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Joseph K, Mills J. Improvements from a small-group multidisciplinary pain self-management intervention for women living with pelvic pain maintained at 12 months. Aust N Z J Obstet Gynaecol 2024. [PMID: 38581105 DOI: 10.1111/ajo.13817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/24/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND A small-group multidisciplinary pain self-management program for women living with pelvic pain, with or without endometriosis, was developed to address identified unmet treatment needs. Following completion, over 80% of participants demonstrated clinically significant improvement across a number of domains. There was no clinically significant deterioration on any measure and benefits continued at three months follow-up. AIMS This study examines patient-reported outcomes at 12 months following program completion to ascertain maintenance of these improvements. MATERIALS AND METHODS Self-report measures assessed quality of life across the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials domains prior to, at completion and 12 months following participation. RESULTS At 12 months follow-up, improvement was seen in mean group scores for all baseline measures for 57% of participants who returned valid 12-month follow-up data, with clinically significant improvement seen for within-subject scores for 50% of these participants for pain severity and also for pain-related activity interference. Improvements were also reported in key predictors of long-term outcomes, pain self-efficacy and catastrophic worry, with 92% reporting improvement in each of these two constructs. There were 83% of respondents who reported feeling both improvement in overall sense of wellbeing and improvement in their physical ability compared to before the program. CONCLUSIONS Results suggest that a six-week multidisciplinary small-group intervention increases participants' abilities to self-manage pain and improves quality of life with lasting clinically significant improvements.
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Affiliation(s)
- Karen Joseph
- Pelvic Pain NZ, Christchurch, New Zealand
- University of Otago, Christchurch, New Zealand
| | - Jessica Mills
- Pelvic Pain NZ, Christchurch, New Zealand
- University of Otago, Christchurch, New Zealand
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Demont A, Chaumeil T. [Physiotherapy treatments for the care of patients with chronic pain]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2023; 68:48-51. [PMID: 37536906 DOI: 10.1016/j.soin.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
In recent years, numerous studies have highlighted the advances made possible by kinesitherapy treatments. These can be used to reduce the frequency, intensity and duration of pain, as well as the functional repercussions of chronic pain. The neurophysiological mechanism involved in primary chronic pain and the pathology producing secondary chronic pain must be taken into account in determining the nature of the treatments to be implemented. This article presents the main physiotherapy interventions recommended for the management of patients with chronic pain, according to the type of pain experienced (nociceptive, neuropathic or nociplastic).
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Affiliation(s)
- Anthony Demont
- Cabinet de kinésithérapie, 6 rue Petrelle, 75009 Paris, France; Inserm UMRS-1153, Centre of Research in Epidemiology and Statistics, Équipe Épidémiologie clinique appliquée aux maladies ostéoarticulaires, Hôtel-Dieu, Galerie A2, Premier étage, 1 place du Parvis-Notre-Dame, 75004 Paris, France.
| | - Théo Chaumeil
- Cabinet de kinésithérapie, 6 rue Petrelle, 75009 Paris, France
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Ryan A, Healey M, Cheng C, Dior U, Reddington C. Central sensitisation in pelvic pain: A cohort study. Aust N Z J Obstet Gynaecol 2022; 62:868-874. [PMID: 35950448 DOI: 10.1111/ajo.13596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Central sensitisation (CS) leads to pain amplification and impacts on the management of pelvic pain (PP). Identification of CS in patients with PP may provide additional treatment pathways and improve patient outcomes. AIMS The aims are to quantify the prevalence of questionnaire-predicted CS (QPCS) in patients presenting with PP and investigate associations between QPCS and clinical variables. MATERIALS AND METHODS This was an observational, cross-sectional study. Subjects with PP completed a questionnaire comprising four validated tools: the Central Sensitisation Inventory (CSI) for QPCS, Pain Catastrophising Scale for Catastrophising Trait, Bladder Pain/Interstitial Cystitis Symptom Score for bladder pain syndrome (BPS) and the Rome IV criteria for irritable bowel syndrome (IBS). RESULTS One hundred and eleven women were enrolled in the study; 74.8% (n = 83) had a CSI score of >40, indicating the presence of QPCS. Subjects with QPCS were more likely to screen positive for catastrophising trait (odds ratio (OR) 3.57, 95% CI 1.19-10.76, P = 0.02), BPS (OR 11.77, 95% CI 2.13-64.89, P = 0.005) and IBS (OR 2.6, 95% CI 1.05-6.43, P = 0.04). They were more likely to experience pain for more than two years (OR 4.98, 95% CI 1.94-12.82, P = 0.001) and other pain symptoms involving bladder (OR 9.87, 95% CI 2.52-38.67, P = 0.001), bowel (OR 3.13, 95% CI 1.31-7.48, P = 0.01), back (OR 4.17, 95% CI 1.66-10.51, P = 0.002) and vulva (OR 3.61, 95% CI 1.21-10.82, P = 0.02). They also had higher previous diagnoses of mental health disorder (OR 3.5, 95% CI 1.5-8.4, P = 0.005) or IBS (OR 8.9, 95% CI 1.6-49.1, P = 0.01). CONCLUSIONS QPCS occurs frequently in patients with PP, and subjects with QPCS experience more prolonged and complex pain.
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Affiliation(s)
- Amelia Ryan
- Waitemata District Health Board, Auckland, New Zealand
| | | | | | - Uri Dior
- Endometriosis Centre, Hadassah-Hebrew University Hospital, Jerusalem, Israel
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Leitch J, Webb A, Pudwell J, Chamberlain S, Henry R, Nitsch R. Magnesium-based trigger point infiltrations versus local anesthetic infiltrations in chronic pelvic myofascial pain: A randomized, double-blind control study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:877-885. [PMID: 35339694 DOI: 10.1016/j.jogc.2022.02.129] [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: 08/17/2021] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine if a novel, magnesium-based trigger point infiltration formulation is more effective in treating chronic myofascial pelvic pain than lidocaine-only infiltration. METHODS This was a single-centre, double-blind, randomized controlled trial of women diagnosed with chronic pelvic myofascial pain associated with trigger points. We compared a novel magnesium-based infiltration formulation with lidocaine infiltration of trigger points and with a control group of participants who were waitlisted for a chronic pain clinic. Treatment groups completed a 12-week program that included 8 trigger point injection treatments and nine visits during which pain scores were recorded and questionnaires administered. The primary outcome measure was change in mean pain score between baseline and the final visit. Secondary outcomes included pain with function scores, scores on the World Health Organization Quality of Life questionnaire, procedural pain, concomitant medication use, and complications. RESULTS We assigned 44 women diagnosed with chronic myofascial pelvic pain associated with trigger points to either the magnesium-based infiltrate (n = 15), lidocaine infiltrate (n = 17), or waitlist (n = 12) group. In the intent-to-treat analysis, a clinically relevant decrease in mean pain score out of 10 was observed in the magnesium-based (-2.6 ± 3.2) and lidocaine (-2.9 ± 3.1) infiltration groups, but not in the waitlist group (-0.5 ± 2.3). The per protocol analysis post-hoc tests, adjusted for multiple comparisons, found a significant difference in the average change in pain score between the magnesium-based infiltrate and the waitlist groups (P = 0.045), while differences between the lidocaine infiltrate and waitlist groups approached statistical significance (P = 0.052). Both treatment groups saw improvements in pain with function and quality of life scores. CONCLUSION While this study is underpowered, it does not support the use of a magnesium-based trigger point infiltrate in the treatment of chronic myofascial pelvic pain over lidocaine-only infiltration. Nonetheless, these results are consistent with current management recommendations and suggest improvements in pain, pain with function, and quality of life scores with either magnesium-based or lidocaine-only infiltration. We outline an approach to assessment and treatment that can be adopted by general gynaecologists.
