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Lin T, Allaire C, As-Sanie S, Stratton P, Vincent K, Adamson GD, Arendt-Nielsen L, Bush D, Jansen F, Longpre J, Rombauts L, Shah J, Toussaint A, Hummelshoj L, Missmer SA, Yong PJ. World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonization Project: V. Physical examination standards in endometriosis research. Fertil Steril 2024; 122:304-315. [PMID: 38508508 DOI: 10.1016/j.fertnstert.2024.03.007] [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: 03/06/2024] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE The World Endometriosis Research Foundation established the Endometriosis Phenome and Biobanking Harmonisation Project (EPHect) to create standardized documentation tools (with common data elements) to facilitate the comparison and combination of data across different research sites and studies. In 2014, 4 data research standards were published: clinician-reported surgical data, patient-reported clinical data, and fluid and tissue biospecimen collection. Our current objective is to create an EPHect standard for the clinician-reported physical examination (EPHect-PE) for research studies. DESIGN An international consortium involving 26 clinical and academic experts and patient partners from 11 countries representing 25 institutions and organizations. Two virtual workshops, followed by the development of the physical examination standards underwent multiple rounds of iterations and revisions. SUBJECTS N/A MAIN OUTCOME MEASURE(S): N/A RESULT(S): The EPHect-PE tool provides standardized assessment of physical examination characteristics and pain phenotyping. Data elements involve examination of back and pelvic girdle; abdomen including allodynia and trigger points; vulva including provoked vestibulodynia; pelvic floor muscle tone and tenderness; tenderness on unidigital pelvic examination; presence of pelvic nodularity; uterine size and mobility; presence of adnexal masses; presence of incisional masses; speculum examination; tenderness and allodynia at an extra-pelvic site (e.g., forearm); and recording of anthropometrics. CONCLUSION(S) The EPHect-PE standards will facilitate the standardized documentation of the physical examination, including the assessment and documentation of examination phenotyping of endometriosis-associated pelvic pain.
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Affiliation(s)
- Tinya Lin
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Catherine Allaire
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sawsan As-Sanie
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | | | - Katy Vincent
- Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - G David Adamson
- World Endometriosis Research Foundation (WERF); Department of Obstetrics & Gynecology, Stanford University, Palo Alto, California
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; Aalborg University Hospital, Mech-Sense, Aalborg, Denmark
| | | | - Femke Jansen
- World Endometriosis Organisations (WEO); EndoHome - Endometriosis Association Belgium, Belgium
| | - Jennifer Longpre
- Department of Obstetrics and Gynecology, Université de Montreal, Montreal, Quebec, Canada
| | - Luk Rombauts
- World Endometriosis Research Foundation (WERF); Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Jay Shah
- National Institutes of Health, Bethesda, Maryland
| | - Abeesha Toussaint
- World Endometriosis Organisations (WEO); Trinidad and Tobago Endometriosis Association, Port of Spain, Trinidad and Tobago
| | | | - Stacey A Missmer
- World Endometriosis Research Foundation (WERF); Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, Michigan
| | - Paul J Yong
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada.
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Camila de Lima Alves da Silva T, da Silva Dantas H, Eduarda Macedo L, Duarte Martins T, Silva-Filho E, Pegado R, McLean L, Thereza Albuquerque Barbosa Cabral Micussi M. Investigating the efficacy of transcranial direct current stimulation on chronic pain management in endometriosis patients: A randomized controlled trial protocol. PLoS One 2024; 19:e0306405. [PMID: 39088433 PMCID: PMC11293689 DOI: 10.1371/journal.pone.0306405] [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: 12/13/2023] [Accepted: 05/23/2024] [Indexed: 08/03/2024] Open
Abstract
INTRODUCTION Similar to chronic pain conditions, individuals with endometriosis can be affected by central sensitization syndrome (CSS), which is characterized by a loss of analgesia and central amplification of pain. Transcranial direct current stimulation (tDCS) has shown potential as an effective intervention to improve pain generated by other chronic pain conditions impacted by CSS, such as fibromyalgia and chronic pelvic issues. This study aims to evaluate the effectiveness of tDCS on pain, fatigue, and quality of life among patients affected by endometriosis. METHODS This is a single-center, parallel, double-blinded, randomized, controlled clinical trial protocol study. We aim to recruit 40 participants affected by endometriosis (active group, n = 20; sham group, n = 20). Anodal tDCS will be delivered at an intensity of 2mA, applied over the primary motor cortex for 20 minutes per day for 10 consecutive days. There will be four assessment times: 1 week before beginning the intervention; on the 10th day following the last tDCS session; and 1 and 2 months after the last tDCS session. Pain evaluated by the algometry will be the primary outcome. Pain intensity, quality of life, fatigue, and global perception of change will be the secondary outcomes. We will calculate the effects of the active versus sham stimulation on primary and secondary outcomes by using generalized estimated equations or mixed model analysis. The effect size calculation will represent the effect measure. We expect that only the active group show reductions in pain, fatigue, and quality of life. The results of this trial will produce an important first step in providing evidence on the effectiveness of neuromodulation for the management of pain and will provide data to support new studies on tDCS. REGISTRATION Brazilian Clinical Trials Registry (RBR-4q69573).
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Affiliation(s)
| | - Hégila da Silva Dantas
- Physical Therapy Graduate Student, Physical Therapy Department, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Luiza Eduarda Macedo
- Physical Therapy Undergraduate Student, Physical Therapy Department, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Talita Duarte Martins
- Physical Therapy Undergraduate Student, Physical Therapy Department, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Edson Silva-Filho
- Ph.D, Physical Therapy, Physical Therapy Department Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Rodrigo Pegado
- Ph.D, Physical Therapy, Physical Therapy Department Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Linda McLean
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
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Mokhtari T, Irandoost E, Sheikhbahaei F. Stress, pain, anxiety, and depression in endometriosis-Targeting glial activation and inflammation. Int Immunopharmacol 2024; 132:111942. [PMID: 38565045 DOI: 10.1016/j.intimp.2024.111942] [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: 02/10/2024] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
Endometriosis (EM) is a gynecological inflammatory disease often accompanied by stress, chronic pelvic pain (CPP), anxiety, and depression, leading to a diminished quality of life. This review aims to discuss the relationship between systemic and local inflammatory responses in the central nervous system (CNS), focusing on glial dysfunctions (astrocytes and microglia) as in critical brain regions involved in emotion, cognition, pain processing, anxiety, and depression. The review presents that EM is connected to increased levels of pro-inflammatory cytokines in the circulation. Additionally, chronic stress and CPP as stressors may contribute to the dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, depleting the production of inflammatory mediators in the circulatory system and the brain. The systemic cytokines cause blood-brain barrier (BBB) breakdown, activate microglia in the brain, and lead to neuroinflammation. Furthermore, CPP may induce neuronal morphological alterations in critical regions through central sensitization and the activation of glial cells. The activation of glial cells, particularly the polarization of microglia, leads to the activation of the NLRP3 inflammasome and the overproduction of inflammatory cytokines. These inflammatory cytokines interact with the signaling pathways involved in neural plasticity. Additionally, persistent inflammatory conditions in the brain lead to neuronal death, which is correlated with a reduced volume of key brain regions such as the hippocampus. This review highlights the involvement of glial cells in the pathogenesis of the mental comorbidities of EM (i.e., pain, anxiety, and depression) and to discuss potential therapeutic approaches for targeting the inflammation and activation of microglia in key brain regions.
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Affiliation(s)
- Tahmineh Mokhtari
- Department of Pharmacology, Hubei University of Medicine, Shiyan, China; Department of Histology and Embryology, Faculty of Basic Medical Sciences, Hubei University of Medicine, Shiyan, China
| | - Elnaz Irandoost
- Sarem Women's Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran.
| | - Fatemeh Sheikhbahaei
- Department of Anatomy, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
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Singh SS, Allaire C, Al-Nourhji O, Bougie O, Bridge-Cook P, Duigenan S, Kroft J, Lemyre M, Leonardi M, Leyland N, Maheux-Lacroix S, Wessels J, Wahl K, Yong PJ. Guideline No. 449: Diagnosis and Impact of Endometriosis - A Canadian Guideline. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102450. [PMID: 38555044 DOI: 10.1016/j.jogc.2024.102450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
OBJECTIVE To provide a contemporary approach to the understanding of the impact and methods for the diagnosis of endometriosis in Canada. TARGET POPULATION Individuals, families, communities, health care providers, and health care administrators who are affected by, care for patients with, or manage delivery of services for endometriosis. OPTIONS The diagnosis of endometriosis is facilitated by a detailed history, examination, and imaging tests with providers who are experienced in endometriosis care. Surgical evaluation with pathology confirms a diagnosis of endometriosis; however, it is not required for those whose diagnosis was confirmed with imaging. OUTCOMES There is a need to address earlier recognition of endometriosis to facilitate timely access to care and support. Education directed at the public, affected individuals and families, health care providers, and health care administrators are essential to reduce delays in diagnosis and treatment. BENEFITS, HARMS, AND COSTS Increased awareness and education about the impact and approach to diagnosis may support timely access to care for patients and families affected by endometriosis. Earlier and appropriate care may support a reduced health care system burden; however, improved clinical evaluation may require initial investments. EVIDENCE Each section was reviewed with a unique search strategy representative of the evidence available in the literature related to the area of focus. The literature searches for each section of this guideline are listed in Appendix A and include information from published systematic reviews described in the text. VALIDATION METHODS The recommendations were developed following two rounds of review by a national expert panel through an iterative 2-year consensus process. Further details on the process are shared in Appendix B. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See Appendix C (Table C1 for definitions and Table C2 for interpretations of strong and conditional recommendations). INTENDED AUDIENCE This guideline is intended to support health care providers and policymakers involved in the care of those impacted by endometriosis and the systems required to support them. TWEETABLE ABSTRACT Endometriosis impact and diagnosis updated guidelines for Canadian health care providers and policymakers. SUMMARY STATEMENTS RECOMMENDATIONS.
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Singh SS, Allaire C, Al-Nourhji O, Bougie O, Bridge-Cook P, Duigenan S, Kroft J, Lemyre M, Leonardi M, Leyland N, Maheux-Lacroix S, Wessels J, Wahl K, Yong PJ. Directive clinique n o 449 : Directive canadienne sur le diagnostic et les impacts de l'endométriose. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102451. [PMID: 38555045 DOI: 10.1016/j.jogc.2024.102451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
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Cetera GE, Merli CEM, Barbara G, Caia C, Vercellini P. Questionnaires for the Assessment of Central Sensitization in Endometriosis: What Is the Available Evidence? A Systematic Review with a Narrative Synthesis. Reprod Sci 2024; 31:633-644. [PMID: 37751146 PMCID: PMC10912156 DOI: 10.1007/s43032-023-01343-4] [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: 07/06/2023] [Accepted: 08/28/2023] [Indexed: 09/27/2023]
Abstract
It has been suggested that central sensitization (CS) may be involved in the failure of standard medical and surgical treatment to relieve endometriosis-related pain. However, there is no gold standard for the diagnosis of CS, and self-reported questionnaires are used as diagnostic surrogates. The main objective of this review was to identify all CS questionnaires used in clinical endometriosis studies. The secondary objective was to qualitatively analyze strengths and weaknesses of each questionnaire. A PubMed and EMBASE systematic literature search conducted in April 2023 using the terms "endometriosis; central pain; central sensitization; questionnaire; patient-reported outcome measure; screening tool" identified 122 publications: six articles were included in the review. The Central Sensitization Inventory (CSI) is the most frequently used questionnaire for the detection of CS in patients with endometriosis. It has been validated in patients with endometriosis, in whom it appears to have good psychometric proprieties. The Fibromyalgia Survey Questionnaire (FSQ) has also been used, although it has not been specifically validated in endometriosis patients. The debate regarding these questionnaires' construct validity is still open and will be so until a gold standard diagnostic tool for CS is found. In fact, some authors argue these questionnaires are measuring psychological vulnerability and a hypervigilant state that is associated with pain, rather than CS itself. However, their use should not be discouraged as they are able to identify chronic pain patients which warrant further attention and who may benefit from broader treatment strategies.
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Affiliation(s)
- Giulia Emily Cetera
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Giussy Barbara
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
- Obstetric and Gynecological Emergency Unit and SVSeD (Service for Sexual and Domestic Violence), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Carlotta Caia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paolo Vercellini
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Bartley EJ, Alappattu MJ, Manko K, Lewis H, Vasilopoulos T, Lamvu G. Presence of endometriosis and chronic overlapping pain conditions negatively impacts the pain experience in women with chronic pelvic-abdominal pain: A cross-sectional survey. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241248017. [PMID: 38682290 PMCID: PMC11057341 DOI: 10.1177/17455057241248017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 02/06/2024] [Accepted: 04/02/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Evidence of overlap between endometriosis and chronic pain conditions is emerging; however, little is known about how the pain experience differs based on the presence or absence of endometriosis. OBJECTIVES In a sample of women reporting chronic pelvic-abdominal pain (CPP), the aim of this study was to characterize differences in pain symptomatology between women with and without endometriosis and to examine the influence of chronic overlapping pain conditions (COPCs) on pain among these two groups. DESIGN This was a cross-sectional study, based on an online survey. METHODS Participants (aged 18+ years) completed a survey collecting pain diagnoses and symptoms assessing pelvic pain severity, pain interference, and pain impact. Independent sample t-tests, chi-square, and multiple linear regression models were employed to analyze group differences in pain symptomatology and COPCs. RESULTS Of the 525 respondents with CPP, 25% (n = 133) reported having endometriosis. Women with endometriosis were younger at the onset of pelvic pain, relative to women without endometriosis (p = 0.04). There were no differences in age, race, ethnicity, or duration of pelvic pain between women with and without endometriosis. Women with endometriosis reported higher pelvic pain severity (+0.8, 95% CI = 0.4-1.1), pain interference (+5.9, 95% CI = 2.4-9.3), and pain impact (+1.9, 95% CI = 0.8-2.9). Endometriosis was associated with a higher number of COPCs (p = 0.003), with 25% (n = 33) of women reporting ⩾3 overlapping pain conditions compared with 12% (n = 45) of those without endometriosis. Women with endometriosis had a higher frequency of fibromyalgia (p < 0.001), chronic fatigue syndrome (p < 0.001), and temporomandibular disorder (p = 0.001). The number of COPCs was associated with higher pain severity, interference, and impact, independently of endometriosis. CONCLUSION Women with endometriosis experienced higher levels of pain-related burden and COPCs compared with those without endometriosis. Pain intensity, interference, and impact increased with a higher number of pain conditions regardless of endometriosis presence.
