post category had an effect on the amount of post engagement (p-value <.001) with emotional posts generating 70% of the overall engagement. The subcategories of the educational posts demonstrated a similar effect on engagement (p-value <.001). Posts were more engaging if they contained epidemiology and pathophysiology information with 44% of all engagement of educational posts occurring within this subcategory. Educational posts were found to be 93.93% accurate. There was no correlation between post engagement and post information accuracy (p-value = .312). CONCLUSION Facebook pages offer emotional support and education to people with endometriosis. Most information found in these Facebook pages is evidence-based. Clinicians should consider discussing the use of Facebook pages with their patients diagnosed with endometriosis.
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Affiliation(s)
- Jordan Towne
- Departments of Obstetrics and Gynecology (Drs. Stuparich, Nahas, Behbehani, Ms. Towne, and Ms. Suliman); Entomology (Ms. Russell), University of California, Riverside, California.
| | - Yasmine Suliman
- Departments of Obstetrics and Gynecology (Drs. Stuparich, Nahas, Behbehani, Ms. Towne, and Ms. Suliman); Entomology (Ms. Russell), University of California, Riverside, California
| | - Kaleigh A Russell
- Departments of Obstetrics and Gynecology (Drs. Stuparich, Nahas, Behbehani, Ms. Towne, and Ms. Suliman); Entomology (Ms. Russell), University of California, Riverside, California
| | - Mallory A Stuparich
- Departments of Obstetrics and Gynecology (Drs. Stuparich, Nahas, Behbehani, Ms. Towne, and Ms. Suliman); Entomology (Ms. Russell), University of California, Riverside, California
| | - Samar Nahas
- Departments of Obstetrics and Gynecology (Drs. Stuparich, Nahas, Behbehani, Ms. Towne, and Ms. Suliman); Entomology (Ms. Russell), University of California, Riverside, California
| | - Sadikah Behbehani
- Departments of Obstetrics and Gynecology (Drs. Stuparich, Nahas, Behbehani, Ms. Towne, and Ms. Suliman); Entomology (Ms. Russell), University of California, Riverside, California
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24
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Living with Restrictions. The Perspective of Nursing Students with Primary Dysmenorrhea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228527. [PMID: 33212985 PMCID: PMC7698483 DOI: 10.3390/ijerph17228527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 12/30/2022]
Abstract
Primary dysmenorrhea (PD) affects a large number of female university students, diminishing their quality of life and hindering academic performance, representing a significant cause of absenteeism. The purpose of our study was to determine how nursing students experienced restrictions as a result of primary dysmenorrhea. A qualitative exploratory study was conducted among 33 nursing students with primary dysmenorrhea. A purposeful sampling strategy was applied. Data were collected from five focus groups (two sessions each) and the field notes of 10 researchers. A video meeting platform was used to conduct the focus groups. A thematic inductive analysis was performed. Thirty-three female nursing students participated in the study with a mean age of 22.72 (SD 3.46) years. Three broad themes emerged: (a) restrictions on daily activities and sports; (b) academic restrictions, and (c) restrictions on social and sexual relationships. The students described restrictions in performing everyday activities, such as carrying weight, and shopping. Some students even gave up the practice of sports and were absent from classes at the university, and from clinical practices at the hospital. The pain affected their ability to maintain and create new social relationships. Primary dysmenorrhea caused restrictions in the personal, social and academic life of the nursing students.
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25
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Allaire C, Long AJ, Bedaiwy MA, Yong PJ. Interdisciplinary Teams in Endometriosis Care. Semin Reprod Med 2020; 38:227-234. [PMID: 33080631 DOI: 10.1055/s-0040-1718943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Endometriosis-associated chronic pelvic pain can at times be a complex problem that is resistant to standard medical and surgical therapies. Multiple comorbidities and central sensitization may be at play and must be recognized with the help of a thorough history and physical examination. If a complex pain problem is identified, most endometriosis expert reviews and guidelines recommend multidisciplinary care. However, there are no specific recommendations about what should be the components of this approach and how that type of team care should be delivered. There is evidence showing the effectiveness of specific interventions such as pain education, physical therapy, psychological therapies, and pharmacotherapies for the treatment of chronic pain. Interdisciplinary team models have been well studied and validated in other chronic pain conditions such as low back pain. The published evidence in support of interdisciplinary teams for endometriosis-associated chronic pain is more limited but appears promising. Based on the available evidence, a model for an interdisciplinary team approach for endometriosis care is outlined.
