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Green I, Briggs M, Encalada Soto D, Cole K, Wygant J, Burnett T, Zhu X, Chen I, Sangaralingam LR, Thao V. Health Care Utilization by Patients With Chronic Pelvic Pain. Obstet Gynecol 2024; 144:4-11. [PMID: 38696811 DOI: 10.1097/aog.0000000000005595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/21/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVE To describe the patterns of health care utilization among patients with chronic pelvic pain. METHODS Deidentified administrative claims data from the OptumLabs Data Warehouse were used. Adult female patients who had their first medical claim for chronic pelvic pain between January 1, 2016, and December 31, 2019, were included. Utilization was examined for 12 months after the index diagnosis. The greedy nearest neighbor matching method was used to identify a control group of individuals without chronic pelvic pain. Comparisons were made between those with and those without chronic pelvic pain using χ 2 tests for categorical data and Wilcoxon rank-sum tests for continuous data. RESULTS In total, 18,400 patients were analyzed in the chronic pelvic pain cohort. Patients with chronic pelvic pain had a higher rate of chronic overlapping pain conditions. Patients with chronic pelvic pain had higher rates of health care utilization across all queried indices. They had more outpatient office visits; 55.5% had 10 or more office visits. Patients with chronic pelvic pain showed higher utilization of the emergency department (ED) (6.3 visits vs 1.9 visits; P <.001). Urine culture and pelvic ultrasonography were the most utilized tests. One-third of patients with chronic pelvic pain utilized physical therapy (PT), and 13% utilized psychological or behavioral therapy. Patients with chronic pelvic pain had higher rates of hysterectomy (8.9% vs 0.6%). The average total health care costs per patient with chronic pelvic pain per year was $12,254. CONCLUSION Patients with chronic pelvic pain have higher rates of chronic overlapping pain conditions and undergo more ED visits, imaging tests, and hysterectomies than patients without chronic pelvic pain. Improving access to multidisciplinary care, increasing utilization of interventions such as PT and psychological or behavioral therapy, and reducing ED utilization may be possible targets to help reduce overall health care costs and improve patient care.
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Affiliation(s)
- Isabel Green
- Department of Obstetrics and Gynecology, Mayo Clinic, and Health Care Policy and Research and the Center for the Science of Health Care Delivery, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; the Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin; Minimally Invasive Gynecologic Surgery, University of South Florida, Tampa, Florida; and the University of Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Wissing MC, van der Net L, Engels Y, Vissers KCP, Kluivers KB, Wal SVD, Notten KJB. Lessons learned from the experiences of patients with chronic pelvic pain syndrome (CPP syndrome) with a multidisciplinary consultation: a qualitative study. Reg Anesth Pain Med 2024:rapm-2024-105548. [PMID: 38866558 DOI: 10.1136/rapm-2024-105548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/30/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Chronic pelvic pain syndrome is a complex multifactorial condition with an increasing prevalence probably due to a rising awareness. Chronic pelvic pain syndrome is pain in the pelvic area and often accompanied with complaints in other organ systems of the lesser pelvis. Patients with chronic pelvic pain syndrome who present at our center are evaluated in a standardized care pathway with an integrated multidisciplinary consultation. The team works in a single center and consists of gynecologists, pain specialists, urologists, a pelvic floor physiotherapist and a psychologist. The aim of this interview study is to evaluate the value of the multidisciplinary consultation from the patient's perspectives. METHODS In a qualitative study, we evaluated the experiences and perspectives of patients with chronic pelvic pain syndrome concerning the multidisciplinary consultation at the Radboud University Medical Center. Semistructured interviews were conducted with patients with chronic pelvic pain syndrome who attended a multidisciplinary consultation between 2019 and 2022. All interviews were transcribed verbatim, coded and analyzed via ATLAS.ti with the conventional content analysis. RESULTS Data saturation was reached after seven interviews, followed by three confirmative interviews. In total, 10 patients (22-76 years) participated in the study. Three relevant themes were identified in the interviews: the deleterious effects of pain on overall health, the importance of the design of the multidisciplinary consultation, and the performance of healthcare professionals (knowledge, skills and interaction with patients and colleagues). Participants suggested that although the consultation did not improve their pain experience, there was value in having a comprehensive assessment of their disease. Patients preferred the consultation to occur at the beginning of the care. Additionally, they acknowledged the performance of healthcare providers and having their complaints recognized. However, some participants suggested the need for additional attention to mental health issues during the multidisciplinary consultation. DISCUSSION Even though patients did not perceive the multidisciplinary consultation to improve their pain experience, they appreciated the sense of recognition by this team. CONCLUSION A multidisciplinary consultation is of value from the patients' perspective. A suggestion for improvement emerged where the multidisciplinary consultation should occur at the beginning of the patient journey.