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Affiliation(s)
- Emily J Bartley
- College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Meryl J Alappattu
- College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA
| | - Kelsey Manko
- College of Medicine, University of Central Florida, Gainesville, FL, USA
| | - Hannah Lewis
- Gynecology Section, Division of Surgery, Orlando Veterans Affairs Healthcare System, Orlando, FL, USA
| | | | - Georgine Lamvu
- College of Medicine, University of Central Florida, Gainesville, FL, USA
- Gynecology Section, Division of Surgery, Orlando Veterans Affairs Healthcare System, Orlando, FL, USA
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Kayacik Günday Ö, Harmanci H, Şenol Y. The Effect of Affective Temperament, Pain Catastrophizing, and Anxiety Sensitivity on Pain Severity in Patients With Chronic Pelvic Pain: A Pilot Study. J Psychiatr Pract 2023; 29:447-455. [PMID: 37801636 DOI: 10.1097/pra.0000000000000742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
OBJECTIVE The goals of this study were to investigate whether there was a dominant temperament type, and to assess the effect of temperament, pain catastrophizing, and anxiety sensitivity on pain severity, in female patients diagnosed with chronic pelvic pain (CPP) compared with healthy controls. METHODS This cross-sectional study involved 51 patients 18 to 65 years of age who were diagnosed with CPP without a history of psychiatric treatment and 97 healthy volunteer women with sociodemographic characteristics similar to those of the study group. A sociodemographic form prepared by the researchers, the Anxiety Sensitivity Index, the Pain Catastrophizing Scale, a temperament scale (Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire), and a visual analog pain scale (VAS) were completed. The results were compared between the patient and control groups. Multiple regression analyses were performed to examine the predictive effects of temperament characteristics, pain catastrophizing, and anxiety sensitivity on pain severity. RESULTS Scores on the Pain Catastrophizing Scale and the VAS were statistically significantly higher in the CPP group ( P <0.001). The frequency of depressive, cyclothymic, and irritable temperaments was found to be significantly higher in the CPP group (CPP: 7.78±3.32 vs. controls: 6.54±3.19; P =0.027; CPP:10.61±4.41 vs. controls: 8.82±4.21; P =0.017; CPP: 5.22±4.29 vs. controls: 3.75±3.41; P =0.025). According to the model established by temperament traits, anxiety sensitivity, and pain catastrophizing level, pain catastrophizing level explained 11.6% of the variance in pain severity. A 1-unit change in the score for pain catastrophizing level caused a 0.278-point change in the VAS total score ( P <0.01). CONCLUSIONS Cyclothymic, depressive, and irritable temperament types that increase the risk of affective disease are more common in patients with CPP. The level of pain catastrophizing in patients with CPP affects their perception of the severity of the pain.
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Coxon L, Vollert J, Perro D, Lunde CE, Ferreira-Gomes J, Charrua A, Abreu-Mendes P, Krassowski M, Birch J, Meijlink J, Hummelshoj L, Hoffmann A, Aziz Q, Arendt-Nielsen L, Pogatzki-Zahn E, Evans E, Demetriou L, McMahon SB, Missmer SA, Becker CM, Zondervan KT, Horne AW, Cruz F, Sieberg CB, Treede RD, Nagel J, Vincent K. Comprehensive quantitative sensory testing shows altered sensory function in women with chronic pelvic pain: results from the Translational Research in Pelvic Pain (TRiPP) Study. Pain 2023; 164:2528-2539. [PMID: 37289573 PMCID: PMC10578421 DOI: 10.1097/j.pain.0000000000002955] [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: 10/21/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 06/10/2023]
Abstract
ABSTRACT Chronic pelvic pain (CPP), despite its high prevalence, is still relatively poorly understood mechanistically. This study, as part of the Translational Research in Pelvic Pain (TRiPP) project, has used a full quantitative sensory testing (QST) paradigm to profile n = 85 women with and without CPP (endometriosis or bladder pain specifically). We used the foot as a control site and abdomen as the test site. Across 5 diagnostically determined subgroups, we found features which are common across different aetiologies, eg, gain of function in pressure pain threshold (PPT) when assessing responses from the lower abdomen or pelvis (referred pain site). However, disease-specific phenotypes were also identified, eg, greater mechanical allodynia in endometriosis, despite there being large heterogeneities within diagnostic groups. The most common QST sensory phenotype was mechanical hyperalgesia (>50% across all the groups). A "healthy' sensory phenotype was seen in <7% of CPP participants. Specific QST measures correlated with sensory symptoms assessed by the painDETECT questionnaire (pressure-evoked pain [painDETECT] and PPT [QST] [ r = 0.47, P < 0.001]; mechanical hyperalgesia (painDETECT) and mechanical pain sensitivity [MPS from QST] [ r = 0.38, P = 0.009]). The data suggest that participants with CPP are sensitive to both deep tissue and cutaneous inputs, suggesting that central mechanisms may be important in this cohort. We also see phenotypes such as thermal hyperalgesia, which may be the result of peripheral mechanisms, such as irritable nociceptors. This highlights the importance of stratifying patients into clinically meaningful phenotypes, which may have implications for the development of better therapeutic strategies for CPP.
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Affiliation(s)
- Lydia Coxon
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Jan Vollert
- University Hospital Muenster, Muenster, Germany
- Heidelberg University, Mannheim, Germany
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Danielle Perro
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Claire E. Lunde
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
- Biobehavioral Pain Innovations Lab, Department of Psychiatry & Behavioral Sciences, Boston Children's Hospital, Boston, MA, United States
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
| | | | - Ana Charrua
- IBMC/I3S, Faculty of Medicine of Porto & Hospital São João, Porto, Portugal
| | - Pedro Abreu-Mendes
- IBMC/I3S, Faculty of Medicine of Porto & Hospital São João, Porto, Portugal
| | - Michal Krassowski
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Judy Birch
- Pelvic Pain Support Network, Poole, United Kingdom
| | - Jane Meijlink
- International Painful Bladder Foundation, Naarden, the Netherlands
| | | | - Anja Hoffmann
- Bayer AG, Research & Development, Pharmaceuticals, Berlin, Germany
| | - Qasim Aziz
- Queen Mary University of London, London, United Kingdom
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
| | | | - Emma Evans
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Lysia Demetriou
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Stephen B. McMahon
- Formerly of Neurorestoration Group, Wolfson Centre for Age-Related Diseases, King's College London, London, United Kingdom
| | - Stacey A. Missmer
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Christian M. Becker
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Krina T. Zondervan
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | | | - Francisco Cruz
- IBMC/I3S, Faculty of Medicine of Porto & Hospital São João, Porto, Portugal
| | - Christine B. Sieberg
- Biobehavioral Pain Innovations Lab, Department of Psychiatry & Behavioral Sciences, Boston Children's Hospital, Boston, MA, United States
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | | | - Jens Nagel
- Bayer AG, Research & Development, Pharmaceuticals, Wuppertal, Germany
| | - Katy Vincent
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
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Song SY, Jung YW, Shin W, Park M, Lee GW, Jeong S, An S, Kim K, Ko YB, Lee KH, Kang BH, Lee M, Yoo HJ. Endometriosis-Related Chronic Pelvic Pain. Biomedicines 2023; 11:2868. [PMID: 37893241 PMCID: PMC10603876 DOI: 10.3390/biomedicines11102868] [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: 07/29/2023] [Revised: 09/17/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Endometriosis, which is the presence of endometrial stroma and glands outside the uterus, is one of the most frequently diagnosed gynecologic diseases in reproductive women. Patients with endometriosis suffer from various pain symptoms such as dysmenorrhea, dyspareunia, and chronic pelvic pain. The pathophysiology for chronic pain in patients with endometriosis has not been fully understood. Altered inflammatory responses have been shown to contribute to pain symptoms. Increased secretion of cytokines, angiogenic factors, and nerve growth factors has been suggested to increase pain. Also, altered distribution of nerve fibers may also contribute to chronic pain. Aside from local contributing factors, sensitization of the nervous system is also important in understanding persistent pain in endometriosis. Peripheral sensitization as well as central sensitization have been identified in patients with endometriosis. These sensitizations of the nervous system can also explain increased incidence of comorbidities related to pain such as irritable bowel disease, bladder pain syndrome, and vulvodynia in patients with endometriosis. In conclusion, there are various possible mechanisms behind pain in patients with endometriosis, and understanding these mechanisms can help clinicians understand the nature of the pain symptoms and decide on treatments for endometriosis-related pain symptoms.
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Affiliation(s)
- Soo Youn Song
- Department of Obstetrics & Gynecology, Chungnam National University School of Medicine, Chungnam National University Sejong Hospital, 20, Bodeum 7 ro, Sejong 30099, Republic of Korea; (S.Y.S.); (Y.W.J.); (W.S.)
| | - Ye Won Jung
- Department of Obstetrics & Gynecology, Chungnam National University School of Medicine, Chungnam National University Sejong Hospital, 20, Bodeum 7 ro, Sejong 30099, Republic of Korea; (S.Y.S.); (Y.W.J.); (W.S.)
| | - WonKyo Shin
- Department of Obstetrics & Gynecology, Chungnam National University School of Medicine, Chungnam National University Sejong Hospital, 20, Bodeum 7 ro, Sejong 30099, Republic of Korea; (S.Y.S.); (Y.W.J.); (W.S.)
| | - Mia Park
- Department of Obstetrics & Gynecology, Chungnam National University School of Medicine, Chungnam National University Hospital, 33, Munhwa-ro, Jung-gu, Daejeon 2868, Republic of Korea; (M.P.); (G.W.L.); (S.J.); (S.A.); (K.K.); (Y.B.K.); (K.H.L.); (B.H.K.); (M.L.)
| | - Geon Woo Lee
- Department of Obstetrics & Gynecology, Chungnam National University School of Medicine, Chungnam National University Hospital, 33, Munhwa-ro, Jung-gu, Daejeon 2868, Republic of Korea; (M.P.); (G.W.L.); (S.J.); (S.A.); (K.K.); (Y.B.K.); (K.H.L.); (B.H.K.); (M.L.)
| | - Soohwa Jeong
- Department of Obstetrics & Gynecology, Chungnam National University School of Medicine, Chungnam National University Hospital, 33, Munhwa-ro, Jung-gu, Daejeon 2868, Republic of Korea; (M.P.); (G.W.L.); (S.J.); (S.A.); (K.K.); (Y.B.K.); (K.H.L.); (B.H.K.); (M.L.)
| | - Sukjeong An
- Department of Obstetrics & Gynecology, Chungnam National University School of Medicine, Chungnam National University Hospital, 33, Munhwa-ro, Jung-gu, Daejeon 2868, Republic of Korea; (M.P.); (G.W.L.); (S.J.); (S.A.); (K.K.); (Y.B.K.); (K.H.L.); (B.H.K.); (M.L.)
| | - Kyoungmin Kim
- Department of Obstetrics & Gynecology, Chungnam National University School of Medicine, Chungnam National University Hospital, 33, Munhwa-ro, Jung-gu, Daejeon 2868, Republic of Korea; (M.P.); (G.W.L.); (S.J.); (S.A.); (K.K.); (Y.B.K.); (K.H.L.); (B.H.K.); (M.L.)
| | - Young Bok Ko
- Department of Obstetrics & Gynecology, Chungnam National University School of Medicine, Chungnam National University Hospital, 33, Munhwa-ro, Jung-gu, Daejeon 2868, Republic of Korea; (M.P.); (G.W.L.); (S.J.); (S.A.); (K.K.); (Y.B.K.); (K.H.L.); (B.H.K.); (M.L.)
| | - Ki Hwan Lee
- Department of Obstetrics & Gynecology, Chungnam National University School of Medicine, Chungnam National University Hospital, 33, Munhwa-ro, Jung-gu, Daejeon 2868, Republic of Korea; (M.P.); (G.W.L.); (S.J.); (S.A.); (K.K.); (Y.B.K.); (K.H.L.); (B.H.K.); (M.L.)
| | - Byung Hun Kang
- Department of Obstetrics & Gynecology, Chungnam National University School of Medicine, Chungnam National University Hospital, 33, Munhwa-ro, Jung-gu, Daejeon 2868, Republic of Korea; (M.P.); (G.W.L.); (S.J.); (S.A.); (K.K.); (Y.B.K.); (K.H.L.); (B.H.K.); (M.L.)
| | - Mina Lee
- Department of Obstetrics & Gynecology, Chungnam National University School of Medicine, Chungnam National University Hospital, 33, Munhwa-ro, Jung-gu, Daejeon 2868, Republic of Korea; (M.P.); (G.W.L.); (S.J.); (S.A.); (K.K.); (Y.B.K.); (K.H.L.); (B.H.K.); (M.L.)
| | - Heon Jong Yoo
- Department of Obstetrics & Gynecology, Chungnam National University School of Medicine, Chungnam National University Sejong Hospital, 20, Bodeum 7 ro, Sejong 30099, Republic of Korea; (S.Y.S.); (Y.W.J.); (W.S.)
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11
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Fortún-Rabadán R, Boudreau SA, Bellosta-López P, Herrero P, Graven-Nielsen T, Doménech-García V. Facilitated Central Pain Mechanisms Across the Menstrual Cycle in Dysmenorrhea and Enlarged Pain Distribution in Women With Longer Pain History. THE JOURNAL OF PAIN 2023; 24:1541-1554. [PMID: 37100358 DOI: 10.1016/j.jpain.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/29/2023] [Accepted: 04/15/2023] [Indexed: 04/28/2023]
Abstract
Dysmenorrhea (DYS), or recurrent menstrual pain, is a highly prevalent pain condition among otherwise healthy women. However, the progression of DYS over time and the influence of the menstrual cycle phases need to be better understood. While the location and distribution of pain have been used to assess pain mechanisms in other conditions, they are unexplored in DYS. Thirty otherwise healthy women with severe DYS and 30 healthy control women were recruited into 3 subgroups (n = 10) according to the length of their menstrual history (<5, 5-15, or>15 years since menarche). The intensity and distribution of menstrual pain were recorded. Pressure pain thresholds at abdominal, hip, and arm sites, pressure-induced pain distribution, temporal summation of pain, and pain intensity after pressure cessation over the gluteus medius were assessed at 3 menstrual cycle phases. Compared with the healthy control women, those with DYS showed lower pressure pain thresholds in every site and menstrual cycle phase (P < .05), enlarged pressure-induced pain areas during menstruations (P < .01), and increased temporal summation and pain intensity after pressure cessation in the overall menstrual cycle (P < .05). Additionally, these manifestations were enhanced during the menstrual and premenstrual phases compared to ovulation in women with DYS (P < .01). Women with long-term DYS demonstrated enlarged pressure-induced pain distribution, enlarged menstrual pain areas, and more days with severe menstrual pain compared to the short-term DYS subgroup (P < .01). Pressure-induced and menstrual pain distributions were strongly correlated (P < .001). These findings suggest that severe DYS is a progressive condition underscored by facilitated central pain mechanisms associated with pain recurrence and exacerbation. PERSPECTIVE: Enlarged pressure-induced pain areas occur in DYS, associated with the length of the condition and the distribution of menstrual pain. Generalized hyperalgesia is present throughout the entire menstrual cycle and intensifies during premenstrual and menstrual phases.