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Affiliation(s)
- Catherine Allaire
- Department of Obstetrics and Gynecology, The University of British Columbia, Vancouver, Canada.,BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, Canada
| | - Alicia Jean Long
- Department of Obstetrics and Gynecology, The University of British Columbia, Vancouver, Canada.,BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, Canada
| | - Mohamed A Bedaiwy
- Department of Obstetrics and Gynecology, The University of British Columbia, Vancouver, Canada.,BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, Canada
| | - Paul J Yong
- Department of Obstetrics and Gynecology, The University of British Columbia, Vancouver, Canada.,BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, Canada
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26
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Metzemaekers J, Slotboom S, Sampat J, Vermolen P, Smeets MJGH, Elske van den Akker-van Marle M, Maas J, Bakker EC, Nijkamp M, Both S, Jansen FW. Crossroad decisions in deep endometriosis treatment options: a qualitative study among patients. Fertil Steril 2020; 115:702-714. [PMID: 33070963 DOI: 10.1016/j.fertnstert.2020.06.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/06/2020] [Accepted: 06/20/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To study the experiences, considerations, and motivations of patients with endometriosis in the decision-making process for deep endometriosis (DE) treatment options. DESIGN Qualitative study using semi-structured in-depth focus group methodology. SETTING University medical center. PATIENT(S) A total of 19 Dutch women diagnosed with DE between 27 and 47 years of age. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) Focus group topics were disease impact and motives for treatment, expectations of the treatment process, and important factors in the decision process. RESULT(S) Women reported that pain, fertility, and strong fear of complications are important decisive factors in the treatment process. The goal of conceiving a child is considered important, however, sometimes doctors emphasize this topic too much. It emerged that complication counseling is frequently about surgical complications, whereas side effects of hormonal treatments are neglected. Shared decision making and information about treatment options, complications, and side effects are not always optimal, making it difficult to make a well-considered choice. Despite negative experiences encountered after surgery, the positive effect of surgery ensures that most women do not regret their choice. CONCLUSION(S) In the treatment decision process for patients with DE, pain is almost always the most important decisive factor. The wish to conceive and strong fear of complications can change this choice. Doctors should understand the importance of fertility for the majority of women, but, also, if this is not considered paramount, respect that view. To improve shared decision making, exploration of treatment goals, training of healthcare providers, and better patient information provision are desirable.
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Affiliation(s)
- Jeroen Metzemaekers
- Department of Gynecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Suzanne Slotboom
- Department of Applied Psychology, University of Applied Sciences, Leiden, the Netherlands
| | - Jonathan Sampat
- Department of Gynecology, Maxima Medical Centre, Veldhoven, the Netherlands
| | - Polo Vermolen
- Department of Gynecology, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - M Elske van den Akker-van Marle
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jacques Maas
- Department of Gynecology, Maxima Medical Centre, Veldhoven, the Netherlands
| | - Esther C Bakker
- Department of Psychology, Open University, Heerlen, the Netherlands
| | - Marjan Nijkamp
- Department of Psychology, Open University, Heerlen, the Netherlands
| | - Stephanie Both
- Department of Gynecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Frank Willem Jansen
- Department of Gynecology, Leiden University Medical Centre, Leiden, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands.