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Affiliation(s)
- Jordan Leitch
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON
| | - Amanda Webb
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON
| | - Jessica Pudwell
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON
| | - Susan Chamberlain
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON
| | - Richard Henry
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON
| | - Romy Nitsch
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON.
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Selected Disorders of the Female Reproductive System. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Elgendi M, Allaire C, Williams C, Bedaiwy MA, Yong PJ. Machine Learning Revealed New Correlates of Chronic Pelvic Pain in Women. Front Digit Health 2021; 2:600604. [PMID: 34713065 PMCID: PMC8521902 DOI: 10.3389/fdgth.2020.600604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/08/2020] [Indexed: 12/19/2022] Open
Abstract
Chronic pelvic pain affects one in seven women worldwide, and there is an urgent need to reduce its associated significant costs and to improve women's health. There are many correlated factors associated with chronic pelvic pain (CPP), and analyzing them simultaneously can be complex and involves many challenges. A newly developed interaction ensemble, referred to as INTENSE, was implemented to investigate this research gap. When applied, INTENSE aggregates three machine learning (ML) methods, which are unsupervised, as follows: interaction principal component analysis (IPCA), hierarchical cluster analysis (HCA), and centroid-based clustering (CBC). For our proposed research, we used INTENSE to uncover novel knowledge, which revealed new interactions in a sample of 656 patients among 25 factors: age, parity, ethnicity, body mass index, endometriosis, irritable bowel syndrome, painful bladder syndrome, pelvic floor tenderness, abdominal wall pain, depression score, anxiety score, Pain Catastrophizing Scale, family history of chronic pain, new or re-referral, age when first experienced pain, pain duration, surgery helpful for pain, infertility, smoking, alcohol use, trauma, dysmenorrhea, deep dyspareunia, CPP, and the Endometriosis Health Profile for functional quality of life. INTENSE indicates that CPP and the Endometriosis Health Profile are correlated with depression score, anxiety score, and the Pain Catastrophizing Scale. Other insights derived from these ML methods include the finding that higher body mass index was clustered with smoking and a history of life trauma. As well, sexual pain (deep dyspareunia) was found to be associated with musculoskeletal pain contributors (abdominal wall pain and pelvic floor tenderness). Therefore, INTENSE provided expert-like reasoning without training any model or prior knowledge of CPP. ML has the potential to identify novel relationships in the etiology of CPP, and thus can drive innovative future research.
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Affiliation(s)
- Mohamed Elgendi
- School of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,British Columbia (BC) Children's & Women's Hospital, Vancouver, BC, Canada
| | - Catherine Allaire
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,British Columbia (BC) Children's & Women's Hospital, Vancouver, BC, Canada
| | - Christina Williams
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,British Columbia (BC) Children's & Women's Hospital, Vancouver, BC, Canada
| | - Mohamed A Bedaiwy
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,British Columbia (BC) Children's & Women's Hospital, Vancouver, BC, Canada
| | - Paul J Yong
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,British Columbia (BC) Children's & Women's Hospital, Vancouver, BC, Canada
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A physiatrist's understanding and application of the current literature on chronic pelvic pain: a narrative review. Pain Rep 2021; 6:e949. [PMID: 34476302 PMCID: PMC8407606 DOI: 10.1097/pr9.0000000000000949] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/12/2021] [Accepted: 06/09/2021] [Indexed: 12/30/2022] Open
Abstract
Understanding the complex, multifactorial nature of chronic pelvic pain can help physicians determine the pain's etiology and thus refer specialists to include in the multidisciplinary treatment required. Chronic pelvic pain (CPP) is a highly prevalent condition which is underdiagnosed and poorly understood. The purpose of this review is to outline the various aspects of the nature of CPP, including its etiologies, clinical presentation, and nonoperative treatment options. For data collection, a PubMed search was conducted using indexing terms such as chronic pelvic pain and pelvic pain. Literature reviews and studies focusing on etiologies, clinical presentation, and/or the diagnosis of CPP were compiled for review by a team of 3 physiatrists. Studies investigating conservative treatments, medications, and interventional procedures for CPP and related conditions with comparable etiologies were also included. Of the 502 articles retrieved, 116 were deemed suitable by the team for this study. Although CPP is a complex, multifaceted condition, a particular susceptibility to nociceptive stimuli was demonstrated as an underlying theme in its evolution. There are many treatment options currently used; however, more robust evidence, such as randomized controlled trials, are needed before creating comprehensive guidelines for treating CPP.