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Affiliation(s)
- Rocío Fortún-Rabadán
- Universidad San Jorge. Campus Universitario, Autov. A23 km 299, 50830. Villanueva de Gállego, Zaragoza, Spain
| | - Shellie A Boudreau
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Pablo Bellosta-López
- Universidad San Jorge. Campus Universitario, Autov. A23 km 299, 50830. Villanueva de Gállego, Zaragoza, Spain.
| | - Pablo Herrero
- Department of Physiatry and Nursing, Faculty of Health Sciences, IIS Aragon, University of Zaragoza, Zaragoza, Spain
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Víctor Doménech-García
- Universidad San Jorge. Campus Universitario, Autov. A23 km 299, 50830. Villanueva de Gállego, Zaragoza, Spain
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12
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Till SR, Schrepf A, Clauw DJ, Harte SE, Williams DA, As-Sanie S. Association Between Nociplastic Pain and Pain Severity and Impact in Women With Chronic Pelvic Pain. THE JOURNAL OF PAIN 2023; 24:1406-1414. [PMID: 36958459 PMCID: PMC10511662 DOI: 10.1016/j.jpain.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/09/2023] [Accepted: 03/12/2023] [Indexed: 03/25/2023]
Abstract
Exploring the relationship between nociplastic pain and the severity and impact of pelvic pain symptoms could lend insight into the heterogeneous symptom presentation and treatment response that complicates management of chronic pelvic pain. In this prospective cross-sectional study, we sought to evaluate relationships between degree of nociplastic pain, measured by the Fibromyalgia (FM) Survey Score, and multiple aspects of the chronic pelvic pain (CPP) experience, including severity, frequency, tenderness during pelvic myofascial exam, interference with daily life, and high-impact pain. The study included 303 women who presented to a tertiary referral clinic for chronic pelvic pain and endometriosis. Multiple measures of pelvic pain, including pain severity, frequency, interference, pelvic myofascial pain, and high-impact pain were examined in General Linear Models with FM Survey Score as the primary predictor of interest in models controlling for endometriosis, surgical history, use of opioids, body mass index, and patient age. Higher level of nociplastic pain was associated with greater pelvic pain severity, frequency, interference, and pelvic myofascial pain (all P < .05). For all models, degree of nociplastic pain was more strongly associated with pain outcomes than the presence of endometriosis, and use of opioids was the only stronger predictor of worse pain outcomes. The likelihood of high impact pain increased 7% for each additional point on the FM Survey Score. Degree of nociplastic pain was robustly associated with severity, frequency, and impact of pelvic pain, and was independent of the presence of endometriosis, history of surgical procedures for pelvic pain, age, and BMI. Trial registration: not applicable PERSPECTIVE: This article evaluates the impact of nociplastic pain on symptoms and functional status in chronic pelvic pain. These findings raise the possibility that a simple screening tool for nociplastic pain might provide clinically actionable information without the need for deep neurobiological phenotyping and may inform development of personalized management strategies.
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Affiliation(s)
- Sara R Till
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan..
| | - Andrew Schrepf
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - David A Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Sawsan As-Sanie
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
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13
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Interdonato L, Marino Y, D'Amico R, Cordaro M, Siracusa R, Impellizzeri D, Macrì F, Fusco R, Cuzzocrea S, Di Paola R. Modulation of the Proliferative Pathway, Neuroinflammation and Pain in Endometriosis. Int J Mol Sci 2023; 24:11741. [PMID: 37511500 PMCID: PMC10380329 DOI: 10.3390/ijms241411741] [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: 06/08/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Endometriosis is a chronic disease characterized by pelvic inflammation. This study aimed at investigating the molecular mechanisms underlying the pathology and how they can be modulated by the administration of a natural compound, Actaea racemosa (AR). We employed an in vivo model of endometriosis in which rats were intraperitoneally injected with uterine fragments from donor animals. During the experiment, rats were monitored by abdominal high-frequency ultrasound analysis. AR was able to reduce the lesion's size and histological morphology. From a molecular point of view, AR reduced hyperproliferation, as shown by Ki-67 and PCNA expression and MAPK phosphorylation. The impaired apoptosis pathway was also restored, as shown by the TUNEL assay and RT-PCR for Bax, Bcl-2, and Caspase levels. AR also has important antioxidant (reduced Nox expression, restored SOD activity and GSH levels, and reduced MPO activity and MDA levels) and anti-inflammatory (reduced cytokine levels) properties. Moreover, AR demonstrated its ability to reduce the pain-like behaviors associated with the pathology, the neuro-sensitizing mediators (c-FOS and NGF) expression, and the related central astrogliosis (GFAP expression in the spinal cord, brain cortex, and hippocampus). Overall, our data showed that AR was able to manage several pathways involved in endometriosis suppression.
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Affiliation(s)
- Livia Interdonato
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy
| | - Ylenia Marino
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy
| | - Ramona D'Amico
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy
| | - Marika Cordaro
- Department of Biomedical, Dental and Morphological and Functional Imaging, University of Messina, Consolare Valeria, 98100 Messina, Italy
| | - Rosalba Siracusa
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy
| | - Daniela Impellizzeri
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy
| | - Francesco Macrì
- Department of Veterinary Sciences, University of Messina, Viale Anunziata, 98168 Messina, Italy
| | - Roberta Fusco
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy
| | - Salvatore Cuzzocrea
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy
| | - Rosanna Di Paola
- Department of Veterinary Sciences, University of Messina, Viale Anunziata, 98168 Messina, Italy
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14
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Kaftan BT. [Somatoform disorders-chronic pelvic pain in women]. UROLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00120-023-02087-4. [PMID: 37145155 DOI: 10.1007/s00120-023-02087-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 05/06/2023]
Abstract
Pelvic pain in women is a clinically common symptom and a frequent finding in general practitioner, urological, gynecological, and pediatric practice. The list of possible differential diagnoses is long and the clarification ranges from a visual diagnosis to technical and surgical examinations to complex interdisciplinary consultations. But when do we talk about chronic lower abdominal pain? What can be the cause of this and how can we approach it diagnostically and therapeutically? What should we pay attention to? The difficulty begins with the definition. If we look at the national and international guidelines and publications, we find different definitions for chronic pelvic pain. There are various causes of chronic pelvic pain. There is often a combination of physical and psychological factors, which is why it is often not possible to identify a single diagnosis behind chronic pelvic pain syndrome. The clarification of these complaints requires a biopsychosocial approach. Multimodal approaches should be considered in assessment and treatment, and experts from other disciplines should be consulted.
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Affiliation(s)
- Björn Theodor Kaftan
- Zentrum für Interstitielle Zystitis und Beckenschmerz (IC/BPS), Städtisches Klinikum Lüneburg gGmbH, Bögelstr. 1, 21335, Lüneburg, Deutschland.
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15
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Zhi WI, Baser RE, Talukder D, Mei YZ, Harte SE, Bao T. Mechanistic and thermal characterization of acupuncture for chemotherapy-induced peripheral neuropathy as measured by quantitative sensory testing. Breast Cancer Res Treat 2023; 197:535-545. [PMID: 36527520 PMCID: PMC11218902 DOI: 10.1007/s10549-022-06846-3] [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: 08/19/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating side effect of chemotherapy. Acupuncture is a promising non-pharmacological intervention for CIPN. However, the physiological effects of acupuncture treatment remain poorly understood. We examined the effects of acupuncture on CIPN using semi-objective quantitative sensory testing (QST). METHODS We conducted a randomized controlled trial of real acupuncture (RA) and sham acupuncture (SA) compared to usual care (UC) in cancer survivors with moderate-to-severe CIPN. Treatment response was assessed with QST measures of tactile and vibration detection thresholds in hands and feet, thermal detection, and pain thresholds at weeks 0, 8, and 12. Constrained linear mixed model (cLMM) regression was used for statistical analysis. RESULTS 63 patients completed QST testing. At week 8, vibrational detection thresholds in feet were significantly lower in RA and SA (p = 0.019 and p = 0.046) than in UC, with no difference between RA and SA (p = 0.637). Both RA and SA also showed significantly higher cool thermal detection than UC (p = 0.008 and p = 0.013, respectively), with no difference between RA and SA (p = 0.790). No differences in tactile detection, vibrational detection in hands, warm thermal detection, and thermal pain thresholds were detected among the three arms at weeks 8 and 12. CONCLUSION QST demonstrated different patterns in RA, SA, and UC. After eight weeks of RA, we observed significant improvements in the vibrational detection threshold in feet and cool thermal detection threshold in hands compared to UC. No significant differences were seen when compared to SA. TRIAL REGISTRATION ClinicalTrials.gov (NCT03183037); June 9, 2017.
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Affiliation(s)
- W Iris Zhi
- Breast Medicine Service, Department of Medicine, Solid Tumor Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Raymond E Baser
- Department of Epidemiology and Biostatistics, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dristi Talukder
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ying Zi Mei
- Barnard College, Columbia University, New York, NY, USA
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ting Bao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 321 East 61st Street, Room 458, New York, NY, 10065, USA.
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16
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Orr NL, Huang AJ, Liu YD, Noga H, Bedaiwy MA, Williams C, Allaire C, Yong PJ. Association of Central Sensitization Inventory Scores With Pain Outcomes After Endometriosis Surgery. JAMA Netw Open 2023; 6:e230780. [PMID: 36848090 PMCID: PMC9972194 DOI: 10.1001/jamanetworkopen.2023.0780] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
IMPORTANCE A subset of people who undergo surgery for endometriosis have persistent pain, suggesting that other factors besides the endometriosis, such as central sensitization, may play a role in this pain. The Central Sensitization Inventory, a validated self-reported questionnaire of central sensitization symptoms, may identify individuals with endometriosis who have more pain after surgery due to pain sensitization. OBJECTIVE To examine whether greater baseline Central Sensitization Inventory scores are associated with postsurgical pain outcomes. DESIGN, SETTING, AND PARTICIPANTS This prospective, longitudinal cohort study performed at a tertiary center for endometriosis and pelvic pain in British Columbia, Canada, included all patients aged 18 to 50 years with diagnosed or suspected endometriosis and a baseline visit between January 1, 2018, and December 31, 2019, who underwent surgery after the baseline visit. Individuals who were menopausal, had a prior hysterectomy, or were missing data for outcomes or measures were excluded. Data analysis was performed from July 2021 to June 2022. MAIN OUTCOMES AND MEASURES The primary outcome was chronic pelvic pain at follow-up measured on a scale of 0 to 10, with 0 to 3 indicating no pain or mild pain, 4 to 6 indicating moderate pain, and 7 to 10 indicating severe pain. Secondary outcomes were deep dyspareunia, dysmenorrhea, dyschezia, and back pain at follow-up. The main variable of interest was baseline Central Sensitization Inventory score (measured from 0 to 100, consisting of 25 self-reported questions rated from 0 to 4 [never, rarely, sometimes, often, and always, respectively]). RESULTS A total of 239 patients (mean [SD] age, 34 [7] years; 189 [79.1%] White [11 (5.8%) identified as White mixed with another ethnicity], 1 [0.4%] Black or African American, 29 [12.1%] Asian, 2 [0.8%] Native Hawaiian or Pacific Islander, 16 [6.7%] other, and 2 [0.8%] mixed race or ethnicity) with follow-up data at more than 4 months after surgery were included in this study (71.0% follow-up rate). The mean (SD) baseline Central Sensitization Inventory score was 43.8 (18.2), and the mean (SD) follow-up was 16.1 (6.1) months. Higher baseline Central Sensitization Inventory scores were significantly associated with higher chronic pelvic pain (odds ratio [OR], 1.02; 95% CI, 1.00-1.03; P = .02), deep dyspareunia (OR, 1.03; 95% CI, 1.01-1.04; P = .004), dyschezia (OR, 1.03; 95% CI, 1.01-1.04; P < .001), and back pain (OR, 1.02; 95% CI, 1.00-1.03; P = .02) at follow-up, when controlling for baseline pain scores. The Central Sensitization Inventory scores themselves decreased slightly from baseline to follow-up (mean [SD] score, 43.8 [18.2] vs 41.7 [18.9]; P = .05); however, individuals with high baseline Central Sensitization Inventory scores still had high scores at follow-up. CONCLUSIONS AND RELEVANCE In this cohort study of 239 patients with endometriosis, higher Central Sensitization Inventory scores at baseline were associated with worse pain outcomes after endometriosis surgery, when controlling for baseline pain scores. The Central Sensitization Inventory could be used to counsel patients with endometriosis on their expected outcomes after surgery.