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Affiliation(s)
- Myrthe C Wissing
- Department of Gynecology and Obstetrics, Radboudumc, Nijmegen, The Netherlands
| | - Lotte van der Net
- Department of Gynecology and Obstetrics, Radboudumc, Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative medicine, Radboudumc, Nijmegen, The Netherlands
| | - Kris C P Vissers
- Department of Anesthesiology, Pain and Palliative medicine, Radboudumc, Nijmegen, The Netherlands
| | - Kirsten B Kluivers
- Department of Gynecology and Obstetrics, Radboudumc, Nijmegen, The Netherlands
| | - Selina van der Wal
- Department of Anesthesiology, Pain and Palliative medicine, Radboudumc, Nijmegen, The Netherlands
| | - Kim J B Notten
- Department of Gynecology and Obstetrics, Radboudumc, Nijmegen, The Netherlands
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Yáñez-Sarmiento A, Kiel L, Kaufman R, Abioye O, Florez N. More than Cramps in Scrubs: Exploring Dysmenorrhea among Women Healthcare Workers. Int J Womens Health 2024; 16:749-753. [PMID: 38706690 PMCID: PMC11069112 DOI: 10.2147/ijwh.s452210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/29/2024] [Indexed: 05/07/2024] Open
Abstract
Though understudied, dysmenorrhea, a painful cramping sensation occurring near and during menses, is the most prevalent gynecological disorder among women of reproductive age, affecting 50-90% of the global population. Contributing factors of this disorder include poor medical assessment, lack of consciousness, gender bias, moderate to high levels of stress, and depression and anxiety. Among school students and healthcare trainees, dysmenorrhea contributes to short-term absenteeism, lower productivity, creativity, and job performance. Among medical trainees, dysmenorrhea has been found to impact daily activities to a disabling degree in nearly one third of instances, resulting in difficulties in relationships and even self-isolation. Dysmenorrhea further produces substantial global economic losses and higher healthcare costs. To begin to alleviate the extensive issue of dysmenorrhea, we must increase awareness to fully understand its prevalence, risk factors, and potential for effective, affordable, and accessible treatments. Concurrently, our clinical environment must adopt a standard description and assessment tool to prevent, measure, and monitor dysmenorrhea, while on a global scale, we must develop and widely disseminate nationwide labor regulations that address the workforce impact due to the effects of dysmenorrhea.
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Affiliation(s)
- Anamaría Yáñez-Sarmiento
- Department of Oncology, Universidad Icesi, Perímetro Urbano Santiago de Cali, Valle del Cauca, Colombia
| | - Lauren Kiel
- Department of Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Rebekah Kaufman
- Department of Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Oyepeju Abioye
- Department of Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Narjust Florez
- Department of Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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Castellanos ME, Carrillo JF, Green I, Milspaw A, Lamvu G. Identifying Gaps in Pelvic Pain Education: A Scoping Review and Structured Analysis of Obstetrics and Gynecology Training Milestones. J Minim Invasive Gynecol 2024; 31:180-192. [PMID: 38081576 DOI: 10.1016/j.jmig.2023.12.002] [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: 08/11/2023] [Revised: 10/08/2023] [Accepted: 12/06/2023] [Indexed: 12/31/2023]
Abstract
OBJECTIVE Several clinical practice guidelines on the evaluation and management (EM) of chronic pelvic pain (CPP) have been published; however, it is not known whether obstetrics and gynecology (OBGYN) educational milestones are aligned with current practice recommendations. Therefore, this scoping review and structured analysis aims to identify gaps between clinical guidelines for the EM of CPP and OBGYN training milestones published by educational authorities like the Accreditation Council for Graduate Medical Education (ACGME) and the AAGL. DATA SOURCES The literature search was performed in MEDLINE, PubMed Central, and Bookshelf on the PubMed interface from January 2018 to September 2022. Peer-reviewed publications were included if they were a systematic review of recent practice guidelines and focused on female CPP. Publications that focused on a single pelvic pain condition or focused on a specific treatment were excluded. METHODS OF STUDY SELECTION Two reviewers extracted the data and appraised the study quality following the Critical Appraisal Skills Programme Checklist for systematic reviews. Four articles met inclusion criteria for thematic analysis. A reflexive thematic analysis via the inductive approach was performed to develop clinical themes common to all