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8
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Compliance With Pelvic Floor Physical Therapy in Patients Diagnosed With High-Tone Pelvic Floor Disorders. Female Pelvic Med Reconstr Surg 2021; 27:94-97. [PMID: 31045618 DOI: 10.1097/spv.0000000000000732] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The primary objective of this study was to describe patient compliance with pelvic floor physical therapy (PFPT) for high-tone pelvic floor disorders (HTPFD) and to compare patients who are compliant with prescribed therapy to those who are not. The secondary objective is to describe second-line treatments offered for HTPFD for returning patients. METHODS This is a retrospective cohort study of women with a HTPFD who were prescribed PFPT at a tertiary care referral center. Patients were excluded if they had a primary diagnosis of urinary incontinence, had undergone prior PFPT, or if PFPT was part of preoperative planning. Noncompliance with PFPT was defined as not being formally discharged from therapy by the treating therapist. RESULTS Data on PFPT compliance were available for 662 patients (87.3%). A total of 128 patients (19.4%) were fully compliant. Noncompliant patients were more likely to smoke and to have mental health disease compared with compliant patients (18% vs 8.7%, P = 0.01, and 50.4% vs 37.5%, P = 0.009, respectively). A total of 285 patients (43.1%) returned to their prescribing provider. Noncompliant patients were less likely to return to their provider: 63.4% versus 29.7%, P = <0.0001. Of the patients who returned, 183 (64.2%) were offered second-line treatment. CONCLUSIONS Only 1 in 5 patients referred to PFPT for management of a high-tone pelvic floor disorder is compliant with the recommended therapy. Patients who are noncompliant are less likely to return to their prescribing provider, and less than half of referred patients return. Sixty percent of patients who return are offered second-line treatment.
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New Approaches in the Study of the Pathogenesis of Urethral Pain Syndrome. Diagnostics (Basel) 2020; 10:diagnostics10110860. [PMID: 33105749 PMCID: PMC7690567 DOI: 10.3390/diagnostics10110860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Urethral pain syndrome (UPS) is still a pathology in which the diagnosis is formulated as a "diagnosis of exclusion". The exact pathogenetic mechanisms are not yet fully understood and clear recommendations for the prevention and treatment of UPS are absent. METHODS AND PARTICIPANTS A clinical and laboratory evaluation of 55 patients with established UPS included history taking, basic laboratory tests (e.g., complete blood count and clinical urine test), physical examination, uroflowmetry, and cystourethroscopy. Additionally, transvaginal ultrasound (TVUS) with compression elastography and cross-polarization optical tomography (CP OCT) were performed in 24 and 33 patients with UPS, respectively. The control group consisted of 14 patients with no complaints from the urinary system. RESULTS TVUS showed an expansion in the diameter of the internal lumen of the urethra, especially in the proximal region compared with the norm. Compression elastography revealed areas with increased stiffness (presence of fibrosis) in urethral and surrounding tissues. The performed CP OCT study showed that in UPS, the structure of the tissues in most cases was changed: trophic alterations in the epithelium (hypertrophy or atrophy) and fibrosis of underlying connective tissue were observed. The proximal fragment of the urethra with UPS underwent changes identical to those of the bladder neck. CONCLUSION This paper showed that the introduction of new technology-CP OCT-in conjunction with TVUS will allow verification of structural changes in tissues of the lower urinary tract at the level of their architectonics and will help doctors understand better the basics of the UPS pathogenesis.
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Alaniz G, Dods M, Dackovic H, Mascola M, Moreira K, Dufour S. Pre-Licensure Inter-Professional Perspectives: Pelvic Health Physiotherapy. Physiother Can 2020; 72:298-304. [PMID: 35110798 DOI: 10.3138/ptc-2018-0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: In this study, we examined knowledge and perspectives pertaining to pelvic health physiotherapy among medical, midwifery, nursing, and physician assistant students at McMaster University. Moreover, we identified opportunities to improve knowledge translation to facilitate inter-professional education in urogynecological care. Method: A cross-sectional design was created to distribute an online survey to participants using a modified Dillman approach. The survey assessed areas of clinical interest in, knowledge of the scope of practice of, and regulations governing pelvic health physiotherapy in specific, in addition to clinical applications. Fisher's exact and Kruskal-Wallis tests were used to assess statistical significance. Results: A total of 90% of the participants incorrectly indicated that internal digital exams could be delegated to physiotherapy assistants, and 50% believed that Kegel exercises were appropriate for all presentations of pelvic floor dysfunction. Moreover, when prompted to select conditions that could be treated by pelvic health physiotherapists, only 2% of the participants selected the correct conditions. Conclusions: Knowledge in all four programmes about the scope of practice, authorized activities, and application of pelvic health physiotherapy is inadequate. To foster the optimal integration of urogynecology into the relevant health science curriculums, enhanced inter-professional education, inclusive of pelvic health physiotherapy knowledge, appears to be needed.
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Affiliation(s)
- Grecia Alaniz
- Faculty of Health Science, McMaster University, Hamilton.,Radius Health Clinic, Chatham
| | - Margot Dods
- Faculty of Health Science, McMaster University, Hamilton
| | | | | | - Karen Moreira
- Faculty of Health Science, McMaster University, Hamilton
| | - Sinéad Dufour
- Faculty of Health Science, McMaster University, Hamilton.,The World of My Baby, Burlington, Ont
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Rodríguez-Torres J, López-López L, Cabrera-Martos I, Prados-Román E, Granados-Santiago M, Valenza MC. Effects of an Individualized Comprehensive Rehabilitation Program on Impaired Postural Control in Women With Chronic Pelvic Pain: A Randomized Controlled Trial. Arch Phys Med Rehabil 2020; 101:1304-1312. [PMID: 32325162 DOI: 10.1016/j.apmr.2020.02.019] [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: 10/11/2019] [Accepted: 02/23/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the effectiveness of an individualized comprehensive rehabilitation program (ICPR) on impaired postural control, pain, self-perceived health status, and functionality in women with chronic pelvic pain. DESIGN Randomized controlled trial. SETTING Women with chronic pelvic pain were recruited from the Gynecology Department of the University Hospital San Cecilio in Granada, Spain. PARTICIPANTS Participants (N=38) who were randomly divided into 2 groups. INTERVENTIONS The intervention group received an 8-week ICRP, and the control group received a leaflet with ergonomic information. MAIN OUTCOME MEASURES The main outcomes included were postural control (Mini Balance Evaluation Systems [Mini BESTest] and timed Up and Go [TUG]), pain (Brief Pain Inventory), self-perceived health status (EuroQol 5 dimensions [EQ-5D]), and functionality (Oswestry Disability Index [ODI]). RESULTS Significant differences were found between groups in the Mini BESTest and TUG scores with large effect sizes. The Brief Pain Inventory, EQ-5D, and ODI also presented significant differences in the between-groups analysis, with better scores in the intervention group after treatment. In the follow-up analysis, significant differences were found between groups in the Mini BESTest (P<.001), the cognitive TUG subscale (P=.032), interference of pain (P<.001), anxiety and depression (P=.001), and visual analog scale EQ-5D (P=.026) subscales, as well as the ODI (P<.001). CONCLUSIONS Our results show significant improvements on postural control, pain, self-perceived health status, and functionality in women with chronic pelvic pain who received an 8-week ICRP.