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Affiliation(s)
- Natasha L. Orr
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
- University of British Columbia Endometriosis and Pelvic Pain Laboratory, Vancouver, British Columbia, Canada
| | - Alice J. Huang
- University of British Columbia Endometriosis and Pelvic Pain Laboratory, Vancouver, British Columbia, Canada
| | - Yang Doris Liu
- University of British Columbia Endometriosis and Pelvic Pain Laboratory, Vancouver, British Columbia, Canada
| | - Heather Noga
- University of British Columbia Endometriosis and Pelvic Pain Laboratory, Vancouver, British Columbia, Canada
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
| | - Mohamed A. Bedaiwy
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
- University of British Columbia Endometriosis and Pelvic Pain Laboratory, Vancouver, British Columbia, Canada
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
| | - Christina Williams
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
- University of British Columbia Endometriosis and Pelvic Pain Laboratory, Vancouver, British Columbia, Canada
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
| | - Catherine Allaire
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
- University of British Columbia Endometriosis and Pelvic Pain Laboratory, Vancouver, British Columbia, Canada
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
| | - Paul J. Yong
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
- University of British Columbia Endometriosis and Pelvic Pain Laboratory, Vancouver, British Columbia, Canada
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
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17
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Myofascial Pain Syndrome in Women with Primary Dysmenorrhea: A Case-Control Study. Diagnostics (Basel) 2022; 12:diagnostics12112723. [PMID: 36359567 PMCID: PMC9689409 DOI: 10.3390/diagnostics12112723] [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: 09/20/2022] [Revised: 10/22/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
There is limited information on myofascial trigger points (MTrPs) and specific symptoms of chronic pelvic pain and, more specifically, dysmenorrhea. The objective of this study was to determine whether patients suffering from primary dysmenorrhea present alterations in mechanosensitivity and pain patterns, and greater presence of MTrPs in the abdominal and pelvic floor muscles. A case-control study was carried out with a total sample of 84 participants distributed based on primary dysmenorrhea and contraceptive treatment. The sample was divided into four groups each comprising 21 women. Data on pain, quality of life, and productivity and work absenteeism were collected; three assessments were made in different phases of the menstrual cycle, to report data on pressure pain threshold, MTrP presence, and referred pain areas. One-way ANOVA tests showed statistically significant differences (p < 0.01) between the groups, for the Physical Health domain and the total score of the SF-12 questionnaire, and for all the domains of the McGill questionnaire; but no significant differences were found in the data from the WPAI-GH questionnaire. Statistically significant data (p < 0.01) were found for mechanosensitivity in the abdominal area and limbs, but not for the lumbar assessment, within the group, with very few significant intergroup differences. The frequency of active MTrPs is higher in the groups of women with primary dysmenorrhea and during the menstrual phase, with the prevalence of myofascial trigger points of the iliococcygeus muscle being especially high in all examination groups (>50%) and higher than 70% in women with primary dysmenorrhea, in the menstrual phase, and the internal obturator muscle (100%) in the menstrual phase. Referred pain areas of the pelvic floor muscles increase in women with primary dysmenorrhea.
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18
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Beales D, Asinelli R, Klokset M, O'Kane L, Urstad T, Wise E, Zabatiero J, Thompson J, Pontre J, Waller R. Association between pelvic pain bothersomeness and pain sensitivity: A community-based cross-sectional study of young adult females in the Raine Study. BJOG 2022; 129:1981-1991. [PMID: 35596698 PMCID: PMC9796573 DOI: 10.1111/1471-0528.17232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/25/2022] [Accepted: 04/27/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Pelvic pain has been associated with augmented nociceptive processing, but large studies controlling for multiple potential confounding factors are lacking. This study investigated the association between pelvic pain bothersomeness and pain sensitivity in young adult women, accounting for potential confounding factors. DESIGN Cross-sectional study. SETTING Community-dwelling sample. POPULATION The Raine Study Gen2-22 year follow-up (n = 475). MAIN OUTCOME MEASURES The experience of bothersomeness related to pelvic pain was determined from a question in the Urogenital Distress Inventory short form. Pain sensitivity was measured using pressure pain and cold pain thresholds. Potential confounding factors included ethnicity, marital status, highest level of education, income, waist-hip ratio, level of activity, sleep quality, smoking, comorbidity history, C-reactive protein level, musculoskeletal pain experience and psychological distress. RESULTS Three hundred and sixty-two women (76.2%) reported no pelvic pain bothersomeness, 74 (15.6%) reported mild pelvic pain bothersomeness and 39 (8.2%) reported moderate-severe pelvic pain bothersomeness. After adjusting for marital status (and test site), moderate-severe pelvic pain bothersomeness was associated with a lower pressure pain threshold (i.e. greater pressure pain sensitivity) (coefficient -51.46, 95% CI -98.06 to -4.86, p = 0.030). After adjusting for smoking, moderate-severe pelvic pain bothersomeness was also associated with a higher cold pain threshold (i.e. greater cold pain sensitivity) (coefficient 4.35, 95% CI 0.90-7.79, p = 0.014). CONCLUSIONS This study suggests augmented nociceptive processing as a contributing factor in pelvic pain bothersomeness for some women. Thorough assessment of women who present clinically with pelvic pain should consider pain sensitivity as a potential contributing factor to their presentation.
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Affiliation(s)
- Darren Beales
- Curtin enAble Institute and Curtin School of Allied HealthCurtin UniversityPerthWestern AustraliaAustralia
| | - Renata Asinelli
- Curtin enAble Institute and Curtin School of Allied HealthCurtin UniversityPerthWestern AustraliaAustralia
| | - Marit Klokset
- Curtin enAble Institute and Curtin School of Allied HealthCurtin UniversityPerthWestern AustraliaAustralia
| | - Lindsay O'Kane
- Curtin enAble Institute and Curtin School of Allied HealthCurtin UniversityPerthWestern AustraliaAustralia
| | - Tonje Urstad
- Curtin enAble Institute and Curtin School of Allied HealthCurtin UniversityPerthWestern AustraliaAustralia
| | - Emma Wise
- Curtin enAble Institute and Curtin School of Allied HealthCurtin UniversityPerthWestern AustraliaAustralia
| | - Juliana Zabatiero
- Curtin enAble Institute and Curtin School of Allied HealthCurtin UniversityPerthWestern AustraliaAustralia,The Raine StudyThe University of Western AustraliaCrawleyWestern AustraliaAustralia
| | - Judith Thompson
- Curtin enAble Institute and Curtin School of Allied HealthCurtin UniversityPerthWestern AustraliaAustralia
| | - Jennifer Pontre
- King Edward Memorial HospitalPerthWestern AustraliaAustralia
| | - Robert Waller
- Curtin enAble Institute and Curtin School of Allied HealthCurtin UniversityPerthWestern AustraliaAustralia
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Myofascial Trigger Points and Central Sensitization Signs, but No Anxiety, Are Shown in Women with Dysmenorrhea: A Case-Control Study. BIOLOGY 2022; 11:biology11111550. [PMID: 36358253 PMCID: PMC9688021 DOI: 10.3390/biology11111550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 11/05/2022]
Abstract
Background primary dysmenorrhea (PD) is considered to be a cyclic chronic pelvic pain, with its onset in menstrual periods, often accompanied by the presence of myofascial trigger points (MTP). Most MTPs in subjects with chronic pelvic pain are in the inferior part of the abdomen, in the rectus abdominis (RA) area. Central sensitization is closely related to chronic pain processes. Previous studies in women with chronic pelvic pain reported central sensitization signs in their subjects, such as lower pain pressure threshold (PPT). Several authors agree that PPT in the tibialis anterior (TA) muscle, seems to be a reliable reference for signs of central sensitization. Amongst the factors that seem to accompany central sensitization, the presence of anxiety needs to be considered. The aim of the present study was to analyze the existence of hyperalgesic MTPs in RA, central sensitization signs and anxiety in women with PD, in comparison with a control group (CG). Methods: This study was designed following an observational, cross-sectional, case-control model. A total sample of 80 subjects was recruited trough social webs and advertising (PD n = 39) (CG n = 41). PPT in RA and AT was assessed bilaterally through algometry, and anxiety was evaluated through the State−Trait Anxiety Inventory. Results: Statistically significant differences (p < 0.001) were shown for NRS average and maximum increase, as well as lower bilaterally RA and TA PPT in favor of PD group compared to CG. State or trait STAI did not show any statistically significant differences (p > 0.05) between groups. Conclusions: In this study, women with PD reported symptoms of myofascial pain syndrome and central sensitization, when compared with healthy controls, without any sign of anxiety acting as a confounder for pain sensitivity.
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20
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Ford RW, Winokur RS. Pelvic Venous Disorders (PeVD). Semin Intervent Radiol 2022; 39:483-489. [PMID: 36561941 PMCID: PMC9767768 DOI: 10.1055/s-0042-1757938] [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: 12/24/2022]
Abstract
Pelvic venous disorders (PeVDs) have replaced the concept of pelvic congestion syndrome encompassing venous origin chronic pelvic pain (VO-CPP) in women. The evaluation of women with VO-CPP includes the assessment for other causes of pelvic pain as well as imaging evaluation for pelvic varicosities measuring greater than 5 mm diameter, ovarian vein diameter, and flow direction, as well as iliac vein diameter and signs of compression. Proper identification of these patients can lead to high degrees of success eliminating chronic pelvic pain following ovarian vein embolization and/or iliac vein stenting. Strong encouragement is provided to use the symptoms, varices, pathophysiology classification for these patients and upcoming research studies on the specific symptoms of patients with VO-CPP will help elucidate patient selection for intervention. Additional future randomized controlled trials are also upcoming to evaluate for outcomes of ovarian vein embolization and iliac vein.
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Affiliation(s)
- Robert W. Ford
- Division of Interventional Radiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Ronald S. Winokur
- Division of Interventional Radiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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21
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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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22
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Otake A, Sasamoto N, Sato N, Kumasaka R, Yamamoto Y, Adachi K. Comparative Study of Postoperative Analgesic Effects of Intraoperative Levobupivacaine Local Infiltration Anesthesia and Transversus Abdominis Plane Block Following Gynecologic Laparoscopy. Gynecol Minim Invasive Ther 2022; 11:231-237. [PMID: 36660329 PMCID: PMC9844037 DOI: 10.4103/gmit.gmit_120_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 04/14/2022] [Accepted: 05/04/2022] [Indexed: 01/22/2023] Open
Abstract
Objectives We aim to assess the postoperative analgesic effect of intraoperative levobupivacaine local infiltration anesthesia (LA) and transversus abdominis plane (TAP) block in gynecologic laparoscopy. Materials and Methods We conducted a retrospective analysis on the data of 260 patients treated by gynecologic laparoscopy (adnexal surgery, hysterectomy, and myomectomy) between January 2019 and December 2020 at Minoh City Hospital, Osaka Japan. Patients were divided into two groups: intraoperative LA group and TAP block group. We assessed clinical characteristics, surgical results, postoperative numerical rating scale (NRS) pain scores, and the frequency of analgesic use up to 24 h after surgery in overall and by each type of surgery. Pearson's χ2 test, Fisher's exact test, and Wilcoxon/Kruskal-Wallis test were used for statistical analysis. Multiple regression analysis was used for multivariate analysis. Results NRS pain score was statistically significantly higher in the LA group than in the TAP group 1 h after surgery in overall (P = 0.04), with NRS difference of 0.4 which was not clinically significant. No significant differences were observed in NRS pain scores at 3, 6, 12, and 24 h after surgery or in the frequency of analgesic use up to 24 h after surgery in overall and by type of surgery. Endometriosis was associated with increased postoperative pain at 1 h after surgery in adnexal surgeries (P = 0.04) and suggestive for all surgeries. Younger age was related to more frequency of analgesic use up to 24 h after surgery in overall, adnexal surgeries, and hysterectomy. Conclusion Intraoperative levobupivacaine LA may have similar postoperative analgesic effects as TAP block in gynecologic laparoscopy.
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Affiliation(s)
- Akiko Otake
- Department of Obstetrics and Gynecology, Minoh City Hospital, Minoh, Osaka, Japan,Address for correspondence: Dr. Akiko Otake, Department of Obstetrics and Gynecology, Minoh City Hospital, 5-7-1, Kayano, Minoo, Osaka 562-8562, Japan. E-mail:
| | - Naoko Sasamoto
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Noriko Sato
- Department of Obstetrics and Gynecology, Minoh City Hospital, Minoh, Osaka, Japan
| | - Ryota Kumasaka
- Department of Obstetrics and Gynecology, Minoh City Hospital, Minoh, Osaka, Japan
| | - Yoshimitsu Yamamoto
- Department of Obstetrics and Gynecology, Minoh City Hospital, Minoh, Osaka, Japan
| | - Kazushige Adachi
- Department of Obstetrics and Gynecology, Minoh City Hospital, Minoh, Osaka, Japan
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23
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Lepping RJ, McMillan ML, Chadwick AL, Mansour ZM, Martin LE, Gustafson KM. Autonomic nervous system markers of music-elicited analgesia in people with fibromyalgia: A double-blind randomized pilot study. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:953118. [PMID: 36185772 PMCID: PMC9521378 DOI: 10.3389/fpain.2022.953118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/09/2022] [Indexed: 01/02/2023]
Abstract
Purpose To investigate the feasibility of using music listening by adults with fibromyalgia (FM) as a potential tool for reducing pain sensitivity. Patients and methods We report results from a double-blind two-arm parallel randomized pilot study (NCT04059042) in nine participants with FM. Pain tolerance and threshold were measured objectively using quantitative sensory tests; autonomic nervous system (ANS) reactivity was measured with an electrocardiogram. Participants were randomized to listen to instrumental Western Classical music or a nature sound control to test whether music listening elicits greater analgesic effects over simple auditory distraction. Participants also completed separate control testing with no sound that was counterbalanced between participants. Results Participants were randomized 1:1 to music or nature sounds (four Music and five Nature). Although the groups were not different on FM scores, the Music group had marginally worse temporal pain summation (p = 0.06), and the Nature group had higher anxiety scores (p < 0.05). Outcome measures showed a significant difference between groups in the magnitude of change in temporal summation between sessions (p < 0.05), revealing that the Nature group had greater pain reduction during audio compared to silence mode, while the Music group had no difference between the sessions. No significant effects were observed for either mechanical pain tolerance or ANS testing. Within the Music group, there was a trend of vagal response increase from baseline to music listening, but it did not reach statistical significance; this pattern was not observed in the Nature group. Conclusion Auditory listening significantly altered pain responses. There may be a greater vagal response to music vs. nature sounds; however, results could be due to group differences in pain and anxiety. This line of study will help in determining whether music could be prophylactic for people with FM when acute pain is expected.