review articles and presumed important in the EM of CPP. Pelvic pain experts and Delphi methodology was used to assess validity and relevance of each theme in OBGYN training. Validated themes were used in a strengths weaknesses opportunities threats (SWOT) analysis of the ACGME and the AAGL Milestones used for training OBGYN residents and fellows. A SWOT analysis is an organizational tool used to analyze processes in terms of strengths, weaknesses, opportunities for improvement, and threats to implementing a potential change. TABULATION, INTEGRATION, AND RESULTS Twelve clinical themes were conceptualized and achieved ≥ 90% consensus as being important in the EM of CPP. Clinical themes pertained to pathophysiology, biopsychosocial approach, trauma-informed care, history and physical examination, diagnostic testing, multimodal/multidisciplinary management, pain education, and medical and surgical management. SWOT analysis showed that the ACGME Milestones lacked milestones specific to CPP, while the AAGL Milestones had 6 CPP-focused competencies with multiple milestones. Milestones on trauma-informed care and application of biopsychosocial assessment were notably absent. CONCLUSION OBGYN educational milestones published by the ACGME and the AAGL are not yet aligned with current clinical guidelines for the EM of CPP.
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Affiliation(s)
- Mario E Castellanos
- Department of Veterans Affairs, Orlando VA Medical Center (Drs. Castellanos, Carrillo, and Lamvu); Department of Obstetrics and Gynecology, University of Central Florida College of Medicine (Drs. Castellanos, Carrillo, and Lamvu), Orlando, Florida.
| | - Jorge F Carrillo
- Department of Veterans Affairs, Orlando VA Medical Center (Drs. Castellanos, Carrillo, and Lamvu); Department of Obstetrics and Gynecology, University of Central Florida College of Medicine (Drs. Castellanos, Carrillo, and Lamvu), Orlando, Florida
| | - Isabel Green
- Department of Obstetrics and Gynecology, Mayo Clinic (Dr. Green), Rochester, Minnesota
| | | | - Georgine Lamvu
- Department of Veterans Affairs, Orlando VA Medical Center (Drs. Castellanos, Carrillo, and Lamvu); Department of Obstetrics and Gynecology, University of Central Florida College of Medicine (Drs. Castellanos, Carrillo, and Lamvu), Orlando, Florida
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Knapman BL, Li FG, Deans R, Nesbitt-Hawes E, Maheux-Lacroix S, Abbott J. Botulinum Toxin for the Management of Pelvic Floor Tension Myalgia and Persistent Pelvic Pain: A Systematic Review and Meta-analysis. Obstet Gynecol 2024; 143:e7-e17. [PMID: 37797336 DOI: 10.1097/aog.0000000000005388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 06/29/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To systematically review the literature on use of botulinum toxin to treat pelvic floor tension myalgia and persistent pelvic pain. DATA SOURCES The ClinicalTrials.gov , PubMed, EMBASE, and Scopus databases were searched from inception to November 2022 by two independent assessors (B.L.K. and F.G.L.). Identified studies were screened by title and abstract and included after full-text review. Data extraction was subsequently performed and recorded in Microsoft Excel. METHODS This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines after registration in PROSPERO (CRD42022289132). All randomized studies, prospective studies with more than five participants, and retrospective studies with more than 10 participants published in English or French and assessing the use of botulinum toxin for the treatment of pelvic floor tension myalgia and persistent pelvic pain in women were included. Meta-analyses were performed on randomized data. TABULATION, INTEGRATION, AND RESULTS Of 4,722 articles identified, 24 satisfied inclusion criteria. A meta-analysis of five randomized controlled trials totaling 329 participants demonstrated no differences in patient- and clinician-reported outcome measures, including pain, dyspareunia, sexual function, and vaginal manometry. Mean duration of follow-up was 6 months. A qualitative analysis of 14 prospective and four retrospective studies including 804 participants is supportive of botulinum toxin; however, the quality of data is low, and there is marked heterogeneity between studies. CONCLUSION Meta-analyses of randomized data do not support the use of botulinum toxin to treat pelvic floor tension myalgia and persistent pelvic pain. Failure of these data to confirm the findings of nonrandomized prospective studies that suggest a treatment benefit may be attributable to the absence of placebo control and confounding outcomes obtained from an active comparator group. Further randomized controlled trials with true placebo are strongly recommended. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42022289132.