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Affiliation(s)
- Janet Rodríguez-Torres
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Laura López-López
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Irene Cabrera-Martos
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Esther Prados-Román
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - María Granados-Santiago
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Marie C Valenza
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain.
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Brooks T, Sharp R, Evans S, Baranoff J, Esterman A. Predictors of Depression, Anxiety and Stress Indicators in a Cohort of Women with Chronic Pelvic Pain. J Pain Res 2020; 13:527-536. [PMID: 32210608 PMCID: PMC7071858 DOI: 10.2147/jpr.s223177] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 01/17/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Establishing predictors of mental health outcomes is a crucial precursor to the development and assessment of psychological interventions for women with chronic pelvic pain (CPP). The objective of this study was to identify predictors of depression, anxiety and stress in a cohort of women with CPP. DESIGN Cross-sectional analytic study. METHODS Pre-treatment questionnaires were collected from 212 women with CPP, who had attended a private specialist pelvic pain clinic over a period of 18 months. Multivariate linear regression with backwards elimination was used to determine the best joint predictors of depression, anxiety and stress scores on the Depression, Anxiety and Stress Scale-21 item (DASS 21). RESULTS Of 19 potential predictor variables, seven key predictors of depression, anxiety and stress indicators were identified. Higher depression scores were associated with higher current pain severity, a history of stabbing pains, prior experience of a sexually distressing event, having experienced pain as a child, and never having been pregnant before. Higher anxiety scores were associated with higher current pain severity, a history of stabbing pains, prior experience of a sexually distressing event, younger age of menarche, and younger age. Predictors of high-stress scores were higher current pain severity, a history of stabbing pains, prior experience of a sexually distressing event, and being younger. CONCLUSION We have identified several important predictors of mental health in women with CPP. Using this information, psychological assessment and treatment for these women may be better tailored to client needs.
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Affiliation(s)
- Tiffany Brooks
- School of Nursing and Midwifery, The University of South Australia, Adelaide, South Australia, Australia
- Aware Women’s Health, Adelaide, South Australia, Australia
| | - Rebecca Sharp
- School of Nursing and Midwifery, The University of South Australia, Adelaide, South Australia, Australia
| | - Susan Evans
- Discipline of Obstetrics and Gynaecology, University of Adelaide, Adelaide, South Australia, Australia
| | - John Baranoff
- Discipline of Obstetrics and Gynaecology, University of Adelaide, Adelaide, South Australia, Australia
- Centre for Treatment of Anxiety and Depression, Adelaide, South Australia, Australia
| | - Adrian Esterman
- School of Nursing and Midwifery, The University of South Australia, Adelaide, South Australia, Australia
- Health and Medicine, James Cook University, Cairns, Queensland, Australia
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Wilk A, Falk A, DeSilva N. Selected Disorders of the Female Reproductive System. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_155-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
OBJECTIVE This guideline reviews the investigation and treatment of primary dysmenorrhea. INTENDED USERS Health care providers. TARGET POPULATION Women and adolescents experiencing menstrual pain for which no underlying cause has been identified. EVIDENCE Published clinical trials, population studies, and review articles cited in PubMed or the Cochrane database from January 2005 to March 2016. VALIDATION METHODS Seven clinical questions were generated by the authors and reviewed by the SOGC Clinical Practice-Gynaecology Committee. The available literature was searched. Guideline No. 169 was reviewed and rewritten in order to incorporate current evidence. Recommendations addressing the identified clinical questions were formulated and evaluated using the ranking of the Canadian Task Force on Preventive Health Care. BENEFITS, HARMS, AND COSTS Primary dysmenorrhea is common and frequently undertreated. Effective therapy is widely available at minimal cost. Treatment has the potential to improve quality of life and to decrease time lost from school or work. GUIDELINE UPDATE This guideline is a revision and update of No. 169, December 2005. SPONSORS SOGC. SUMMARY STATEMENTS RECOMMENDATIONS.
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Abstract
OBJECTIVES The aim of this study was to determine the prevalence of opioid pain medication use among patients presenting for a new visit to the urogynecology clinic compared with those presenting to general gynecology. METHODS We identified all patients who presented for new patient visits to the urogynecology and gynecology clinics between January 1, 2016, and December 31, 2016. Any previous or current opioid use was extracted from the electronic medical record medication list. Statistical analysis was performed using χ and Fisher exact tests for comparisons of categorical variables. Modified Poisson regression models were used to estimate prevalence proportion ratios (PPRs). RESULTS There were 1835 (955 gynecology, 880 urogynecology) patients included. Median age was 47 years (interquartile range, 29 years), and median body mass index was 28.15 kg/m (interquartile range, 9.96 kg/m). Prevalence of opioid use was lowest among women who identified as Asian or other race and highest among black and Native American women; however, when compared by ethnicity, use was lowest among Hispanic women (P = 0.01). Among new urogynecology patients, 14% had self-reported opioid pain medication usage. Opioid use was almost twice as likely in the urogynecology group (PPR, 1.86; 95% confidence interval, 1.4-2.4). When adjusted for confounders, the urogynecology group was 1.3 times as likely to report opioid use (PPR 1.29; 95% confidence interval, 1.0-1.8), with this result approaching statistical significance. CONCLUSIONS Opioid use is greater in patients presenting to the urogynecology clinic compared with general gynecology. Urogynecologists need to know this information for planning and optimizing pain management in this population.
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Klotz SGR, Schön M, Ketels G, Löwe B, Brünahl CA. Physiotherapy management of patients with chronic pelvic pain (CPP): A systematic review. Physiother Theory Pract 2018; 35:516-532. [PMID: 29589778 DOI: 10.1080/09593985.2018.1455251] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Chronic pelvic pain (CPP) is a common pain condition. However, treatment remains challenging. Musculoskeletal findings are frequent; therefore physiotherapy might be helpful. The purpose of this review was to evaluate the current evidence on physiotherapy in patients with CPP (PROSPERO registration number CRD42016037516). METHODS Six databases were searched and additional hand searches were performed. Two reviewers independently conducted the database search and selected studies using a two-step approach. The methodological quality was assessed applying the Critical Review Form - Quantitative Studies. RESULTS A total of eight studies were included. Trigger point therapy was examined in four studies; two of which were randomized controlled trials. All studies indicate a significant change in pain measurement. The other four studies evaluated the effect of biofeedback, Thiele massage, Mensendieck somatocognitive therapy and aerobic exercises, whereas the last two were tested in controlled trials. All studies showed significant improvements in pain assessment. CONCLUSIONS The evidence currently available is sparse with methodological flaws, making it difficult to recommend a specific physiotherapy option. There is an urgent need for high-quality randomized controlled trials to identify the most effective physiotherapy management strategy for patients with CPP.