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Affiliation(s)
- Rebecca J. Lepping
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, United States,*Correspondence: Rebecca J. Lepping
| | - Miranda L. McMillan
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Andrea L. Chadwick
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Zaid M. Mansour
- Department of Physical and Occupational Therapy, The Hashemite University, Zarqa, Jordan
| | - Laura E. Martin
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, United States,Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States,Department for McMillan and Chadwick, Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, KS, United States
| | - Kathleen M. Gustafson
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, United States,Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States
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24
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Kohns DJ, Scott R, Castellanos J, Scribner D, Hodges R, Clauw DJ. The impact of nociplastic pain features on the response to physical therapy in patients with primary myofascial pain. J Back Musculoskelet Rehabil 2022; 35:1143-1151. [PMID: 35213348 DOI: 10.3233/bmr-210244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Myofascial pain is a common, but poorly understood multifactorial condition. OBJECTIVE This study analyzed how the degree of central sensitization (nociplastic pain) can impact the response to physical therapy for patients with myofascial pain. METHODS This prospective, observational cohort study compared pain phenotyping and functional measures in 30 participants with non-acute neck/shoulder girdle primary myofascial pain following 3-months of physical therapy. The Fibromyalgia Survey Questionnaire Score served as a surrogate of central sensitization. RESULTS All participants demonstrated some benefit from physical therapy; however, those with moderate levels of nociplastic pain features were less likely to have clinically significant improvements on the Neck Disability Index, PEG score, or pain catastrophizing measures. Those with higher levels of nociplastic pain had a similar chance of showing improvement as those with lower levels, except regarding catastrophizing. Significant improvements were independent of the type or amount of therapy received. CONCLUSION The degree of nociplastic pain in patients with myofascial pain appears to be inversely related to improvements from a peripherally based treatment. This is not to say that individuals with moderate to higher levels of nociplastic pain do not benefit from physical therapy, but they proportionally benefit less.
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Affiliation(s)
- David J Kohns
- Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, MI, USA
| | - Ryan Scott
- Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Joel Castellanos
- Center of Pain Medicine, Department of Anesthesia, University of California San Diego, La Jolla, CA, USA
| | - Darin Scribner
- Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, MI, USA
| | - Ryan Hodges
- Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, MI, USA
| | - Daniel J Clauw
- Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
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25
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Yang M, Baser RE, Li SQ, Hou YN, Chong K, Zhang YL, Hoque I, Bao T, Mao JJ. Tibetan Herbal Pain-Relieving Plaster for Chronic Musculoskeletal Pain Among Cancer Survivors: Study Protocol of a Randomized, Double-Blind, Placebo-Controlled Trial. Front Pharmacol 2022; 13:878371. [PMID: 35600872 PMCID: PMC9114465 DOI: 10.3389/fphar.2022.878371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic pain is common and debilitating in cancer survivors. Tibetan herbal pain-relieving plaster is used as an external analgesic to treat musculoskeletal pain in China; however, its safety and efficacy have not been evaluated via clinical trials in cancer survivors. We designed this Phase II randomized, double-blind, placebo-controlled trial (ClinicalTrials.gov Identifier: NCT04916249) to assess the efficacy and safety of the pain-relieving plaster for temporary pain relief among cancer survivors with chronic musculoskeletal pain. Under ethical approval from the Institutional Review Board at the Memorial Sloan Kettering Cancer Center, we will enroll eligible cancer survivors who have a clinical diagnosis of moderate to severe chronic musculoskeletal pain in this study. We use a central randomization system to allocate the eligible participants to either the treatment or the control group in a 1:1 ratio, with stratification by baseline opioid use. We will instruct the participants to apply the herbal patch (Tibetree Pain-Relieving Plaster, Tibet Cheezheng Tibetan Medicine Co. Ltd., Tibet, China) or placebo patch daily at the focal area with worst pain for 14 consecutive days. Study physician, participant, outcome assessor, and biostatistician are blinded to the group allocation. The primary outcome is pain severity measured by the Brief Pain Inventory on Days 2–7. Secondary outcomes include changes in insomnia, anxiety, depression, fatigue, pressure pain threshold, pain medication use, and global impression of change. We will also monitor the adverse events throughout the study period. Statistical analysis will follow the intention-to-treat principle and linear mixed modeling will be used. With rigorous design and implementation, this randomized, placebo-controlled trial will provide the initial evidence on the efficacy and safety of the pain-relieving plaster for pain relief among cancer survivors with chronic musculoskeletal pain.
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Affiliation(s)
- Mingxiao Yang
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Raymond E. Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering, New York, NY, United States
| | - Susan Q. Li
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Yen-Nien Hou
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Kamyar Chong
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Yi Lily Zhang
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Irfan Hoque
- Investigational Drug Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Ting Bao
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Jun J. Mao
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
- *Correspondence: Jun J. Mao,
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26
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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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27
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Yong PJ. Deep dyspareunia: a narrative review of impact on sexual function and quality-of-life. Minerva Obstet Gynecol 2022; 74:222-233. [PMID: 35107234 DOI: 10.23736/s2724-606x.22.04974-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Deep dyspareunia refers to pain with deep penetration or insertion into the vagina, which affects quality-of-life. The aim of this narrative review is to examine how the underlying conditions that give rise to deep dyspareunia, and the symptoms of these conditions, can affect sexual function and quality-of-life beyond the deep dyspareunia itself. For example, deep dyspareunia may be associated with gynaecological pathologies that cause cyclical pain symptoms (e.g dysmenorrhea, dyschezia/dysuria), resulting in quality-of-life changes related to menstrual cycle events such as ovulation or menstruation. Recurrent dysmenorrhea can cause hyperalgesic priming that sensitizes the nervous system, leading to chronic pelvic pain that can be exacerbated with sexual activity. The co-existence of functional bowel or bladder disorders can result in urgency and frequency that affect the sexual response cycle. Myofascial/musculoskeletal origins of deep dyspareunia may affect body positioning during sexual activity. Central nervous system sensitization can underlie these different factors, and also be associated with mental health conditions, which together can cause symptomatology across body systems that can affect all aspects of one's sexual life. Recognition and management of the far-reaching impacts of deep dyspareunia and its associated comorbidities may be important in clinical care to meaningfully improve quality-of-life. Future research should include a comprehensive empirical validation of the hypotheses and potential mechanisms in this review.
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Affiliation(s)
- Paul J Yong
- Divisions of Gynaecologic Specialities & Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada -
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28
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Orr NL, Wahl KJ, Lisonek M, Joannou A, Noga H, Albert A, Bedaiwy MA, Williams C, Allaire C, Yong PJ. Central sensitization inventory in endometriosis. Pain 2022; 163:e234-e245. [PMID: 34030173 DOI: 10.1097/j.pain.0000000000002351] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 05/17/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT A key clinical problem is identifying the patient with endometriosis whose pain is complicated by central nervous system sensitization, where conventional gynecologic treatment (eg, hormonal therapy or surgery) may not completely alleviate the pain. The Central Sensitization Inventory (CSI) is a questionnaire previously validated in the chronic pain population. The objective of this study was an exploratory proof-of-concept to identify a CSI cutoff in the endometriosis population to discriminate between individuals with significant central contributors (identified by central sensitivity syndromes [CSS]) to their pain compared to those without. We analyzed a prospective data registry at a tertiary referral center for endometriosis, and included subjects aged 18 to 50 years with endometriosis who were newly or re-referred to the center in 2018. The study sample consisted of 335 subjects with a mean age of 36.0 ± 7.0 years. An increasing number of CSS was significantly correlated with dysmenorrhea, deep dyspareunia, dyschezia, and chronic pelvic pain scores (P < 0.001), and with the CSI score (0-100) (r = 0.731, P < 0.001). Receiver operating characteristic analysis indicated that a CSI cutoff of 40 had a sensitivity of 78% (95% CI: 72.7%-84.6%) and a specificity of 80% (95% CI: 70.3%-84.5%) for identifying a patient with endometriosis with ≥3 CSS. In the group with CSI ≥ 40, 18% retrospectively self-reported pain nonresponsive to hormonal therapy and 40% self-reported daily pain, compared with 6% and 20% in the CSI < 40 group (P = 0.003 and 0.002, respectively). In conclusion, a CSI ≥ 40 may be a practical tool to help identify patients with endometriosis with pain contributors related to central nervous system sensitization.
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Affiliation(s)
- Natasha L Orr
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
- BC Women's Center for Pelvic Pain and Endometriosis Vancouver, BC, Canada
| | - Kate J Wahl
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
- BC Women's Center for Pelvic Pain and Endometriosis Vancouver, BC, Canada
| | - Michelle Lisonek
- BC Women's Center for Pelvic Pain and Endometriosis Vancouver, BC, Canada
| | - Angela Joannou
- BC Women's Center for Pelvic Pain and Endometriosis Vancouver, BC, Canada
| | - Heather Noga
- Women's Health Research Institute, Vancouver, BC, Canada
| | - Arianne Albert
- Women's Health Research Institute, Vancouver, BC, Canada
| | - Mohamed A Bedaiwy
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
- BC Women's Center for Pelvic Pain and Endometriosis Vancouver, BC, Canada
- Women's Health Research Institute, Vancouver, BC, Canada
| | - Christina Williams
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
- BC Women's Center for Pelvic Pain and Endometriosis Vancouver, BC, Canada
| | - Catherine Allaire
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
- BC Women's Center for Pelvic Pain and Endometriosis Vancouver, BC, Canada
- Women's Health Research Institute, Vancouver, BC, Canada
| | - Paul J Yong
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
- BC Women's Center for Pelvic Pain and Endometriosis Vancouver, BC, Canada
- Women's Health Research Institute, Vancouver, BC, Canada
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29
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Gordon HG, Mooney SS, Conroy IC, Grover SR. When pain is not the whole story: Presenting symptoms of women with endometriosis. Aust N Z J Obstet Gynaecol 2022; 62:434-438. [DOI: 10.1111/ajo.13482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Hannah G. Gordon
- Department of Obstetrics and Gynaecology University of Melbourne Melbourne VictoriaAustralia
- Mercy Hospital for Women Melbourne VictoriaAustralia
| | - Samantha S. Mooney
- Department of Obstetrics and Gynaecology University of Melbourne Melbourne VictoriaAustralia
- Mercy Hospital for Women Melbourne VictoriaAustralia
| | - Isabelle C. Conroy
- Department of Obstetrics and Gynaecology University of Melbourne Melbourne VictoriaAustralia
| | - Sonia R. Grover
- Department of Obstetrics and Gynaecology University of Melbourne Melbourne VictoriaAustralia
- Mercy Hospital for Women Melbourne VictoriaAustralia
- Paediatric and Adolescent Gynaecology Royal Children's Hospital Melbourne Melbourne Victoria Australia
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30
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Harte SE, Wiseman J, Wang Y, Smith AR, Yang CC, Helmuth M, Kreder K, Kruger GH, Gillespie BW, Amundsen C, Kirkali Z, Lai HH. Experimental Pain and Auditory Sensitivity in Overactive Bladder Syndrome: A Symptoms of the Lower Urinary Tract Dysfunction Research Network (LURN) Study. J Urol 2022; 207:161-171. [PMID: 34428922 PMCID: PMC9237822 DOI: 10.1097/ju.0000000000002147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of this study was to investigate the presence of nonbladder sensory abnormalities in participants with overactive bladder syndrome (OAB). MATERIALS AND METHODS Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) study participants with OAB symptoms and controls were recruited from 6 U.S. tertiary referral centers. Quantitative sensory testing (QST) was performed to determine pressure pain sensitivity at the thumbnail bed and auditory sensitivity. Fixed and mixed effect multivariable linear regressions and Weibull models were used to compare QST responses between groups. Pearson correlations were used to assess the relationship between QST measures. Associations between QST and self-reported symptoms were explored with linear regression. RESULTS A total of 297 participants were analyzed (191 OAB, 106 controls; 76% white, 51% male). OAB cases were older than controls (57.4 vs 52.2 years, p=0.015). No significant differences in experimental thumbnail (nonbladder) pain or auditory sensitivity were detected between OAB cases and controls. Correlations between pressure and auditory derived metrics were weak to moderate overall for both groups, with some significantly stronger correlations for cases. Exploratory analyses indicated increased pressure pain and auditory sensitivity were modestly associated with greater self-reported bladder pain and pain interference with physical function. CONCLUSIONS As a group, no significant differences between OAB cases and controls were observed in experimental nonbladder pain or auditory sensitivity during QST. Associations between QST outcomes and clinical pain raise the possibility of centrally mediated sensory amplification in some individuals with OAB.
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Affiliation(s)
- Steven E. Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jon Wiseman
- Arbor Research Collaborative for Health, Ann Arbor, MI USA
| | - Ying Wang
- Department of Anesthesia, Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Claire C. Yang
- Department of Urology, University of Washington, Seattle, WA, 98195-6510 USA
| | | | - Karl Kreder
- Department of Urology, University of Iowa, Iowa City, IA, USA
| | - Grant H. Kruger
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Cindy Amundsen
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - H. Henry Lai
- Division of Urologic Surgery, Departments of Surgery and Anesthesiology, Washington University School of Medicine, St Louis, MO, USA
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Effectiveness of intracavitary monopolar dielectric radiofrequency in women with endometriosis-associated pain: A case series. Complement Ther Clin Pract 2021; 46:101517. [PMID: 34864492 DOI: 10.1016/j.ctcp.2021.101517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 08/04/2021] [Accepted: 11/22/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND and Purpose: Endometriosis-associated pain is the main cause of chronic pelvic pain in women. Endometriosis has a significant negative impact across different domains of patients' quality of life. This study aimed to evaluate the efficacy of an intracavitary application of monopolar dielectric radiofrequency in women with endometriosis-associated pain. PATIENT PRESENTATION Five women with endometriosis received 25 sessions of an intracavitary application of monopolar dielectric radiofrequency within three months. Outcomes, including quality of life, sex interference (Endometriosis Health Profile [EHP]-30 + section C), myofascial pain syndrome (myofascial trigger points), pain intensity (Visual Analogue Scale), frequency and referral pattern, pressure pain thresholds, allodynia and neuropathic pain (modified DN4), were examined both during and outside menses, after intervention and six months later. RESULTS Clinically meaningful improvements were achieved by most participants regarding pelvic pain intensity, abdominal sensitivity, and myofascial pain of the pelvic floor. CONCLUSION This study lays the foundation for future in-depth research, suggesting that monopolar dielectric radiofrequency could be helpful in improving the symptomatology and quality of life of women with endometriosis, also in patients who are unresponsive to medical and/or surgical treatments, or who cannot undergo them in the short term.