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27
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Mellado BH, Pilger TL, Poli Neto OB, Rosa E Silva JC, Nogueira AA, do Vale Brandão C, Candido Dos Reis FJ. Daily life attitudes of women with moderate or severe chronic pelvic pain. A qualitative study. Eur J Obstet Gynecol Reprod Biol 2020; 254:109-113. [PMID: 32950889 DOI: 10.1016/j.ejogrb.2020.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/28/2020] [Accepted: 09/04/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE How a woman copes with the pain might play a significant role in the management of chronic pelvic pain. This study aimed to understand the attitudes adopted by women with chronic pelvic pain (CPP) to deal with daily life problems caused by the illness. STUDY DESIGN We conducted a qualitative study including 58 women diagnosed with chronic pelvic pain regardless of the cause. To collect the data, we used semi-structured interviews with the key question: "How do you handle the pain in your daily life?". The interviews were audio-recorded and transcribed. We conducted a qualitative thematic analysis of transcribed texts following the sequence: 1) initial reading; 2) preliminary identification of codes; 3) identification of themes; 4) review of themes; 5) nominating the themes in categories; 6) final study synthesis. The analysis was performed with the aid of the RQDA package in the R environment. RESULTS Daily life attitudes varied from submission to the pain to positive coping. We identified five major categories: 1) shaping life by pain; 2) isolating from social contact; 3) avoiding sexual relationship; 4) seeking pain relief; 5) seeking positive strategies. Positive strategies were more frequent in older women. CONCLUSION Women with chronic pelvic pain adopted a broad spectrum of attitudes to deal with the pain in daily life. The depth understanding of patient perspectives has the potential to improve the multidisciplinary care of this debilitating condition.
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Affiliation(s)
- Bruna Helena Mellado
- Department of Gynecology and Obstetrics of Ribeirão Preto School of Medicine - University of São Paulo, Brazil
| | - Taynara Louisi Pilger
- Department of Gynecology and Obstetrics of Ribeirão Preto School of Medicine - University of São Paulo, Brazil
| | - Omero Benedicto Poli Neto
- Department of Gynecology and Obstetrics of Ribeirão Preto School of Medicine - University of São Paulo, Brazil
| | - Julio Cesar Rosa E Silva
- Department of Gynecology and Obstetrics of Ribeirão Preto School of Medicine - University of São Paulo, Brazil
| | - Antonio Alberto Nogueira
- Department of Gynecology and Obstetrics of Ribeirão Preto School of Medicine - University of São Paulo, Brazil
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28
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Villegas-Echeverri JD, Carrillo JF. Navigating the COVID-19 waters with chronic pelvic pain. Int J Gynaecol Obstet 2020; 151:172-174. [PMID: 32936448 PMCID: PMC9087540 DOI: 10.1002/ijgo.13359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/03/2020] [Accepted: 08/24/2020] [Indexed: 12/14/2022]
Affiliation(s)
| | - Jorge F Carrillo
- Department of Obstetrics and Gynecology, University of Central Florida, Orlando, FL, USA
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29
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Allyn K, Evans S, Seidman LC, Payne LA. "Tomorrow, I'll Be Fine": Impacts and coping mechanisms in adolescents and young adults with primary dysmenorrhoea. J Adv Nurs 2020; 76:2637-2647. [PMID: 32761654 DOI: 10.1111/jan.14460] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/13/2020] [Accepted: 06/01/2020] [Indexed: 12/30/2022]
Abstract
AIMS To understand the experiences of adolescents and young adults with primary dysmenorrhoea through the lens of structured frameworks extant in contemporary pain literature. DESIGN Descriptive qualitative study. METHODS Thirty-nine adolescents and young adults (ages 16-24 years) with primary dysmenorrhoea participated in semi-structured in-person interviews. Transcripts of the interviews were analysed using deductive thematic analysis from November 2018 to April 2019. RESULTS Two overarching themes, each with subthemes, were identified. The first theme, primary dysmenorrhoea impacts the whole person, contained the following subthemes: biological, social, and psychological. The second theme, coping mechanisms of women with primary dysmenorrhoea, contained the following subthemes: primary, secondary, and passive coping. CONCLUSION Women experience several primary dysmenorrhoea-related impacts on their biological, social, and psychological functioning. Women employ a variety of coping mechanisms to manage their primary dysmenorrhoea pain. IMPACT This study emphasizes the significant effects of primary dysmenorrhoea on nearly every aspect of women's lives and contributes to an understanding of the ways women cope with this pain. The findings of this study underscore the need for continued consideration of primary dysmenorrhoea as a debilitating pain process as well as the need for additional interventions to help women manage this condition.