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Affiliation(s)
- Blake Lawson Knapman
- University of New South Wales, Sydney, New South Wales, Australia; and Université Laval, Québec City, Québec, Canada
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Allaire C, Yong PJ, Bajzak K, Jarrell J, Lemos N, Miller C, Morin M, Nasr-Esfahani M, Singh SS, Chen I. Directive clinique n o445 : Gestion de la douleur pelvienne chronique. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102284. [PMID: 38341222 DOI: 10.1016/j.jogc.2023.102284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
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Allaire C, Yong PJ, Bajzak K, Jarrell J, Lemos N, Miller C, Morin M, Nasr-Esfahani M, Singh SS, Chen I. Guideline No. 445: Management of Chronic Pelvic Pain. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102283. [PMID: 38341225 DOI: 10.1016/j.jogc.2023.102283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To provide evidence-based recommendations for the management of chronic pelvic pain in females. TARGET POPULATION This guideline is specific to pelvic pain in adolescent and adult females and excluded literature that looked at pelvic pain in males. It also did not address genital pain. BENEFITS, HARMS, AND COSTS The intent is to benefit patients with chronic pelvic pain by providing an evidence-based approach to management. Access to certain interventions such as physiotherapy and psychological treatments, and to interdisciplinary care overall, may be limited by costs and service availability. EVIDENCE Medline and the Cochrane Database from 1990 to 2020 were searched for articles in English on subjects related to chronic pelvic pain, including diagnosis, overlapping pain conditions, central sensitization, management, medications, surgery, physiotherapy, psychological therapies, alternative and complementary therapies, and multidisciplinary and interdisciplinary care. The committee reviewed the literature and available data and used a consensus approach to develop recommendations. Only articles in English and pertaining to female subjects were included. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE Family physicians, gynaecologists, urologists, pain specialists, physiotherapists, and mental health professionals. TWEETABLE ABSTRACT Management of chronic pelvic pain should consider multifactorial contributors, including underlying central sensitization/nociplastic pain, and employ an interdisciplinary biopsychosocial approach that includes pain education, physiotherapy, and psychological & medical treatments. SUMMARY STATEMENTS RECOMMENDATIONS.
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Ali AM, Alameri RA, Brooks T, Ali TS, Ibrahim N, Khatatbeh H, Pakai A, Alkhamees AA, Al-Dossary SA. Cut-off scores of the Depression Anxiety Stress Scale-8: Implications for improving the management of chronic pain. J Clin Nurs 2023; 32:8054-8062. [PMID: 37674274 DOI: 10.1111/jocn.16878] [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: 04/13/2023] [Revised: 07/13/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023]
Abstract
AIM Mental distress, non-specific symptoms of depression and anxiety, is common in chronic pelvic pain (CPP). It contributes to poor recovery. Women's health nurses operate in multidisciplinary teams to facilitate the assessment and treatment of CPP. However, valid cut-off points for identifying highly distressed patients are lacking, entailing a gap in CPP management. DESIGN This instrumental cross-sectional study identified a statistically derived cut-off score for the Depression Anxiety Stress Scale-8 (DASS-8) among 214 Australian women with CPP (mean age = 33.3, SD = 12.4, range = 13-71 years). METHODS Receiver operator characteristic curve, decision trees and K-means clustering techniques were used to examine the predictive capacity of the DASS-8 for psychiatric comorbidity, pain severity, any medication intake, analgesic intake and sexual abuse. The study is prepared according to the STROBE checklist. RESULTS Cut-off points resulting from the analysis were ordered ascendingly. The median (13.0) was chosen as an optimal cut-off score for predicting key outcomes. Women with DASS-8 scores below 15.5 had higher analgesic intake. CONCLUSION CPP women with a DASS-8 score above 13.0 express greater pain severity, psychiatric comorbidity and polypharmacy. Thus, they may be a specific target for nursing interventions dedicated to alleviating pain through the management of associated co-morbidities. IMPLICATIONS FOR PATIENT CARE At a cut-off point of 13.0, the DASS-8 may be a practical instrument for recommending a thorough clinician-based examination for psychiatric comorbidity to facilitate adequate CPP management. It may be useful for evaluating patients' response to nursing pain management efforts. Replications of the study in different populations/countries are warranted.