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Affiliation(s)
- Susanne G R Klotz
- a Department of Psychosomatic Medicine and Psychotherapy , University Medical Centre Hamburg-Eppendorf, Hamburg, Germany and Schön Klinik Hamburg Eilbek , Hamburg , Germany.,b Department of Physiotherapy , University Medical Centre Hamburg-Eppendorf , Hamburg , Germany
| | - Mila Schön
- b Department of Physiotherapy , University Medical Centre Hamburg-Eppendorf , Hamburg , Germany
| | - Gesche Ketels
- b Department of Physiotherapy , University Medical Centre Hamburg-Eppendorf , Hamburg , Germany
| | - Bernd Löwe
- a Department of Psychosomatic Medicine and Psychotherapy , University Medical Centre Hamburg-Eppendorf, Hamburg, Germany and Schön Klinik Hamburg Eilbek , Hamburg , Germany
| | - Christian A Brünahl
- a Department of Psychosomatic Medicine and Psychotherapy , University Medical Centre Hamburg-Eppendorf, Hamburg, Germany and Schön Klinik Hamburg Eilbek , Hamburg , Germany
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17
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Pelvic musculoskeletal dysfunctions in women with and without chronic pelvic pain. J Bodyw Mov Ther 2018; 22:92-96. [DOI: 10.1016/j.jbmt.2017.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 04/04/2017] [Accepted: 04/29/2017] [Indexed: 01/13/2023]
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Abstract
OBJECTIVE To determine the feasibility of a detailed pain sensitivity assessment using body-wide musculoskeletal tender points (TPs) in women with different types of chronic pelvic pain (CPP) and compare phenotypic differences. MATERIALS AND METHODS Seventy women with CPP and 35 pain-free women underwent musculoskeletal evaluation of TPs in the pelvic floor, abdomen, groin, inner thigh, and all 18 fibromyalgia TPs. Patients scored elicited pain on a numeric rating scale. TP pain scores were used for intergroup comparison and intragroup correlation. RESULTS Women with CPP were grouped as having either bladder pain syndrome (BPS, n=24) or myofascial pelvic pain (MPP, n=11) singularly or both concomitantly (BPS+MPP, n=35). TP pain scores for all evaluations were higher in women with CPP compared with healthy women (P<0.001). Women with BPS+MPP had elevated TP pain for each evaluation compared with women with BPS alone. Pelvic floor and fibromyalgia TP scores correlated strongly in the MPP group, moderately in the BPS+MPP group, and weakly in the BPS alone group. Although some moderate and strong correlations between different body locations were present in all 3 groups, only the BPS+MPP group showed moderate to strong correlations between all body TPs. CONCLUSIONS Detailed musculoskeletal evaluation of women with CPP is feasible and well tolerated. Careful phenotyping differentiated BPS, MPP, and BPS+MPP groups. Attending to the differences between these groups clinically may lead to more effective treatment strategies and improved outcomes for patients with CPP.
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An Interdisciplinary Approach to Endometriosis-associated Persistent Pelvic Pain. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2017. [DOI: 10.5301/jeppd.5000284] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Endometriosis-associated pelvic pain is a common and often challenging problem. For certain patients, pain persists or recurs despite adequate medical or surgical therapy targeted to endometriosis. In this patient population, there is often the presence of coexisting pain conditions such as irritable bowel syndrome, painful bladder syndrome and myofascial pain as well central sensitisation. An interdisciplinary approach where both peripheral pain triggers and central sensitization are addressed is likely to lead to improved pain and quality of life. The approach to the evaluation and treatment of the patients with persistent/chronic pelvic pain and endometriosis is outlined in this article.
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Chen I, Thavorn K, Shen M, Goddard Y, Yong P, MacRae GS, Nishi C, Matar A, Allaire C. Hospital-associated Costs of Chronic Pelvic Pain in Canada: A Population-based Descriptive Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:174-180. [PMID: 28343559 DOI: 10.1016/j.jogc.2016.12.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/19/2016] [Accepted: 12/05/2016] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To determine the hospital-related costs incurred by women requiring surgery or inpatient admission for chronic pelvic pain in Canada. METHODS We conducted a population-based, cross-sectional study, focusing on women ages 15-59 with a most responsible International Classification of Diseases diagnosis of pelvic and perineal pain, dysmenorrhea, or dyspareunia who had surgery or inpatient admission with a discharge date between April 1, 2008 and March 31, 2012. This study was based on the Canadian Institute for Health Information Discharge Abstract database and the National Ambulatory Care Reporting System. Clinical diagnoses and interventions and resource intensity weights (RIW) were extracted. Hospital costs were estimated by multiplying cost per weighted case (CPWC) calculated at the national level with respective RIWs. RESULTS Over four years, there were 34 346 cases of surgery or inpatient admission for chronic pelvic pain amounting to $100.5 million with an average cost of $25 million per year. Pelvic and perineal pain accounted for 61.5% (n = 21 127) of the cases, while dysmenorrhea accounted for 31.8% (n = 10 936), and dyspareunia accounted for 6.6% (n = 2283). The vast majority of the cases (92.9%, n = 31 923) were associated with surgical interventions, with the most common surgeries being hysterectomy (47.1%, n = 16 189), followed by laparoscopy (25.8%, n = 8850), adnexal surgery (6.8%, n = 2349), and other procedures (11.6%, n = 3968). CONCLUSION While these estimates do not take into account non-hospital related costs, such as outpatient treatment, loss of productivity, and impact on quality of life, this study demonstrates that chronic pelvic pain represents a considerable economic burden to Canada's health care system.