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Affiliation(s)
| | - Subhadra Evans
- School of Psychology, Deakin University, Geelong, Vic., Australia
| | | | - Laura A Payne
- McLean Hospital, Belmont, MA, USA.,Harvard Medical School, Boston, MA, USA
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30
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Leonardi M, Horne AW, Vincent K, Sinclair J, Sherman KA, Ciccia D, Condous G, Johnson NP, Armour M. Self-management strategies to consider to combat endometriosis symptoms during the COVID-19 pandemic. Hum Reprod Open 2020; 2020:hoaa028. [PMID: 32509977 PMCID: PMC7263080 DOI: 10.1093/hropen/hoaa028] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 04/30/2020] [Indexed: 12/19/2022] Open
Abstract
The care of patients with endometriosis has been complicated by the coronavirus disease 2019 (COVID-19) pandemic. Medical and allied healthcare appointments and surgeries are being temporarily postponed. Mandatory self-isolation has created new obstacles for individuals with endometriosis seeking pain relief and improvement in their quality of life. Anxieties may be heightened by concerns over whether endometriosis may be an underlying condition that could predispose to severe COVID-19 infection and what constitutes an appropriate indication for presentation for urgent treatment in the epidemic. Furthermore, the restrictions imposed due to COVID-19 can impose negative psychological effects, which patients with endometriosis may be more prone to already. In combination with medical therapies, or as an alternative, we encourage patients to consider self-management strategies to combat endometriosis symptoms during the COVID-19 pandemic. These self-management strategies are divided into problem-focused and emotion-focused strategies, with the former aiming to change the environment to alleviate pain, and the latter address the psychology of living with endometriosis. We put forward this guidance, which is based on evidence and expert opinion, for healthcare providers to utilize during their consultations with patients via telephone or video. Patients may also independently use this article as an educational resource. The strategies discussed are not exclusively restricted to consideration during the COVID-19 pandemic. Most have been researched before this period of time and all will continue to be a part of the biopsychological approach to endometriosis long after COVID-19 restrictions are lifted.
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Affiliation(s)
- Mathew Leonardi
- Acute Gynaecology, Early Pregnancy, and Advanced Endoscopy Surgery Unit, Nepean Hospital, Kingswood, Australia
- Sydney Medical School Nepean, University of Sydney, Sydney, Australia
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
| | - Andrew W Horne
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Katy Vincent
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Justin Sinclair
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Kerry A Sherman
- Department of Psychology, Centre for Emotional Health, Macquarie University, North Ryde, Australia
| | - Donna Ciccia
- Endometriosis Australia, Sydney South, Australia
| | - George Condous
- Acute Gynaecology, Early Pregnancy, and Advanced Endoscopy Surgery Unit, Nepean Hospital, Kingswood, Australia
- Sydney Medical School Nepean, University of Sydney, Sydney, Australia
| | - Neil P Johnson
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- Auckland Gynaecology Group and Repromed Auckland, Auckland, New Zealand
| | - Mike Armour
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
- Translational Health Research Institute (THRI); Western Sydney University, Penrith, Australia
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31
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Dnes N, Coley B, Frisby K, Keller A, Suyom J, Tsui C, Grant G, Vader K, Hunter J. "A little bit of a guidance and a little bit of group support": a qualitative study of preferences, barriers, and facilitators to participating in community-based exercise opportunities among adults living with chronic pain. Disabil Rehabil 2020; 43:3347-3356. [PMID: 32223460 DOI: 10.1080/09638288.2020.1742801] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Purpose: To understand preferences, barriers, and facilitators to participating in community-based exercise opportunities among adults living with chronic pain.Materials and Methods: An interpretive description methodology based on semi-structured interviews was conducted. Adults (age>18 years) living with chronic pain (pain >3 months in duration) were recruited from a multidisciplinary chronic pain clinic in Toronto, Canada. Thematic analysis was used to conceptualize interview data.Results: Fifteen adults living with chronic pain (11/15 women) were interviewed. Four themes regarding preferences, barriers, and facilitators to participation in community-based exercise are described: (1) accessibility (e.g., cost, location, scheduling, and access to program information from healthcare providers); (2) intrinsic factors (e.g., pain, mental health, and motivation); (3) social factors (e.g., isolation, participation with people with similar capabilities, and safe environment); and (4) program factors (e.g., tailored to adults living with chronic pain, gentle exercise, group-based, and delivered by an instructor knowledgeable about chronic pain).Conclusions: Participation in community-based exercise opportunities among adults living with chronic pain may be influenced by accessibility, intrinsic factors, social factors, and program factors. Results provide a foundation of understanding to develop person-centered community-based exercise opportunities that are tailored to meet the preferences of this population.Implications for RehabilitationAlthough community-based exercise is commonly recommended as part of ongoing self-management of chronic pain, there is limited research exploring perspectives towards community-based exercise opportunities from the perspective of adults living with chronic pain.Adults living with chronic pain reported specific preferences, barriers, and facilitators to participating in community-based exercise opportunities, including accessibility, instrinsic factors, social factors, and program factors.Most adults living with chronic pain reported a preference for community-based exercise opportunities that: (1) are delivered by an instructor who is knowledgeable about chronic pain; (2) involve gentle exercise; (3) are group-based; and (4) include other individuals with similar physical capabilities.Healthcare providers, community-based organizations, and researchers should develop, implement, and evaluate person-centered community-based exercise opportunities for adults living with chronic pain that consider their unique preferences, barriers, and facilitators to participation.