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As-Sanie S, Till SR, Schrepf AD, Griffith KC, Tsodikov A, Missmer SA, Clauw DJ, Brummett CM. Incidence and predictors of persistent pelvic pain following hysterectomy in women with chronic pelvic pain. Am J Obstet Gynecol 2021; 225:568.e1-568.e11. [PMID: 34464585 DOI: 10.1016/j.ajog.2021.08.038] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/12/2021] [Accepted: 08/24/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Chronic pelvic pain is a debilitating problem that afflicts 15% to 20% of women in the United States. Although more than 200,000 hysterectomies are performed annually for the treatment of chronic pelvic pain, previous studies indicate that 1 in 4 women undergo the discomfort and morbidity of hysterectomy without the relief of pain. The factors that predict treatment failure remain poorly characterized. OBJECTIVE To describe the incidence of persistent pelvic pain 6 months following hysterectomy in women with chronic pelvic pain and determine whether a simple, self-reported measure of central sensitization is associated with a greater risk of persistent pelvic pain following hysterectomy. STUDY DESIGN We conducted a prospective, observational cohort study of women undergoing hysterectomy at an academic tertiary care center for a benign indication. Patients with preoperative chronic pelvic pain, defined as average pelvic pain ≥3 on a 0 to 10 numeric rating scale for >3 months before hysterectomy, were included in this analysis. The patients completed validated assessments of pain, anxiety, depression, and centralized pain (using the 2011 Fibromyalgia Survey Criteria, 0-31 points) preoperatively and 6 months after hysterectomy. The demographic information, surgical history, intraoperative findings, and surgical pathology were abstracted from the electronic medical records. Multivariate logistic regression was used to identify the independent predictors of persistent pelvic pain 6 months following hysterectomy, defined as <50% improvement in pelvic pain severity. RESULTS Among 176 participants with pelvic pain before hysterectomy, 126 (71.6%) were retained at 6 months, and 15 (11.9%) reported persistent pelvic pain. There was no difference in age (P=.46), race (P=.55), average pain severity during menses (P=.68), average overall pelvic pain (P=.10), or pain duration (P=.80) in those with and without persistent pelvic pain. Whereas intraoperative findings of endometriosis (P=.05) and uterine fibroids (P=.03) were associated with a higher incidence of persistent pain on univariate analysis, the surgical route (P=.46), pelvic adhesions (0.51), uterine weight (P=.66), and adenomyosis on histopathology (P=.27) were not related to the risk of persistent pain. Higher preoperative centralized pain scores (P=.01) but not depression (P=.64) or anxiety (P=.45) were more common in women with persistent pelvic pain. Multivariate logistic regression adjusting for age, preoperative pain severity, anxiety, depression, and operative findings of endometriosis and fibroids indicated that every 1-point increase in centralized pain before hysterectomy was associated with a 27% increase in the odds of persistent pelvic pain (odds ratio, 1.27; 95% confidence interval, 1.03-1.57) 6 months after surgery. CONCLUSION Although the majority of women with chronic pelvic pain report considerable improvement in pain following hysterectomy, higher degrees of centralized pain before hysterectomy is a robust predictor of persistent pelvic pain.
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Affiliation(s)
- Sawsan As-Sanie
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI.
| | - Sara R Till
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Andrew D Schrepf
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI; Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI
| | - Kendall C Griffith
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Alex Tsodikov
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Stacey A Missmer
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI; Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI; Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI
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Postoperative Pain Is Driven by Preoperative Pain, Not by Endometriosis. J Clin Med 2021; 10:jcm10204727. [PMID: 34682850 PMCID: PMC8537544 DOI: 10.3390/jcm10204727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The aim of this study was to evaluate the impact of endometriosis on postoperative pain following laparoscopic hysterectomy; (2) Methods: A total of 214 women who underwent a laparoscopic hysterectomy between January 2013 and October 2017 were divided into four subgroups as follows: (1) endometriosis with chronic pain before the surgery (n = 57); (2) pain-free endometriosis (n = 50); (3) pain before the surgery without endometriosis (n = 40); (4) absence of both preoperative pain and endometriosis (n = 67). Postoperative pain was compared by using Visual Analog Scale (VAS) scores and by tracking the use of painkillers during the day of surgery and the first two postoperative days; (3) Results: Women with chronic pain before the surgery reported higher VAS scores during the first postoperative days, while the use of analgesics was similar across the groups. There was no difference in the postoperative pain when comparing endometriosis patients to non-endometriosis patients; (4) Conclusions: Women with chronic pelvic pain demonstrated increased postoperative pain after laparoscopic hysterectomy, which was independent of the presence or severity of endometriosis. The increased VAS scores did not, however, translate into equally greater use of painkillers, possibly due to the standardised protocols of analgesia in the immediate postoperative period. These findings support the need for careful postsurgical pain management in patients with pain identified as an indication for hysterectomy, independent of the extent of the surgery or underlying diagnosis.
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Mousa M, Al-Jefout M, Alsafar H, Becker CM, Zondervan KT, Rahmioglu N. Impact of Endometriosis in Women of Arab Ancestry on: Health-Related Quality of Life, Work Productivity, and Diagnostic Delay. Front Glob Womens Health 2021; 2:708410. [PMID: 34816238 PMCID: PMC8593935 DOI: 10.3389/fgwh.2021.708410] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/23/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction: Endometriosis has a negative effect on health-related quality of life (HRQoL), wellbeing and daily functioning. Endometriosis is an under-researched condition within non-western populations. Cultural representations are needed to understand the relative roles of societal norms, traditional factors, and religious sensitivities on the impact of endometriosis on HRQoL in various populations. In particular, there is a lack of emphasis placed in understanding the association of HRQoL on endometriosis in Arab women. Method: In this prospective case-control study, 2,610 Arab ancestry women in the United Arab Emirates were recruited to investigate the impact of endometriosis on HRQoL, diagnostic delay, psychological co-morbidities, work productivity, and physical activity. Participants completed the following standardized, validated questionnaires: Short Form-36 version 2 questionnaire, the World Endometriosis Research Foundation EPHect minimum clinical questionnaire version, and Work Productivity and Activity Impairment questionnaire. Translations to the Arabic language, validated using the forward-backward translation method, of the questionnaires were utilized. Results: HRQoL scores were significantly impaired in women with endometriosis, as demonstrated in the Physical Composite Scores and Mental Composite Scores in the symptomatic control group (p = 0.001; p = 0.003, respectively) and the asymptomatic control group (p < 0.001; p < 0.001, respectively). Susceptibility and severity of multiple pain syndromes and infertility in women with endometriosis was the main indicator of lower HRQoL. Anxiety (p = 0.007) and depression (p = 0.005) were significantly associated with endometriosis, in comparison to symptomatic controls. The average diagnostic delay was 11.61 years, however single women experience 15.81 years of diagnosis delay, with approximately 18% (n = 15) of the single women experiencing more than a 20-year delay in diagnosis. The intensity of physical activity was not associated with endometriosis, when compared to symptomatic (p = 0.405) or asymptomatic controls (p = 0.144). Conclusion: For the first time, we provide evidence from a combined hospital, clinic, and population-based study that Arab women with endometriosis experience significant impacts on HRQoL, substantial diagnostic delay after the onset of symptoms, significant association to psychological disorders (anxiety and depression), and a negative impact on work productivity. Future research must focus on understanding the personal and culturally centered beliefs of Arab women to ensure a positive HRQoL trajectory by improving diagnosis and management strategies.
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Affiliation(s)
- Mira Mousa
- Nuffield Department of Women's and Reproductive Health, Endometriosis CaRe Centre, University of Oxford, Oxford, United Kingdom
| | - Moamar Al-Jefout
- Department of Obstetrics and Gynaecology, College of Medical and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Department of Obstetrics and Gynaecology, Mutah Medical Faculty, Mutah University, Al-Karak, Jordan
| | - Habiba Alsafar
- Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Department of Genetics and Molecular Biology, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Christian M. Becker
- Nuffield Department of Women's and Reproductive Health, Endometriosis CaRe Centre, University of Oxford, Oxford, United Kingdom
| | - Krina T. Zondervan
- Nuffield Department of Women's and Reproductive Health, Endometriosis CaRe Centre, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Nilufer Rahmioglu
- Nuffield Department of Women's and Reproductive Health, Endometriosis CaRe Centre, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
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35
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Grundström H, Larsson B, Arendt-Nielsen L, Gerdle B, Kjølhede P. Pain catastrophizing is associated with pain thresholds for heat, cold and pressure in women with chronic pelvic pain. Scand J Pain 2021; 20:635-646. [PMID: 32383692 DOI: 10.1515/sjpain-2020-0015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/19/2020] [Indexed: 01/06/2023]
Abstract
Background and aims Psychological traits such as pain catastrophizing may play a role in the development of chronic pelvic pain (CPP). Pain catastrophizing is the tendency to amplify negative cognitive and emotional pain processes. The Pain Catastrophizing Scale (PCS) assesses elements of pain catastrophizing divided into three subgroups of factors (rumination, helplessness and magnification). Previous studies have shown associations between CPP and increased pain sensitivity, widespread generalized hyperalgesia, and decreased pain thresholds, but the relation between pain catastrophizing and specific pain thresholds has not yet been widely examined in this patient group. The aims of this study were (a) to determine if catastrophizing is increased in women with CPP compared with pain-free women, (b) to assess the importance of pain catastrophizing, psychological distress variables, and subjective pain sensitivity for pain thresholds of heat, cold and pressure in these two groups, and (c) to determine whether psychological variables or pain thresholds best contribute to the differentiation between CPP and controls. Methods Thirty-seven women with chronic pelvic pain who underwent diagnostic laparoscopy on the suspicion of endometriosis participated along with 55 healthy and pain-free controls. All underwent quantitative sensory testing on six locations on the body to determine heat (HPT), cold (CPT) and pressure (PPT) pain thresholds. The PCS, the Pain Sensitivity Questionnaire (PSQ), the Hospital Anxiety Depression Scale, (HADS) demographics and clinical data were collected prospectively. Principal component analysis and orthogonal partial least square regressions were used to assess the associations between PCS scores and pain thresholds. Results The women with CPP scored significantly higher on PCS than the healthy controls. PCS-helplessness, PCS-rumination and HADS-depression were significantly associated with pain thresholds for the whole group. In the CPP group, PCS-rumination, body mass index and PSQ were significant regressors for HPT and CPT. The PCS and the HADS subscales were strongly intercorrelated in women with CPP and were stronger regressors of group membership than the three pain thresholds. In the group of healthy control women, no relationships were found to be significant. The psychological variables were somewhat stronger significant regressors than pain thresholds (also significant) for group membership. Conclusions Women with CPP have significantly higher pain catastrophizing scores than women without CPP. The pain catastrophizing rumination factor is significantly associated with pain thresholds of heat and cold in CPP women. PCS and HADS are strongly intercorrelated and PSQ correlates positively with these variables. It seems that the psychological variables are important for group differentiation. Implications The results clearly indicate the need for a multimodal assessment (bio-psycho-social) of CPP patients including psychological symptoms such as catastrophizing, anxiety and depression. The registration of semi-objective pain thresholds captures both specific pain sensitivity information (mechanical pressure, cold or heat) and the degree of wide spread pain hypersensitivity. There is a need for future larger studies investigating whether certain profiles in the clinical presentations (including pain thresholds and psychological variables) are associated with outcomes after different types of interventions.
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Affiliation(s)
- Hanna Grundström
- Department of Obstetrics and Gynaecology in Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Linköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Britt Larsson
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Lars Arendt-Nielsen
- Center for Sensory-Motor Interactions, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Preben Kjølhede
- Department of Obstetrics and Gynaecology in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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36
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Shafrir AL, Martel E, Missmer SA, Clauw DJ, Harte SE, As-Sanie S, Sieberg CB. Pelvic floor, abdominal and uterine tenderness in relation to pressure pain sensitivity among women with endometriosis and chronic pelvic pain. Eur J Obstet Gynecol Reprod Biol 2021; 264:247-253. [PMID: 34340095 DOI: 10.1016/j.ejogrb.2021.07.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 06/29/2021] [Accepted: 07/19/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Pelvic floor pain, abdominal wall pain, and central nervous system pain amplification can be contributing factors in chronic pelvic pain (CPP), however; limited research has investigated the association of pelvic floor, abdominal, and uterine tenderness with central nervous system pain amplification. We assessed whether pressure pain thresholds on the non-dominant thumbnail, a marker of central nervous system pain amplification, were associated with pelvic floor, abdominal, and uterine tenderness among women with endometriosis or CPP. STUDY DESIGN We conducted a cross-sectional study among 88 females with endometriosis and/or CPP. Abdominal (6 locations), pelvic floor (6 locations) and uterine (1 location) tenderness were assessed via a standardized physical exam. Participants reported their pain levels (0-10 scale) with application of 2 kg of pressure at each area, with a pain rating of ≥4 on the 0-10 scale considered moderate to severe pain. Pain sensitivity was measured on the non-dominant thumbnail by applying discrete pressure stimuli using a previously validated protocol. RESULTS Overall, 50% (44/88), 42% (37/88), and 58% (51/88) of participants reported high pelvic floor, abdominal, and uterine tenderness, respectively. Pressure intensities needed to elicit 'faint' and 'mild' pain were lower for participants with high vs. low pelvic floor tenderness (median intensity for 'faint' pain = 0.50 kgf/cm2(min-max:0.25-3.25) vs. 1.06(0.25-3.00), p-value = 0.006; median intensity for 'mild' pain = 2.00(0.63-4.88) vs. 2.63(0.75-6.00), p-value = 0.03). No association was observed between pressure pain sensitivity and abdominal or uterine tenderness (p > 0.11). Participants with endometriosis without pain were less likely to have high pelvic floor (22.2%), abdominal (11.1%), and uterine (25.9%) tenderness compared to participants with endometriosis with pain (63.0%, 50%, 65.2%, respectively) and participants with chronic pelvic pain (60%, 73.3%, 93.3%, respectively). CONCLUSIONS These results suggest that high pelvic floor tenderness among women with endometriosis/CPP may be a marker of heightened pain sensitivity suggestive of central nervous system pain amplification and may impact treatment response. Future research should examine whether this clinical phenotype predicts response to medical and behavioral treatments (e.g, anti-convulsants, behavioral therapy, Physical Therapy).