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Affiliation(s)
- Amira Mohammed Ali
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Rana Ali Alameri
- Fundamentals of Nursing Department, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Tiffany Brooks
- University of Adelaide and Aware Women's Health, North Adelaide, South Australia, Australia
| | - Tazeen Saeed Ali
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Nashwa Ibrahim
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | | | - Annamaria Pakai
- Institute of Nursing Sciences, Basic Health Sciences and Health Visiting, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Abdulmajeed A Alkhamees
- Department of Medicine, Unayzah College of Medicine and Medical Sciences, Qassim University, Unayzah, Saudi Arabia
| | - Saeed A Al-Dossary
- Psychology Department, College of Education, University of Ha'il, Ha'il, Saudi Arabia
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Karp BI, Stratton P. Applications of botulinum toxin to the female pelvic floor: Botulinum toxin for genito-pelvic pain penetration disorder and chronic pelvic pain in women. Toxicon 2023; 230:107162. [PMID: 37201800 PMCID: PMC10330736 DOI: 10.1016/j.toxicon.2023.107162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/15/2023] [Indexed: 05/20/2023]
Abstract
Chronic pain conditions like genito-pelvic pain penetration disorder and chronic pelvic pain cause significant morbidity in women worldwide and yet are underdiagnosed and undertreated. While the use of botulinum toxin for pain conditions has expanded, there are few randomized controlled studies of botulinum toxin for pelvic pain conditions in women. This paper provides an update on the current status and context for considering botulinum toxin treatment for these conditions to complement and expand currently available approaches. High quality clinical trials to evaluate safety and efficacy and to determine optimal doses and approaches to injection are urgently needed.
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Affiliation(s)
- Barbara I Karp
- National Institutes of Neurological Disorder and Stroke, National Institutes of Health, Bethesda, MD, 20892, USA.
| | - Pamela Stratton
- National Institutes of Neurological Disorder and Stroke, National Institutes of Health, Bethesda, MD, 20892, USA
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Hemodynamic and neurobiological factors for the development of chronic pelvic pain in patients with pelvic venous disorder. J Vasc Surg Venous Lymphat Disord 2023; 11:610-618.e3. [PMID: 36781107 DOI: 10.1016/j.jvsv.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/18/2022] [Accepted: 01/05/2023] [Indexed: 02/13/2023]
Abstract
OBJECTIVE The study was aimed at the identification of hemodynamic and neurobiological factors for the development of chronic pelvic pain (CPP) in patients with pelvic venous disorder (PeVD) using ultrasound, radionuclide, and enzyme immunoassay methods. METHODS This cohort study included 110 consecutive patients with PeVD and 20 healthy controls. Seventy patients with PeVD had symptoms (CPP in 100% of cases, discomfort in hypogastrium, dyspareunia, vulvar varices, and dysuria), and 40 were asymptomatic. Patients underwent clinical examination, duplex ultrasound study of the pelvic veins and lower extremities, and single-photon emission computed tomography of the pelvic veins with in vivo labeled red blood cells. The prevalence, duration, severity, and pattern of reflux in the pelvic veins, as well as the severity of pelvic venous congestion, were evaluated. Healthy controls underwent only clinical and duplex ultrasound examination. All 130 patients were assessed using enzyme