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Affiliation(s)
- Natalie Dnes
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Bridget Coley
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Kaitlyn Frisby
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Anna Keller
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Jezreel Suyom
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Cindy Tsui
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Gillian Grant
- Toronto Academic Pain Medicine Institute, Women's College Hospital, Toronto, Canada
| | - Kyle Vader
- Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Canada.,School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Judith Hunter
- Department of Physical Therapy, University of Toronto, Toronto, Canada
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32
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Vrekoussis T, Siafaka V, Tsitou A, Tsonis O, Navrozoglou I, Makrigiannakis A, Paschopoulos M. Endometriosis-related chronic pelvic pain: A mini review on pathophysiology and impact on mental health. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2020. [DOI: 10.1177/2284026519895829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Endometriosis-related chronic pelvic pain is a major component of the disease that affects quality of life in women of reproductive age suffering from endometriosis. The present review summarizes current evidence upon pathophysiology and its impact on mental health. It seems that endometriosis-related chronic pelvic pain is the result of chronic stress on the central nervous system as a consequence of chronic pelvic inflammation. Mental health issues may rise as a result of central nervous system derangement and further aggravate pain perception and therefore quality of life. Further properly designed studies are needed in order to elucidate the connection between mental disorders and endometriosis-related chronic pelvic pain.
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Affiliation(s)
- Thomas Vrekoussis
- Department of Obstetrics and Gynecology, School of Medicine, University of Crete, Heraklion, Greece
| | - Vassiliki Siafaka
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Alexandra Tsitou
- Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Orestis Tsonis
- Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Iordanis Navrozoglou
- Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Antonis Makrigiannakis
- Department of Obstetrics and Gynecology, School of Medicine, University of Crete, Heraklion, Greece
| | - Minas Paschopoulos
- Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Mellado BH, Pilger TL, Poli-Neto OB, Rosa E Silva JC, Nogueira AA, Candido Dos Reis FJ. Current usage of qualitative research in female pelvic pain: a systematic review. Arch Gynecol Obstet 2019; 300:495-501. [PMID: 31201537 DOI: 10.1007/s00404-019-05212-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 06/07/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Qualitative research has received growing attention in the multidisciplinary investigation of patients' perceptions about chronic diseases. The purpose of this systematic review was to characterize the usage of qualitative research in women with chronic pelvic pain (CPP). METHODS We performed a structured search in Web of Science, Pubmed, and EMBASE platforms until June 2019. The search combined the keywords: "pelvic pain", "endometriosis", "dyspareunia", "dysmenorrhea", "vaginismus", "focus groups", "qualitative research", "hermeneutics", "grounded theory", and "women". Qualitative studies on female CPP were included and the main findings combined using thematic synthesis. RESULTS We found 1211 citations, of which 52 were included in this review. The majority of included studies were based on phenomenological design. The main method for data collection was semi-structured interviews. Endometriosis was the theme of 23 studies, chronic pelvic pain of eight, dysmenorrhea of eight, dyspareunia of four, interstitial cystitis of two, vaginismus of two, vulvodynia of two, and pelvic inflammatory disease of one study. We found a wide variety of contributions. Among them, the impact of the disease on women's lives was the commonest. CONCLUSION Qualitative research has the potential to reveal and explain several aspects of CPP in women. The medical community may better accept knowledge gained from these studies if the methods are described more transparently in published articles.