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Affiliation(s)
- Amy L Shafrir
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA; Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, MA, USA
| | - Elena Martel
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Stacey A Missmer
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA; Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Daniel J Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Sawsan As-Sanie
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Christine B Sieberg
- Departments of Anesthesiology, Critical Care, & Pain Medicine and Psychiatry, Boston Children's Hospital, Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Biobehavioral Pediatric Pain Lab, Boston Children's Hospital, Boston, MA, USA.
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37
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Conroy I, Mooney SS, Kavanagh S, Duff M, Jakab I, Robertson K, Fitzgerald AL, Mccutchan A, Madden S, Maxwell S, Nair S, Origanti N, Quinless A, Mirowski-Allen K, Sewell M, Grover SR. Pelvic pain: What are the symptoms and predictors for surgery, endometriosis and endometriosis severity. Aust N Z J Obstet Gynaecol 2021; 61:765-772. [PMID: 34028794 DOI: 10.1111/ajo.13379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/04/2021] [Accepted: 04/30/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Chronic pelvic pain (CPP) is a common condition which significantly impacts the quality of life and wellbeing of many women. Laparoscopy with histopathology is recommended for investigation of pelvic pain and identification of endometriosis with concurrent removal. Never-the-less, the association between endometriosis and pelvic pain is challenging, with endometriosis identified in only 30-50% of women with pain. AIMS To explore the predictors for undergoing surgery, for identifying endometriosis and endometriosis severity in a cohort of women with CPP. MATERIALS AND METHODS This study forms part of the Persistent Pelvic Pain project, a prospective observational cohort study (ANZCTR:ACTRN12616000150448). Women referred to a public gynaecology clinic with pain were randomised to one of two gynaecology units for routine care and followed for 36 months with 6-monthly surveys assessing demographics, medical history, quality of life, and pain symptoms measured on a Likert scale. Operative notes were reviewed and endometriosis staged. RESULTS Of 471 women recruited, 102 women underwent laparoscopy or laparotomy, of whom 52 had endometriosis (n = 37 stage I-II; n = 15 Stage III-IV). Gynaecology unit, pelvic pain intensity and lower parity were all predictors of surgery (odds ratio (OR) 0.342; 95% CI 0.209-0.561; OR 1.303; 95% CI: 1.079-1.573; OR 0.767; 95% CI: 0.620-0.949, respectively). There were no predictors identified for endometriosis diagnosis and the only predictor of severity was increasing age (OR 1.155; 95% CI: 1.047-1.310). CONCLUSIONS Gynaecology unit and pain intensity were key predictors of undergoing laparoscopy; however, pain severity did not predict endometriosis diagnosis or staging. These findings indicate the need to review current frameworks guiding practice toward surgery for pelvic pain.
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Affiliation(s)
- Isabelle Conroy
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women (MHW), University of Melbourne, Melbourne, Victoria, Australia.,Austin Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Samantha S Mooney
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women (MHW), University of Melbourne, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Shane Kavanagh
- School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia
| | - Michael Duff
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women (MHW), University of Melbourne, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Ballarat Hospital, Ballarat, Victoria, Australia
| | - Ilona Jakab
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women (MHW), University of Melbourne, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Katharine Robertson
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women (MHW), University of Melbourne, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Peninsula Hospital, Langwarrin, Victoria, Australia
| | - Amy L Fitzgerald
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women (MHW), University of Melbourne, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Monash Health, Clayton, Victoria, Australia
| | - Alexandra Mccutchan
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women (MHW), University of Melbourne, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Western Health, Footscray, Victoria, Australia
| | - Siana Madden
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women (MHW), University of Melbourne, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Sarah Maxwell
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Shweta Nair
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women (MHW), University of Melbourne, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Western Health, Footscray, Victoria, Australia
| | - Nimita Origanti
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women (MHW), University of Melbourne, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia
| | - Alish Quinless
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women (MHW), University of Melbourne, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia.,South West Healthcare, Warrnambool, Victoria, Australia
| | - Kelly Mirowski-Allen
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women (MHW), University of Melbourne, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Megan Sewell
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women (MHW), University of Melbourne, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Sonia R Grover
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women (MHW), University of Melbourne, Melbourne, Victoria, Australia.,Austin Hospital, Melbourne, Victoria, Australia
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Cordaro M, Trovato Salinaro A, Siracusa R, D’Amico R, Impellizzeri D, Scuto M, Ontario ML, Interdonato L, Crea R, Fusco R, Cuzzocrea S, Di Paola R, Calabrese V. Hidrox ® and Endometriosis: Biochemical Evaluation of Oxidative Stress and Pain. Antioxidants (Basel) 2021; 10:720. [PMID: 34064310 PMCID: PMC8147870 DOI: 10.3390/antiox10050720] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/26/2021] [Accepted: 04/30/2021] [Indexed: 12/26/2022] Open
Abstract
Endometriosis is a gynecological and painful condition affecting women of reproductive age. It is characterized by dysfunctional endometrium-like implants outside of the uterine cavity. The purpose of this study was to evaluate the effects of Hidrox®, an aqueous extract of olive pulp containing hydroxytyrosol, on endometriotic lesions associated with pro-oxidative alterations and pain-like behaviors. Endometriosis was induced by intraperitoneal injection of uterine fragments, and Hidrox® was administered daily. At the end of the 14-day treatment, behavioral alterations were assessed and hippocampal tissues were collected. Laparotomy was performed, and the endometrial implants were harvested for histological and biochemical analysis. Hidrox® treatment reduced endometriotic implant area, diameter and volumes. Vehicle-treated rats showed lesional fibrosis, epithelial-mesenchymal transition and fibroblast-myofibroblast transdifferentiation, angiogenesis and pro-oxidative alterations in the peritoneal cavity. Hidrox® treatment reduced the aniline blue-stained area, α-smooth muscle actin (α-sma) and CD34 positive expressions. Moreover, it reduced mast cell recruitment into the lesions, myeloperoxidase activity and lipid peroxidation and increased superoxide dismutase (SOD) activity and glutathione levels in the endometrial explants. In the peritoneal fluid, Hidrox® treatment reduced interleukin (IL)-1β, IL2, IL6, tumor necrosis factor-α (TNF-α) and vascular endothelial grow factor (VEGF) levels increased by the disease. Hidrox® administration also reduced peripheral and visceral sensibility as shown by the behavioral tests (open field test, hot plate test, elevated plus maze test and acetic-acid-induced abdominal contractions). Animals treated with Hidrox® also showed reduced blood-brain barrier permeability and mast cell infiltration in the hippocampus, as well as astrocyte and microglia activation and brain oxidative status restoring brain-derived neurotrophic factor (BDNF) protein expression and increasing Nuclear factor erythroid 2-related factor 2 (Nfr2) nuclear translocation. In conclusion, Hidrox® displayed potential ameliorative effects on endometriotic implants and related pain-induced behaviors due to its potent antioxidative properties.
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Affiliation(s)
- Marika Cordaro
- Department of Biomedical, Dental and Morphological and Functional Imaging University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (M.C.); (R.D.P.); (V.C.)
| | - Angela Trovato Salinaro
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95124 Catania, Italy; (A.T.S.); (M.S.); (M.L.O.)
| | - Rosalba Siracusa
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (R.S.); (R.D.); (D.I.); (L.I.)
| | - Ramona D’Amico
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (R.S.); (R.D.); (D.I.); (L.I.)
| | - Daniela Impellizzeri
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (R.S.); (R.D.); (D.I.); (L.I.)
| | - Maria Scuto
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95124 Catania, Italy; (A.T.S.); (M.S.); (M.L.O.)
| | - Maria Laura Ontario
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95124 Catania, Italy; (A.T.S.); (M.S.); (M.L.O.)
| | - Livia Interdonato
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (R.S.); (R.D.); (D.I.); (L.I.)
| | - Roberto Crea
- Oliphenol LLC., 26225 Eden Landing Road, Unit C, Hayward, CA 94545, USA;
| | - Roberta Fusco
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (R.S.); (R.D.); (D.I.); (L.I.)
| | - Salvatore Cuzzocrea
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (R.S.); (R.D.); (D.I.); (L.I.)
| | - Rosanna Di Paola
- Department of Biomedical, Dental and Morphological and Functional Imaging University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (M.C.); (R.D.P.); (V.C.)
| | - Vittorio Calabrese
- Department of Biomedical, Dental and Morphological and Functional Imaging University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (M.C.); (R.D.P.); (V.C.)
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Abstract
The term pelvic venous disorders (PeVD) describes a group of related clinical entities with overlapping clinical presentations that were previously characterized by separate imprecise syndromic terminology. The clinical manifestations of PeVD may variously include chronic pelvic pain; pelvic origin extrapelvic lower extremity and genital varices; lower extremity pain and swelling; and left flank pain and hematuria. This manuscript focuses on the primary manifestations of PeVD in women - chronic pelvic pain and pelvic origin lower extremity and vulvar varices - and will review the underlying pathophysiology and related complicating factors (such as maladaptive pain responses) to explain the variety of clinical presentations.
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Carbone MG, Campo G, Papaleo E, Marazziti D, Maremmani I. The Importance of a Multi-Disciplinary Approach to the Endometriotic Patients: The Relationship between Endometriosis and Psychic Vulnerability. J Clin Med 2021; 10:jcm10081616. [PMID: 33920306 PMCID: PMC8069439 DOI: 10.3390/jcm10081616] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/04/2021] [Accepted: 04/06/2021] [Indexed: 12/24/2022] Open
Abstract
Endometriosis is a chronic inflammatory condition, which is distinguished by the presence of the endometrial-like glands and stroma outside the uterine cavity. Pain and infertility are the most commonly expressed symptoms, occurring in 60% and 40% of cases, respectively. Women with endometriosis, especially those with pelvic pain, also have a greater vulnerability to several psychiatric disorders. There is, in particular, a tendency to contract affective or anxiety disorders as well as panic-agoraphobic and substance use disorders. Endometriosis with pelvic pain, infertility and psychic vulnerability usually leads to disability and a markedly lower quality of life for women of reproductive age. Thus, the burden of endometriosis is not limited to the symptoms and dysfunctions of the disease; it extends to the social, working and emotional spheres, leading to a severe impairment of global functioning. An analysis of scientific literature revealed a close relationship between specific temperamental traits, the expression of several psychiatric symptoms, chronicity of pain, risk of substance use and lower probability of a positive outcome. Endometriosis symptoms and the impact of related psychological consequences, increased vulnerability and the possible onset of psychiatric symptoms may influence coping strategies and weaken resilience, so triggering a vicious cycle leading to a marked deterioration in the quality of life. A multidisciplinary approach consisting of a medical team composed of gynecologists, psychologists, psychiatrists, experts in Dual Disorder, algologists and sexologists, would guarantee the setting of a target and taking the best decision on a personalized treatment plan. That approach would allow the prompt detection of any psychopathological symptoms and improve the endometriosis-related physical symptoms, bringing a healthier quality of life and a greater likelihood of a positive outcome.
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Affiliation(s)
- Manuel Glauco Carbone
- PISA-School of Experimental and Clinical Psychiatry, 56100 Pisa, Italy;
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, 21100 Varese, Italy
| | - Giovanni Campo
- Obstetrics and Gynecology Department, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.C.); (E.P.)
| | - Enrico Papaleo
- Obstetrics and Gynecology Department, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.C.); (E.P.)
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Donatella Marazziti
- 1st Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy;
- Saint Camillus International University of Health and Medical Sciences-UniCamillus, 00131 Rome, Italy
| | - Icro Maremmani
- Saint Camillus International University of Health and Medical Sciences-UniCamillus, 00131 Rome, Italy
- Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), 55045 Pietrasanta, Lucca, Italy
- Vincent P. Dole Dual Disorder Unit, 2nd Psychiatric Unit, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
- G. De Lisio Institute of Behavioral Sciences, 56100 Pisa, Italy
- Correspondence: ; Tel.: +39-050-993045
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Lara-Ramos A, Álvarez-Salvago F, Fernández-Lao C, Galiano-Castillo N, Ocón-Hernández O, Mazheika M, Salinas-Asensio MM, Mundo-López A, Arroyo-Morales M, Cantarero-Villanueva I, Artacho-Cordón F. Widespread Pain Hypersensitivity and Lumbopelvic Impairments in Women Diagnosed with Endometriosis. PAIN MEDICINE 2021; 22:1970-1981. [PMID: 33675228 DOI: 10.1093/pm/pnaa463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To explore hypersensitivity to pain and musculoskeletal impairments in the lumbopelvic area in women with and without endometriosis. METHODS This cross-sectional study included 66 women (41 women with endometriosis and 25 healthy women). Pain and related catastrophizing thoughts were assessed through a numeric rating scale, pressure pain thresholds (PPTs), the slump test, and the Pain Catastrophizing Scale. Lumbopelvic muscles were evaluated through ultrasound imaging, flexor/extensor resistance tests, and the lumbopelvic stability test. RESULTS Women with endometriosis showed increased self-reported intensity of current pelvic pain (CuPP), reduced local PPTs (42.8-64.7% in the affected area, P-value <.001) and higher prevalence of lumbar nerve root impingement/irritation pain and catastrophizing thoughts (P-value ≤.002). Moreover, affected women showed decreased thickness of transversus abdominis, reduced resistance of flexor and extensor trunk muscles and lower lumbopelvic stability (P-values <.030). Endometriosis stage and severity of CuPP were related to worse results in these parameters. CONCLUSIONS The presence of pain sensitization signs and lumbopelvic impairments, more pronounced in patients with stage IV endometriosis and moderate/severe CuPP, warrants the development of rehabilitation interventions targeting pain and lumbopelvic impairments in women with endometriosis.