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Affiliation(s)
- Innie Chen
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON; Faculty of Medicine, University of Ottawa, Ottawa, ON.
| | - Kednapa Thavorn
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON; Faculty of Medicine, University of Ottawa, Ottawa, ON; Institute for Clinical and Evaluative Sciences (ICES UOttawa), Ottawa, ON
| | - Minxue Shen
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - Yvette Goddard
- Faculty of Medicine, University of Ottawa, Ottawa, ON; Department of Anesthesia, University of Ottawa, Ottawa, ON
| | - Paul Yong
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
| | - George S MacRae
- Performance Measurement & Reporting, Provincial Health Services Authority, Vancouver, BC
| | - Corrine Nishi
- Performance Measurement & Reporting, Provincial Health Services Authority, Vancouver, BC
| | - Ayah Matar
- Faculty of Medicine, University of Ottawa, Ottawa, ON
| | - Catherine Allaire
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
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Burnett M, Lemyre M. N° 345-Directive clinique de consensus sur la dysménorrhée primaire. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017. [DOI: 10.1016/j.jogc.2017.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Obedin-Maliver J, de Haan G. Gynecologic Care for Transgender Adults. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0204-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Dureja GP, Iyer RN, Das G, Ahdal J, Narang P. Evidence and consensus recommendations for the pharmacological management of pain in India. J Pain Res 2017; 10:709-736. [PMID: 28435313 PMCID: PMC5386610 DOI: 10.2147/jpr.s128655] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Despite enormous progress in the field of pain management over the recent years, pain continues to be a highly prevalent medical condition worldwide. In the developing countries, pain is often an undertreated and neglected aspect of treatment. Awareness issues and several misconceptions associated with the use of analgesics, fear of adverse events - particularly with opioids and surgical methods of analgesia - are major factors contributing to suboptimal treatment of pain. Untreated pain, as a consequence, is associated with disability, loss of income, unemployment and considerable mortality; besides contributing majorly to the economic burden on the society and the health care system in general. Available guidelines suggest that a strategic treatment approach may be helpful for physicians in managing pain in real-world settings. The aim of this manuscript is to propose treatment recommendations for the management of different types of pain, based on the available evidence. Evidence search was performed by using MEDLINE (by PubMed) and Cochrane databases. The types of articles included in this review were based on randomized control studies, case-control or cohort studies, prospective and retrospective studies, systematic reviews, meta-analyses, clinical practice guidelines and evidence-based consensus recommendations. Articles were reviewed by a multidisciplinary expert panel and recommendations were developed. A stepwise treatment algorithm-based approach based on a careful diagnosis and evaluation of the underlying disease, associated comorbidities and type/duration of pain is proposed to assist general practitioners, physicians and pain specialists in clinical decision making.
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Affiliation(s)
| | - Rajagopalan N Iyer
- Department of Orthopaedics, Raja Rajeswari Medical College and Hospital, Bengaluru, Karnataka
| | - Gautam Das
- Daradia Pain Clinic, Kolkata, West Bengal
| | - Jaishid Ahdal
- Department of Medical Affairs, Janssen India, Johnson & Johnson Pvt Ltd, Mumbai, Maharashtra, India
| | - Prashant Narang
- Department of Medical Affairs, Janssen India, Johnson & Johnson Pvt Ltd, Mumbai, Maharashtra, India
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24
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Selected Disorders of the Female Reproductive System. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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25
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Vitale SG, Petrosino B, La Rosa VL, Rapisarda AMC, Laganà AS. A Systematic Review of the Association Between Psychiatric Disturbances and Endometriosis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:1079-1080. [PMID: 27986180 DOI: 10.1016/j.jogc.2016.09.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Salvatore Giovanni Vitale
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Beatrice Petrosino
- Unit of Psychiatry, Department of Experimental Medicine, University of Catania, Catania, Italy
| | | | | | - Antonio Simone Laganà
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
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Tefft AJ, Jordan IO. Eye Movement Desensitization Reprocessing as Treatment for Chronic Pain Syndromes: A Literature Review. J Am Psychiatr Nurses Assoc 2016; 22:192-214. [PMID: 27048429 DOI: 10.1177/1078390316642519] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic pain is public health problem in the United States, costing upwards of $560 to $635 billion annually. Guidelines consistently recommend psychological treatment for chronic pain. Eye movement desensitization reprocessing (EMDR) psychotherapy may provide an alternate approach to treating chronic pain. OBJECTIVE Review of literature to evaluate the effectiveness of EMDR in the treatment of chronic pain. METHOD A literature search of seven databases was conducted to find relevant studies addressing the use of EMDR for chronic pain. RESULTS Most studies reported improvement in pain and psychological indices with EMDR. CONCLUSIONS Because most literature reported case studies, the results have limited generalizability. However, for clients who suffer from chronic pain, EMDR is a reasonable treatment alternative.
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Affiliation(s)
- Angela J Tefft
- 1 Angela J. Tefft, DNP, ARNP, FNP-C, PMHNP-BC, Kitsap Mental Health Services, Bremerton, WA, USA
| | - Irma O Jordan
- 2 Irma O. Jordan, DNP, APRN, FNP/PMHNP-BC, FAANP, Frontier Nursing University, Arlington, TN, USA
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27
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A Systematic Review of the Association Between Psychiatric Disturbances and Endometriosis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:1006-15. [DOI: 10.1016/s1701-2163(16)30050-0] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Ayorinde AA, Macfarlane GJ, Saraswat L, Bhattacharya S. Chronic pelvic pain in women: an epidemiological perspective. ACTA ACUST UNITED AC 2015; 11:851-64. [PMID: 26450216 DOI: 10.2217/whe.15.30] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chronic pelvic pain (CPP) is common in women of reproductive age and has a significant impact on quality of life, work efficiency and healthcare utilization. CPP can be a manifestation of many different, often multifactorial conditions, and in the absence of an identified cause, the management can be particularly challenging. High quality epidemiological studies would improve the understanding of CPP and identify risk factors which may be targeted for the development of appropriate management strategies. This review focuses on what is known about the prevalence, risk factors, individual and societal burden of CPP and outlines important management strategies.