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Affiliation(s)
- Bruna Helena Mellado
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes, 3900, 8º andar, Ribeirão Preto, SP, 14048-900, Brazil
| | - Taynara Louisi Pilger
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes, 3900, 8º andar, Ribeirão Preto, SP, 14048-900, Brazil
| | - Omero Benedicto Poli-Neto
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes, 3900, 8º andar, Ribeirão Preto, SP, 14048-900, Brazil
| | - Julio Cesar Rosa E Silva
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes, 3900, 8º andar, Ribeirão Preto, SP, 14048-900, Brazil
| | - Antonio Alberto Nogueira
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes, 3900, 8º andar, Ribeirão Preto, SP, 14048-900, Brazil
| | - Francisco José Candido Dos Reis
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes, 3900, 8º andar, Ribeirão Preto, SP, 14048-900, Brazil.
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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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Márki G, Bokor A, Rigó J, Rigó A. Physical pain and emotion regulation as the main predictive factors of health-related quality of life in women living with endometriosis. Hum Reprod 2018; 32:1432-1438. [PMID: 28482063 DOI: 10.1093/humrep/dex091] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 04/20/2017] [Indexed: 12/15/2022] Open
Abstract
STUDY QUESTION To what extent are pain symptoms, psychological variables (anxiety, depression and distress) and emotion regulation associated with women's health in endometriosis? SUMMARY ANSWER Physical pain symptoms and emotion regulation difficulties via psychological stress negatively affect the health-related quality of life (HRQoL) of women living with endometriosis. WHAT IS KNOWN ALREADY There are some missing links in the definitive treatment and recovery from endometriosis. Women with chronic pain report a decrease in HRQoL and an increase in the frequency of psychological problems, but little is known about the complex relationship between these variables in the context of endometriosis. STUDY DESIGN, SIZE, DURATION This cross-sectional study was conducted between October 2014 and October 2015 on 193 women living with endometriosis. PARTICIPANTS/MATERIALS, SETTING, METHODS The sample consisted of women with a medically confirmed diagnosis of endometriosis who received treatment at the participating clinic. All participants completed the Short Form Health Survey (SF-36), the Hospital Anxiety and Depression Scale, the Perceived Stress Scale and the Difficulties in Emotion Regulation Scale. Spearman's rank correlation was used to explore the associations between the measured variables, and structural equation modeling was used to test the proposed mediation models. MAIN RESULTS AND THE ROLE OF CHANCE The response rate was 46%. In this study, 54.79% of the participants presented with anxiety and 20.3% with depressive symptoms. Pain symptoms, psychological variables and difficulties in emotion regulation were negatively associated with HRQoL. Mediation models revealed that physical pain, psychological stress and difficulties in emotion regulation explained 55% of the variance in the overall HRQoL, 41% of the variation in physical and 55% of the variation in mental HRQoL. Accordingly, severe physical pain (β = -0.39, P < 0.001) was directly, and difficulties in emotion regulation (β = -0.38, P < 0.001) was indirectly related to deterioration in overall HRQoL. Physical pain had a higher direct standardized effect (β = -0.51, P < 0.001) on physical HRQoL, and had no significant direct effect on mental HRQoL. Furthermore, both physical pain (β = -0.07, P < 0.001) and difficulties in emotion regulation (β = -0.46, P < 0.001) had a significant indirect effect on mental HRQoL. LIMITATIONS, REASONS FOR CAUTION The data were heterogeneous with regard to the severity of endometriosis. The validity of this cross-sectional study is limited to correlations; therefore, further longitudinal studies using a more representative sample are needed to explore valid causal relationships. WIDER IMPLICATIONS OF THE FINDINGS The results of this study indicate that HRQoL can be improved through pain management and emotion regulation strategies. The authors believe that HRQoL would increase with concomitant application of physical treatment and psychological care. STUDY FUNDING/COMPETING INTEREST(S) There were no external funding sources for this study, and the authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Gabriella Márki
- Doctoral School of Psychology, Eötvös Loránd University, Budapest 1064, Hungary.,Institute of Psychology, Eötvös Loránd University, Budapest 1064, Hungary
| | - Attila Bokor
- I. Department of Obstetrics and Gynecology, Semmelweis University, Budapest 1085, Hungary
| | - János Rigó
- I. Department of Obstetrics and Gynecology, Semmelweis University, Budapest 1085, Hungary