immunoassays to determine plasma levels of calcitonin gene-related peptide (CGRP) and substance P (SP). RESULTS Symptomatic patients with PeVD had a higher prevalence of reflux in the ovarian veins (OVs) than asymptomatic ones (45.7% vs 10%, respectively; P = .001) and a greater reflux duration (4.1 ± 1.7 seconds vs 1.4 ± 0.3 seconds; P = .002), although no differences in the OV diameter were found. Similar results were obtained when comparing the diameters of the parametrial veins (PVs) and the duration of reflux in them. Type II/III reflux (greater than 2 seconds) was identified in 41.4% of symptomatic and in only 5% of asymptomatic patients (P = .001). Among patients with CPP, 24.2% had a combined reflux in the OVs, PVs, and uterine veins, and 45.7% had a combined reflux in the OVs and PVs, whereas 90% of patients without CPP had only an isolated reflux in the PVs. The pelvic venous congestion was moderate or severe in 95.7% of patients with CPP and in only 15% patients without CPP (P = .001). In patients with PeVD, the presence of CPP was associated with higher levels of CGRP and SP compared with asymptomatic patients (CGRP: 0.48 ± 0.06 vs 0.19 ± 0.02 ng/mL, respectively, P = .001; SP: 0.38 ± 0.08 vs 0.13 ± 0.03 ng/mL, P = .001). CONCLUSIONS In patients with PeVD, significant hemodynamic and neurobiological factors for the CPP development were found to be reflux in the pelvic veins greater than 2 seconds, involvement of several venous collectors, and increased plasma levels of CGRP and SP.
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Zwickl S, Burchill L, Wong AFQ, Leemaqz SY, Cook T, Angus LM, Eshin K, Elder CV, Grover SR, Zajac JD, Cheung AS. Pelvic Pain in Transgender People Using Testosterone Therapy. LGBT Health 2023; 10:179-190. [PMID: 36603056 PMCID: PMC10079239 DOI: 10.1089/lgbt.2022.0187] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose: This descriptive study aimed to assess the characteristics of pelvic pain and explore predictive factors for pelvic pain in transgender (trans) individuals using testosterone therapy. Methods: An online cross-sectional survey was open between August 28, 2020, and December 31, 2020, to trans people presumed female at birth, using testosterone for gender affirmation, living in Australia, and >16 years of age. The survey explored characteristics of pelvic pain following initiation of testosterone therapy, type and length of testosterone therapy, menstruation history, and relevant sexual, gynecological, and mental health experiences. Logistic regression was applied to estimate the effect size of possible factors contributing to pain after starting testosterone. Results: Among 486 participants (median age = 27 years), 351 (72.42%) reported experiencing pelvic pain following initiation of testosterone therapy, described most commonly as in the suprapubic region and as "cramping." Median duration of testosterone therapy was 32 months. Persistent menstruation, current or previous history of post-traumatic stress disorder, and experiences of pain with orgasm were associated with higher odds of pelvic pain after testosterone therapy. No association was observed with genital dryness, intrauterine device use, previous pregnancy, penetrative sexual activities, touching external genitalia, or known diagnoses of endometriosis, vulvodynia, vaginismus, depression, anxiety, or obesity. Conclusions: Pelvic pain is frequently reported in trans people following initiation of testosterone therapy. Given the association with persistent menstruation and orgasm, as well as the known androgen sensitivity of the pelvic floor musculature, further research into pelvic floor muscle dysfunction as a contributor is warranted.