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Affiliation(s)
- Abimbola A Ayorinde
- Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - Gary J Macfarlane
- Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - Lucky Saraswat
- Department of Obstetrics & Gynaecology, Aberdeen Maternity Hospital, Aberdeen AB25 2ZL, Scotland, UK
| | - Siladitya Bhattacharya
- Institute of Applied Health Sciences, School of Medicine & Dentistry, University of Aberdeen, Aberdeen, Scotland, UK
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29
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Holbrook S, Wolf S. Selected Disorders of the Female Reproductive System. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_115-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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30
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Yong PJ, Mui J, Allaire C, Williams C. Pelvic Floor Tenderness in the Etiology of Superficial Dyspareunia. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:1002-1009. [DOI: 10.1016/s1701-2163(15)30414-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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31
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Yeung P. The Laparoscopic Management of Endometriosis in Patients with Pelvic Pain. Obstet Gynecol Clin North Am 2014; 41:371-83. [DOI: 10.1016/j.ogc.2014.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Endometriosis patients in the postmenopausal period: pre- and postmenopausal factors influencing postmenopausal health. BIOMED RESEARCH INTERNATIONAL 2014; 2014:746705. [PMID: 24987703 PMCID: PMC4058668 DOI: 10.1155/2014/746705] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 05/20/2014] [Indexed: 11/30/2022]
Abstract
Objective. To evaluate patients' health status and the course of endometriosis from the premenopausal to the postmenopausal period and evaluate influencing factors that may be relevant. Methods. Questionnaire completed by 35 postmenopausal women in whom endometriosis had been histologically confirmed premenopausally. Correlation and regression analyses were carried out to identify factors relevant to their postmenopausal health status. Results. Overall, there was clear improvement in typical endometriosis symptoms and sexual life. Clear associations (P < 0.005) were observed between premenopausal factors like physical limitations caused by the disease, impaired social contacts and psychological problems, and postmenopausal pain and impairment of sexual life. Three statistical models for assessing pain and impairment of sexual life in the postmenopausal period were calculated on the basis of clinical symptoms in the premenopausal period, with a very high degree of accuracy (P < 0.001; R2 = 0.833/0.857/0.931). Conclusions. The results of the survey strongly suggest that physical fitness and freedom from physical restrictions, a good social environment, and psychological care in both the premenopausal and postmenopausal periods lead to marked improvements in the postmenopausal period with regard to pain, dyspareunia, and influence on sexual life in endometriosis patients.
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Stacy J, Frawley H, Powell G, Goucke R, Pavy T. Persistent pelvic pain: Rising to the challenge. Aust N Z J Obstet Gynaecol 2012; 52:502-7. [DOI: 10.1111/j.1479-828x.2012.01473.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 07/08/2012] [Indexed: 12/30/2022]
Affiliation(s)
- Jackie Stacy
- Department of Obstetrics and Gynaecology; University of Notre Dame; Sydney; Australia
| | - Helena Frawley
- Melbourne School of Health Sciences; University of Melbourne; Parkville; Vic.; Australia
| | - Gail Powell
- MSS Caulfield Hospital Pain Management and Research Centre; Caulfield; Vic.; Australia
| | - Roger Goucke
- WA Pain Management Centre; Sir Charles Gairdner Hospital; Nedlands; WA; Australia
| | - Timothy Pavy
- Pelvic Pain Clinic; King Edward Memorial Hospital For Women; Subiaco; WA; Australia
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Jarrell J. Endometriosis and abdominal myofascial pain in adults and adolescents. Curr Pain Headache Rep 2012; 15:368-76. [PMID: 21755274 DOI: 10.1007/s11916-011-0218-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Endometriosis and myofascial pain are common disorders with significant impact on quality of life. Increasingly, these conditions are being recognized as highly interconnected through processes that have been described for more than a century. This review is directed to this interconnection through a description of the relationships of endometriosis to proposed mechanisms of pain and chronic pain physiology; the clinical assessment of myofascial representations of this pain; and an approach to the management of these interconnected disorders.
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Affiliation(s)
- John Jarrell
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada.
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36
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Díaz-Mohedo E, Barón-López F, Pineda-Galán C. [Etiological, diagnostic and therapeutic consideration of the myofascial component in chronic pelvic pain]. Actas Urol Esp 2011; 35:610-4. [PMID: 21917358 DOI: 10.1016/j.acuro.2011.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 06/18/2010] [Indexed: 10/26/2022]
Abstract
CONTEXT Chronic pelvic pain is localized in the lower abdomen or pelvis and persists for at least 6 months. It may be continuous or intermittent, without association to a cyclic menstrual condition or to maintaining sexual relationships. OBJECTIVE To justify the important role played by the myofascial component in the etiology and clinical manifestation of Chronic Pelvic Pain and encourage the consideration of a therapeutic approach to such component in the intervention protocols. ACQUIRING OF EVIDENCE A systematic review was made in PubMed and Cochrane Library (2000-2009) that included previous reviews, randomized controlled clinical studies, cohort studies and case studies with patients suffering chronic pelvic pain. SYNTHESIS OF EVIDENCE Chronic pelvic pain and the different conditions associated to it occur with myofascial alterations that may be responsible for the perpetuation of the body symptoms and lack of evolutive resolution of the condition when said component is not approached in a specific way. CONCLUSION This is a clinical situation with elevated prevalence and incidence with significant impact in terms of quality of life and financial cost.
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Affiliation(s)
- Chin-wern Chan
- Wasser Pain Management Center, Mount Sinai Hospital, Toronto, Ontario, Canada
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Tabibian B, Roach CJ, Hanson EH, Wynn BL, Orrison WW. Clinical indications and utilization of 320-detector row CT in 2500 outpatients. Comput Med Imaging Graph 2011; 35:266-74. [PMID: 21371859 DOI: 10.1016/j.compmedimag.2011.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2010] [Accepted: 02/02/2011] [Indexed: 10/18/2022]
Abstract
Clinical indications and utilization patterns for 3963 CT scans on 2500 consecutive patents on a 320-detector row CT in an outpatient setting were retrospectively analyzed and compared with previously reported CT studies. The impact of the latest generation CT technology, including whole organ perfusion, on indications and utilization patterns during the study period was also assessed. The top five requested CT scan types were abdomen/pelvis, chest, head, sinuses, and coronary CT angiography. Indication and utilization rates were similar to prior studies for abdomen/pelvis, non-cardiac chest, and head CT scans. Abdominal pain and headaches were the most frequent indications for abdomen/pelvis and head CTs, respectively. The 7.3% cardiac CT scan utilization rate was not comparable to rates of up to 72% in self-referral outpatient settings. Whole organ volume CT imaging was utilized in 100% of coronary CT angiography and 22.7% of head CTs. The 320-row CT had fewer negative head and body CT findings as compared to prior reports. The availability of new technology, such as whole organ dynamic scans, appears to have influenced CT indications, utilization and finding rates with a decrease in negative brain and body results. Comparisons with previous outpatient CT studies were similar for multiple categories with the exception of cardiac CT utilization, which is heavily influenced by self-referral. Further study of outpatient imaging indications and utilization rates from multiple centers may benefit from a standardized categorization to improve understanding of the disparate outpatient imaging environment.