| | - Adrien Rigó
- Institute of Psychology, Eötvös Loránd University, Budapest 1064, Hungary
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Denouel A, Fauconnier A, Torre A. [Expectations of women with endometriosis: What information to deliver? CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018. [PMID: 29530554 DOI: 10.1016/j.gofs.2018.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Women with endometriosis often say that the information doctors give them should be improved. Patient support groups can provide missing information but may lack objectivity, or reliability, and may even generate anxiety or even harm their health. Clear unbiased medical information is the ideal. New patients with endometriosis wish to be taken seriously by primary care physicians, and be referred quickly to a specialist without further unnecessary investigation or delay. The diagnosis of endometriosis should ideally be made quickly, and should clearly specify the nature of the disease, its evolution, and its consequences on quality of life, relationships, and fertility. When choosing a treatment, information should state the risks of each treatment, the risks of recurrence long term, and the therapeutic alternatives. These should include conventional medical treatment, lifestyle adaptation, or alternative therapies. In case of surgery, prior written information should be provided, the likely scar appearance, the short and long term consequences in terms of pain, postoperative recovery time and complication rates. Once the surgery is performed, the degree of endometriotic involvement and the treatment undertaken should be explained. At discharge, patients should be told the expected recovery time, and the consequences of the operation on daily life.
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Affiliation(s)
- A Denouel
- Association Endofrance, BP 50053, 01124 Montluel cedex, France; Direction de la recherche et de l'innovation, centre hospitalier universitaire de montpellier, 39, avenue Charles-Flahault, 34295 Montpellier cedex 5, France
| | - A Fauconnier
- EA 7285 risques cliniques et sécurité en santé des femmes, service de gynécologie-obstétrique, université Versailles-Saint-Quentin-en-Yvelines, CHI Poissy-St-Germain, 10, rue du Champ-Gaillard, 78303 Poissy, France
| | - A Torre
- Service de gynécologie-obstétrique et médecine de la reproduction, hopital Arnaud-de-Villeneuve, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France; Division of Child Health, Obstetrics & Gynaecology, Dept of Obstetrics and Gynaecology, School of Medicine, University of Nottingham, City Hospital, Hucknall Road, NG5 1PB Nottingham, Royaume-Uni.
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The Impact of Chronic Pelvic Pain and Its Associated Symptoms on Women'S Quality of Life in a TERTiary Care Hospital in Brazil. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2016. [DOI: 10.5301/je.5000262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction Chronic pelvic pain (CPP) is a common manifestation of multiple diseases, and might be related to gynecological, musculoskeletal and gastrointestinal causes. CPP is often associated with reduced quality of life (QOL). Objective To investigate whether pain intensity correlates negatively with the QOL in Brazilian women with CPP. Methods We recruited women with CPP referred to our outpatient service from December 2014 to December 2015. QOL was assessed using the Short Form Health Survey (SF-36) while clinical and demographic data were obtained using a standardized form. Statistics included Spearman's rank coefficient test and chi-square test. Results The total SF-36 score correlated negatively with pain intensity as measured by visual analog scale (rho = -0.46). Significant correlations were seen in the role-physical (rho = -0.596), physical functioning (rho = -0.463), role-emotional (rho = -0.402) and bodily pain (rho = -0.471) domains, but not in the other SF-36 domains. There was a positive association between presence of acyclic chronic pain and history of being at emergency rooms for pain control (p = 0.026, chi-square test). Conclusions Pain intensity correlates negatively with QOL in Brazilian women with CPP, but different QOL domains are affected in a heterogeneous fashion. Further research is needed in order to determine the specific reasons behind such differences.
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Abstract
Clear cell thymic carcinoma is a rare and invasive tumor of the mediastinum for which there are no uniform treatment guidelines. The combination of carboplatin plus paclitaxel seems to be the most effective regimen for this disease. We report a case of locally advanced clear cell thymic carcinoma treated with this schedule, in which we observed a relevant and rapid tumor shrinkage.
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