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Affiliation(s)
- Sav Zwickl
- Trans Health Research group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Australia
| | - Laura Burchill
- Physiotherapy Department, The Royal Women's Hospital, Melbourne, Australia
| | - Alex Fang Qi Wong
- Trans Health Research group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Australia
| | - Shalem Y Leemaqz
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | | | - Lachlan M Angus
- Trans Health Research group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Australia.,Gender Clinic, Department of Endocrinology, Austin Health, Melbourne, Australia
| | - Kalen Eshin
- Department of Community and Clinical Health, La Trobe University, Melbourne, Australia
| | - Charlotte V Elder
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia.,Mercy Hospital for Women, Melbourne, Australia.,Austin Health, Melbourne, Australia
| | - Sonia R Grover
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia.,Mercy Hospital for Women, Melbourne, Australia.,Austin Health, Melbourne, Australia
| | - Jeffrey D Zajac
- Trans Health Research group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Australia.,Gender Clinic, Department of Endocrinology, Austin Health, Melbourne, Australia
| | - Ada S Cheung
- Trans Health Research group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Australia.,Gender Clinic, Department of Endocrinology, Austin Health, Melbourne, Australia
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Volker C, Mills J. Endometriosis and body image: Comparing people with and without endometriosis and exploring the relationship with pelvic pain. Body Image 2022; 43:518-522. [PMID: 36375365 DOI: 10.1016/j.bodyim.2022.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 10/24/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022]
Abstract
Qualitative studies have shown that people with endometriosis report feeling discontent with their bodies relating to the visual and functional effects of the disease. However, few studies exist which compare people with endometriosis to those without, leaving it largely unknown as to whether this discontentment differs from that regularly experienced by women. The current study therefore aimed to 1) quantitatively assess body image, namely appearance satisfaction and functionality appreciation, in people with and without endometriosis, and 2) explore the relationship between endometriosis-related pelvic pain and body image. Australians aged 18 and over were recruited for two groups: those with endometriosis (n = 312, 99 % female, Mage = 30.78, SDage = 7.40) and a control group without suspected or diagnosed endometriosis (n = 74, 100 % female, Mage = 32.38, SDage = 8.84). Participants completed an online survey consisting of measures of appearance satisfaction, functionality appreciation, and pelvic-pain impact. The endometriosis group demonstrated significantly poorer body image when compared to the control group, and endometriosis-related pelvic pain was shown to negatively correlate with body image. These findings demonstrate the likely negative effects endometriosis and pelvic pain have on body image and provide much needed insight to help develop interventions tailored to endometriosis.
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Psychological Profile in Women with Chronic Pelvic Pain. J Clin Med 2022; 11:jcm11216345. [PMID: 36362572 PMCID: PMC9658626 DOI: 10.3390/jcm11216345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/12/2022] [Accepted: 10/23/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Chronic Pelvic Pain (CPP) is a prevalent medical condition with a complex treatment due to different variables that influence its clinical course. (2) Methods: Psychological variables such as depression, anxiety, catastrophizing or neuroticism have been described as influencing CPP. This is a cross-sectional study of 63 patients with CPP sent for a psychological evaluation due to participation in group therapy for CPP. The main purpose of this study was to characterize the baseline psychological characteristics of women with CPP. The NEO Five Factor Inventory (NEO-FFI), State and Trait Anxiety Inventory (STAI), Beck Depression Inventory-Fast Screen (BDI-FS), Pain Catastrophizing Scale (PCS) and Chronic Pain Acceptance Questionnaire (CPAQ) were performed. (3) Results: The personality profile of patients (NEO FFI) shows high neuroticism, low extraversion and low conscientiousness. The 25.4% of patients had moderate or severe depression according to BDI-FS results, almost half of the patients had high levels of anxiety trait (>P75, 49.2%) and more than half the patients had high levels of anxiety state (>P75, 59.5%). Punctuations of PCS and CPAQ are similar to patients with fibromyalgia. (4) Conclusions: CPP is associated with high levels of depression, anxiety, neuroticism, catastrophizing and low pain acceptance. It is important to develop interventions that can modify these psychological factors in order to improve the clinical course of CPP.