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Affiliation(s)
- Benjamin Tabibian
- Loma Linda University Medical Center, Department of Internal Medicine, 11234 Anderson Street, Loma Linda, CA 92354-2804, USA
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Vercellini P, Barbara G, Abbiati A, Somigliana E, Viganò P, Fedele L. Repetitive surgery for recurrent symptomatic endometriosis: what to do? Eur J Obstet Gynecol Reprod Biol 2009; 146:15-21. [PMID: 19482404 DOI: 10.1016/j.ejogrb.2009.05.007] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Accepted: 05/05/2009] [Indexed: 11/19/2022]
Abstract
In spite of the increasing number of operative laparoscopies performed for endometriosis associated pelvic pain, postoperative symptomatic recurrences are very common. Reoperation is often considered the best treatment option, but the extent and duration of the effect of second-line surgery is still unclear. The best available evidence has been reviewed in order to define the results of repetitive conservative surgery, the effects of pelvic denervating procedures and postoperative medical treatments, as well as the long-term outcome of definitive surgery. Because of the paucity of published data, estimating the real risk of symptomatic recurrence and need for reoperation after repetitive conservative surgery for endometriosis is very difficult. Based on the limited information available, the long-term outcome appears suboptimal, with a cumulative probability of pain recurrence between 20% and 40%, and of a further surgical procedure between 15% and 20%. These figures are probably an underestimate related to drawbacks in study design, exclusions of dropouts, and publication bias and should be considered with caution. Systematic complementary performance of denervating procedures in addition to reoperation cannot be recommended, as only a few symptomatic patients complain of predominantly midline, hypo-gastric pain. The outcome of hysterectomy for endometriosis-associated pain at medium-term follow-up seems quite satisfactory. Nevertheless, about 15% of patients had persistent symptoms, and 3-5% experienced worsening of pain. Concomitant bilateral oophorectomy reduced the risk of reoperation due to recurrent pelvic pain by six times. However, at least one gonad should be preserved in young women, especially in those with objections to the use of oestrogen-progestogens. Medical treatment appears to have limited and inconsistent effects when used for only a few months after conservative procedures. Data on the benefit of prolonged drug regimens with oral contraceptives or progestogen are lacking. The risk of recurrence of endometriosis during hormone replacement therapy seems marginal if combined preparations or tibolone are used and oestrogen-only treatments are avoided. The opportune surgical solution in women with recurrent symptoms after previous conservative procedures for endometriosis should be based on the desire for conception as well as on psychological characteristics. Studies on surgical management of recurrent rectovaginal endometriosis are warranted, due to the peculiar technical difficulties as well as the high risk of complications associated with this challenging disease form.
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Affiliation(s)
- Paolo Vercellini
- Department of Obstetrics and Gynaecology, University of Milan, Istituto Luigi Mangiagalli, Via Commenda 12-20122 Milan, Italy.
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Vercellini P, Viganò P, Somigliana E, Abbiati A, Barbara G, Fedele L. Medical, surgical and alternative treatments for chronic pelvic pain in women: a descriptive review. Gynecol Endocrinol 2009; 25:208-21. [PMID: 19296329 DOI: 10.1080/09513590802530940] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Several causes of chronic pelvic pain (CPP) are recognised, but in many women a definite diagnosis cannot be made. Few randomised controlled trials on treatment of CPP have been conducted. In a Cochrane systematic review, only medroxy-progesterone acetate, counselling, a multidisciplinary approach and lysis of deep adhesions had a proven benefit. The aim of this descriptive review is to describe the management of CPP, which can focus on treating the pain itself, the underlying cause, or both. Combination drug therapy with medications with different mechanisms of action may improve therapeutic results. Pelvic denervating procedures should be indicated in selected circumstances, as the magnitude of the effect is undefined. Several alternative non-invasive treatments have been proposed including exercise programmes, cognitive and behavioural medicine, physical therapy, dietary modification, massage and acupuncture. When the woman has completed her family and particularly when pelvic varices have been demonstrated, hysterectomy can be considered after a careful pre-operative assessment. However, substantial pain relief may be achieved in no more than 60-70% of the cases. A minority of patients (3-5%) will experience worsening of pain or will develop new symptoms after surgery. Treatment of CPP, generally, requires acceptance of the concept of managing rather than curing symptoms.
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Affiliation(s)
- Paolo Vercellini
- Clinica Ostetrica e Ginecologica I, University of Milan, Milan, Italy.
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Palomba S, Zupi E, Falbo A, Russo T, Tolino A, Marconi D, Mattei A, Zullo F. Presacral neurectomy for surgical management of pelvic pain associated with endometriosis: a descriptive review. J Minim Invasive Gynecol 2007; 13:377-85. [PMID: 16962518 DOI: 10.1016/j.jmig.2006.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2006] [Revised: 06/07/2006] [Accepted: 06/09/2006] [Indexed: 11/16/2022]
Abstract
Pelvic pain associated with endometriosis is a common clinical problem. In approximately 20% of cases endometriosis-related pelvic pain is either minimally or not responsive to medical treatment; thus surgical treatment seems to be a valid option. The aim of this review is to describe presacral neurectomy surgical techniques, data regarding safety and efficacy of this procedure, its indications, and future research on its applications in clinical practice.
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Affiliation(s)
- Stefano Palomba
- Department of Obstetrics and Gynecology, University Magna Graecia Catanzaro, Rome, Italy.
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Lefebvre G, Pinsonneault O, Antao V, Black A, Burnett M, Feldman K, Lea R, Robert M. Primary Dysmenorrhea Consensus Guideline. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2005; 27:1117-46. [PMID: 16524531 DOI: 10.1016/s1701-2163(16)30395-4] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
METHODS Members of this consensus group were selected based on individual expertise to represent a range of practical and academic experience both in terms of location in Canada and type of practice, as well as subspecialty expertise along with general gynaecology backgrounds. The consensus group reviewed all available evidence through the English and French medical literature and available data from a survey of Canadian women. Recommendations were established as consensus statements. The final document was reviewed and approved by the Executive and Council of the SOGC. RESULTS This document provides a summary of up-to-date evidence regarding the diagnosis, investigations, and medical and surgical management of dysmenorrhea. The resulting recommendations may be adapted by individual health care workers when serving women who suffer from this condition. CONCLUSIONS Dysmenorrhea is an extremely common and sometimes debilitating condition for women of reproductive age. A multidisciplinary approach involving a combination of lifestyle, medications, and allied health services should be used to limit the impact of this condition on activities of daily living. In some circumstances, surgery is required to offer the desired relief. OUTCOMES This guideline discusses the various options in managing dysmenorrhea. Patient information materials may be derived from these guidelines in order to educate women in terms of their options and possible risks and benefits of various treatment strategies. Women who find an acceptable management strategy for this condition may benefit from an improved quality of life.
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