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Tracey A. Pelvic Floor Physical Therapy and Its Merit in the Treatment of Female Urogenital Pain. Curr Pain Headache Rep 2022; 26:775-782. [DOI: 10.1007/s11916-022-01076-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 11/03/2022]
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Ruffini N, D’Alessandro G, Pimpinella A, Galli M, Galeotti T, Cerritelli F, Tramontano M. The Role of Osteopathic Care in Gynaecology and Obstetrics: An Updated Systematic Review. Healthcare (Basel) 2022; 10:healthcare10081566. [PMID: 36011223 PMCID: PMC9408311 DOI: 10.3390/healthcare10081566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/30/2022] [Accepted: 08/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Many efforts are made to find safer and more feasible therapeutic strategies to improve gynaecological care. Non-pharmacological treatments, such as osteopathic interventions, could be used as complementary strategies to better manage different gynaecological conditions. This review aims to report the effectiveness of osteopathic treatment in the gynaecology and obstetrics field, updating the previous review published in 2016. The secondary aim was to elucidate the role of somatic dysfunction (SD) in osteopathic assessment and treatment procedures, as well as their health and economic implications. Methods: An electronic search was conducted in the following databases: Embase, MEDLINE (PubMed), and Science direct. All types of clinical studies published between May 2014 and December 2021 have been included: randomised controlled trial (RCT), controlled before/after, interrupted time series quasi RCT, case controls, case reports, case series, observational, clinical studies involving any type of osteopathic treatment, (standardised, semi-standardised or patients’ need-based treatment) performed alone or in combination with other treatments, were included). Results: A total of 76,750 were identified through database searching and other sources. After the removal of duplicates, 47,655 papers were screened based on title and abstract. A total of 131 full-text articles were consequently assessed for eligibility. Twenty-one new articles were included in the synthesis. A total of 2632 participants with a mean age of 28.9 ± 10.5 years were included in the review. Conclusions: Results showed an effectiveness of osteopathic care in gynaecology and obstetrics, but the studies were too heterogeneous to perform quantitative analysis and make clinical recommendations. Nevertheless, osteopathic care could be considered a safe complementary approach to traditional gynaecological care.
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Affiliation(s)
- Nuria Ruffini
- National Centre Germany, Foundation COME Collaboration, 10825 Berlin, Germany
- Centre pour l’Etude, la Recherche et la Diffusion Ostéopathiques “C.E.R.D.O.”, 00199 Rome, Italy
| | - Giandomenico D’Alessandro
- Centre pour l’Etude, la Recherche et la Diffusion Ostéopathiques “C.E.R.D.O.”, 00199 Rome, Italy
- Clinical-Based Human Research Department, Foundation COME Collaboration, 65121 Pescara, Italy
| | - Annalisa Pimpinella
- Centre pour l’Etude, la Recherche et la Diffusion Ostéopathiques “C.E.R.D.O.”, 00199 Rome, Italy
| | - Matteo Galli
- Clinical-Based Human Research Department, Foundation COME Collaboration, 65121 Pescara, Italy
- Research Department, SOMA, Istituto Osteopatia Milano, 20126 Milan, Italy
| | - Tiziana Galeotti
- Centre pour l’Etude, la Recherche et la Diffusion Ostéopathiques “C.E.R.D.O.”, 00199 Rome, Italy
| | - Francesco Cerritelli
- Clinical-Based Human Research Department, Foundation COME Collaboration, 65121 Pescara, Italy
- Correspondence:
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Siqueira-Campos VM, de Deus MSC, Poli-Neto OB, Rosa-E-Silva JC, de Deus JM, Conde DM. Current Challenges in the Management of Chronic Pelvic Pain in Women: From Bench to Bedside. Int J Womens Health 2022; 14:225-244. [PMID: 35210869 PMCID: PMC8863341 DOI: 10.2147/ijwh.s224891] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/04/2022] [Indexed: 12/11/2022] Open
Abstract
Chronic pelvic pain (CPP) affects a significant proportion of women worldwide And has a negative impact on several aspects of these women’s lives including mental health, work, relationships and sexual function, among others. This set of factors ultimately reflects negatively on quality Of life. The physiopathology of CPP is complex and remains to be fully clarified; however, recent advances have increased understanding of the mechanisms involved in chronic pain in general, and more specifically, CPP. Nonetheless, even when a detailed clinical history is obtained, meticulous physical examination is performed and imaging resources are appropriately used, the organic cause of the pain may still fail to be identified in a substantial number of women with CPP. Management of CPP may therefore be challenging. This narrative review was aimed at adding to the available literature on the subject, presenting and discussing the principal characteristics of CPP in women. The paper highlights gaps in the literature while providing the most up-to-date evidence associated with the physiopathology and classification of pain, its diagnosis and treatment. In addition, current challenges in the management of women with CPP are discussed.
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Affiliation(s)
- Vânia Meira Siqueira-Campos
- Department of Obstetrics and Gynecology, School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | - Omero Benedicto Poli-Neto
- Laboratory for Translational Data Science, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.,Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Julio Cesar Rosa-E-Silva
- Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - José Miguel de Deus
- Department of Obstetrics and Gynecology, School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Délio Marques Conde
- Department of Obstetrics and Gynecology, School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
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