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Affiliation(s)
- Ana Lara-Ramos
- Gynaecology and Obstetrics Unit, 'Virgen de las Nieves' University Hospital, Granada, Spain
| | - Francisco Álvarez-Salvago
- "Cuídate" Support Unit for Oncology Patients (UAPO), Granada, Spain.,Department of Physiotherapy, European University of Valencia, Valencia, Spain
| | - Carolina Fernández-Lao
- "Cuídate" Support Unit for Oncology Patients (UAPO), Granada, Spain.,Department of Physiotherapy, University of Granada. Granada, Spain.,Sport and Health University Research Institute (iMUDS), Granada, Spain.,Biohealth Research Institute in Granada (ibs.GRANADA), Granada, Spain
| | - Noelia Galiano-Castillo
- "Cuídate" Support Unit for Oncology Patients (UAPO), Granada, Spain.,Department of Physiotherapy, University of Granada. Granada, Spain.,Sport and Health University Research Institute (iMUDS), Granada, Spain.,Biohealth Research Institute in Granada (ibs.GRANADA), Granada, Spain
| | - Olga Ocón-Hernández
- Biohealth Research Institute in Granada (ibs.GRANADA), Granada, Spain.,Gynaecology and Obstetrics Unit, 'San Cecilio' University Hospital, Granada, Spain
| | - Maryna Mazheika
- Department of Obstetrics and Gynaecology, University of Granada, Granada, Spain
| | | | | | - Manuel Arroyo-Morales
- "Cuídate" Support Unit for Oncology Patients (UAPO), Granada, Spain.,Department of Physiotherapy, University of Granada. Granada, Spain.,Sport and Health University Research Institute (iMUDS), Granada, Spain.,Biohealth Research Institute in Granada (ibs.GRANADA), Granada, Spain
| | - Irene Cantarero-Villanueva
- "Cuídate" Support Unit for Oncology Patients (UAPO), Granada, Spain.,Department of Physiotherapy, University of Granada. Granada, Spain.,Sport and Health University Research Institute (iMUDS), Granada, Spain.,Biohealth Research Institute in Granada (ibs.GRANADA), Granada, Spain
| | - Francisco Artacho-Cordón
- "Cuídate" Support Unit for Oncology Patients (UAPO), Granada, Spain.,Biohealth Research Institute in Granada (ibs.GRANADA), Granada, Spain.,Department of Radiology and Physical Medicine, University of Granada, Granada, Spain.,CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Taylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet 2021; 397:839-852. [PMID: 33640070 DOI: 10.1016/s0140-6736(21)00389-5] [Citation(s) in RCA: 386] [Impact Index Per Article: 128.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 08/09/2020] [Accepted: 08/14/2020] [Indexed: 12/14/2022]
Abstract
Endometriosis is a common disease affecting 5-10% of women of reproductive age globally. However, despite its prevalence, diagnosis is typically delayed by years, misdiagnosis is common, and delivery of effective therapy is prolonged. Identification and prompt treatment of endometriosis are essential and facilitated by accurate clinical diagnosis. Endometriosis is classically defined as a chronic, gynaecological disease characterised by endometrial-like tissue present outside of the uterus and is thought to arise by retrograde menstruation. However, this description is outdated and no longer reflects the true scope and manifestations of the disease. The clinical presentation is varied, the presence of pelvic lesions is heterogeneous, and the manifestations of the disease outside of the female reproductive tract remain poorly understood. Endometriosis is now considered a systemic disease rather than a disease predominantly affecting the pelvis. Endometriosis affects metabolism in liver and adipose tissue, leads to systemic inflammation, and alters gene expression in the brain that causes pain sensitisation and mood disorders. The full effect of the disease is not fully recognised and goes far beyond the pelvis. Recognition of the full scope of the disease will facilitate clinical diagnosis and allow for more comprehensive treatment than currently available. Progestins and low-dose oral contraceptives are unsuccessful in a third of symptomatic women globally, probably as a result of progesterone resistance. Oral gonadotropin-releasing hormone (GnRH) antagonists constitute an effective and tolerable therapeutic alternative when first-line medications do not work. The development of GnRH antagonists has resulted in oral drugs that have fewer side-effects than other therapies and has allowed for rapid movement between treatments to optimise and personalise endometriosis care. In this Review, we discuss the latest understanding of endometriosis as a systemic disease with multiple manifestations outside the parameters of classic gynaecological disease.
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Affiliation(s)
- Hugh S Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA.
| | - Alexander M Kotlyar
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Valerie A Flores
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
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Phan VT, Stratton P, Tandon HK, Sinaii N, Aredo JV, Karp BI, Merideth MA, Shah JP. Widespread myofascial dysfunction and sensitisation in women with endometriosis-associated chronic pelvic pain: A cross-sectional study. Eur J Pain 2021; 25:831-840. [PMID: 33326662 DOI: 10.1002/ejp.1713] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 12/12/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Chronic pelvic pain persists in some women with endometriosis even after lesion removal and optimized hormonal treatment. OBJECTIVE Characterize the presence and distribution of pain, myofascial dysfunction and sensitisation beyond the pelvis in women with endometriosis-associated chronic pelvic pain. METHODS Cross-sectional study of 30 women prior to participation in a clinical trial. Evaluation included pain-focused abdominopelvic gynaecologic examination with the identification of pelvic floor muscle spasm. Neuro-musculoskeletal examination assessed paraspinal allodynia and hyperalgesia bilaterally and myofascial trigger points in 13 paired muscles. Pressure-pain thresholds were measured over interspinous ligaments and trigger points. Women completed the body territories element of the Body Pain Index. RESULTS All women had a pelvic floor muscle spasm that they self-identified as a major focus of pain. Twenty of 30 women described their pelvic pain as focal. However, all demonstrated widespread myofascial dysfunction with low pressure-pain thresholds and trigger points in over two-thirds of 26 assessed regions. Widespread spinal segmental sensitisation was present in 17/30, thoracic in 21/30 and lumbosacral/pelvic in 18/30. Cervical sensitisation manifested as low pressure-pain thresholds with 23/30 also reporting recurrent, severe headaches and 21/30 experiencing orofacial pain. Those reporting diffuse pelvic pain were more likely to have widespread (p = .024) and lumbosacral/pelvic (p = .036) sensitisation and report over 10 painful body areas (p = .009). CONCLUSIONS Women with endometriosis-associated chronic pelvic pain often have myofascial dysfunction and sensitisation beyond the pelvic region that may be initiated or maintained by on-going pelvic floor spasm. These myofascial and nervous system manifestations warrant consideration when managing pain in this population. Clinicaltrials.gov identifier: NCT01553201. SIGNIFICANCE Women with endometriosis often have pelvic pain persisting after surgery despite hormonal therapies and these women have regional pelvic sensitisation and myofascial dysfunction. Pelvic floor muscle spasm is a major pain focus in this population. Sensitisation and myofascial dysfunction are widespread, beyond the pelvic region. On-going pelvic floor spasm may initiate or maintain sensitisation. Myofascial/sensitisation manifestations warrant consideration when managing pain in this population.
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Affiliation(s)
- Vy T Phan
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Pamela Stratton
- Office of the Clinical Director, Intramural Research Program, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Hannah K Tandon
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Ninet Sinaii
- Biostatistics & Clinical Epidemiology Service, Intramural Research Program, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | | | - Barbara I Karp
- Office of the Clinical Director, Intramural Research Program, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Melissa A Merideth
- Office of the Clinical Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jay P Shah
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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44
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Missmer SA, Tu FF, Agarwal SK, Chapron C, Soliman AM, Chiuve S, Eichner S, Flores-Caldera I, Horne AW, Kimball AB, Laufer MR, Leyland N, Singh SS, Taylor HS, As-Sanie S. Impact of Endometriosis on Life-Course Potential: A Narrative Review. Int J Gen Med 2021; 14:9-25. [PMID: 33442286 PMCID: PMC7800443 DOI: 10.2147/ijgm.s261139] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/08/2020] [Indexed: 12/16/2022] Open
Abstract
Endometriosis may exert a profound negative influence on the lives of individuals with the disorder, adversely affecting quality of life, participation in daily and social activities, physical and sexual functioning, relationships, educational and work productivity, mental health, and well-being. Over the course of a lifetime, these daily challenges may translate into limitations in achieving life goals such as pursuing or completing educational opportunities; making career choices or advancing in a chosen career; forming stable, fulfilling relationships; or starting a family, all of which ultimately alter one's life trajectory. The potential for endometriosis to impact the life course is considerable, as symptom onset generally occurs at a time of life (menarche through menopause, adolescence through middle age) when multiple life-changing and trajectory-defining decisions are made. Using a life-course approach, we examine how the known effects of endometriosis on life-domain satisfaction may impact health and well-being across the life course of affected individuals. We provide a quasi-systematic, narrative review of the literature as well as expert opinion on recommendations for clinical management and future research directions.
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Affiliation(s)
- Stacey A Missmer
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
| | - Frank F Tu
- Department of Obstetrics and Gynecology, NorthShore University Health System, Evanston, IL, USA
| | - Sanjay K Agarwal
- Department of Reproductive Medicine, Center for Endometriosis Research and Treatment, University of California San Diego, La Jolla, CA, USA
| | - Charles Chapron
- Department of Gynecology Obstetrics II and Reproductive Medicine, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, Paris, France
| | | | | | | | - Idhaliz Flores-Caldera
- Department of Obstetrics and Gynecology, Ponce Health Sciences University - Ponce Research Institute, School of Medicine, Ponce, Puerto Rico
| | - Andrew W Horne
- Department of Gynaecology and Reproductive Sciences, MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Alexandra B Kimball
- Harvard Medical Faculty Physicians, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Marc R Laufer
- Department of Obstetrics, Gynecology, and Reproductive Biology, Boston Center for Endometriosis and Boston Children's Hospital and Brigham and Women's Hospital, Boston, MA, USA
| | - Nicholas Leyland
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, Ontario, Canada
| | - Sukhbir S Singh
- Department of Obstetrics and Gynaecology, University of Ottawa, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Sawsan As-Sanie
- Department of Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, MI, USA
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45
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Mooney SS, Grover SR. The persistent pelvic pain study: Factors that influence outcomes in women referred to a public hospital with chronic pelvic pain - A study protocol. Aust N Z J Obstet Gynaecol 2021; 61:E6-E11. [PMID: 33386748 DOI: 10.1111/ajo.13289] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 11/24/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Persistent pelvic pain affects between 10-20% of women with a significant impact on their physical and mental health, sexual relationships, families and society. Estimates of the cost to women and the community is over $9 billion/annum. Although endometriosis is considered a leading cause of pelvic pain, no symptoms reliably allow the identification of those with and without endometriosis. Furthermore, the significance of mild endometriosis is now debated. The optimal clinical approach for pelvic pain and endometriosis remains unclear, with increasing evidence of other contributing factors such as central sensitisation. Studies to date have significant limitations due to their sample size, relatively short follow-up, and inclusion of only women with laparoscopically identified endometriosis. AIMS To undertake a real-world study of women referred with pain to gynaecology outpatients of a women's hospital and explore factors influencing three-year outcomes. MATERIALS AND METHODS Five hundred women will be randomised to one of two gynaecology units. The units will provide routine clinical care but their approaches to management of women with pelvic pain and endometriosis differ: one with skilled endoscopic gynaecologists has greater emphasis on surgery, the other, gynaecologists have more medical expertise in managing pain and menstrual problems. Participants will complete six-monthly questionnaires regarding pain and quality of life for three years. This information will not be available to clinicians. Their medical care will be followed from their medical records. The cost of outpatient care and admissions will be calculated. Data will be analysed using STATA software with appropriate post hoc tests. Australian and New Zealand Clinical Trials Registry (ANZCTR:ACTRN12616000150448).
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Affiliation(s)
- Samantha S Mooney
- Endosurgery Department, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Sonia R Grover
- Plenty Gynaecology Unit, Mercy Hospital for Women, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
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46
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Lucas R, Zhang Y, Walsh SJ, Starkweather A, Young E. OXTR rs53576 Variation with Breast and Nipple Pain in Breastfeeding Women. Pain Manag Nurs 2020; 22:369-376. [PMID: 33303340 DOI: 10.1016/j.pmn.2020.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/18/2020] [Accepted: 09/14/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Thirty percent of women who seek professional breastfeeding support require assistance with ongoing breast and nipple pain and < 50% of women report resolution of their pain. It is unknown if there is a molecular risk for ongoing breast and nipple pain during breastfeeding. Aim -To evaluate associations among breast and nipple pain sensitivity and candidate pain sensitivity single-nucleotide polymorphisms [SNPs], (COMT rs6269, rs4633, rs4818, rs4680 and OXTR rs2254298, rs53576) in breastfeeding women. Design - A secondary analysis of a pilot randomized controlled trial of a pain self-management intervention conducted over 6 weeks postpartum. Setting and Participants - Sixty women were recruited from two hospital settings after birth. Methods - All participants underwent standardized mechanical somatosensory testing for an assessment of pain sensitivity and provided baseline buccal swabs for genetic analysis. At 1, 2, and 6 weeks postpartum, women self-reported breast and nipple pain severity using a visual analogue scale. Results - Women with the minor allele OXTR rs53576 reported 8.18-fold higher breast and nipple pain severity over time. For every 1-unit increase in Mechanical detection threshold and windup ratio, women reported 16.51-fold and 4.82-fold higher breast and nipple pain severity respectively. Six women with the OXTR rs2254298 minor allele reported allodynia. Conclusion - The presence of OXTR alleles in women with enhanced pain sensitivity suggests a phenotype of genetic risk for ongoing breast and nipple with potential for pain-associated breastfeeding cessation. Somatosensory testing identified women who reported higher breast and nipple pain during the first weeks of breastfeeding.
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Affiliation(s)
- Ruth Lucas
- University of Connecticut School of Nursing, Storrs, Connecticut.
| | - Yiming Zhang
- University of Connecticut School of Nursing, Storrs, Connecticut
| | - Stephen J Walsh
- University of Connecticut School of Nursing, Storrs, Connecticut
| | | | - Erin Young
- University of Connecticut School of Nursing, Storrs, Connecticut; University of Kansas Medical Center, Kansas City, Kansas
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47
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Zhang N, Liu Y, He Y, Shi J, Zhou M, Liu H. Transvaginal four-dimensional hysterosalpingo-contrast sonography: Pain perception and factors influencing pain severity. J Obstet Gynaecol Res 2020; 47:302-310. [PMID: 33107172 DOI: 10.1111/jog.14538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/23/2020] [Accepted: 09/28/2020] [Indexed: 11/28/2022]
Abstract
AIM The purpose is to investigate pain perception during transvaginal four-dimensional hysterosalpingo-contrast sonography (TV 4D-HyCoSy) and factors influencing pain severity. METHODS This was a retrospective study included 340 women who underwent TV 4D-HyCoSy examination from January 2016 to October 2017. The factors were recorded, including age, childbearing history, infertility type, history of pelvic inflammation, pelvic surgery, history of uterine manipulation, history of ectopic pregnancy, atropine delivery mode, uterine position, uterine malformation, uterine lesion, fibroid, intrauterine adhesion, polycystic ovary, endometrial implantation cyst, dysmenorrhea score, the degree of patency of fallopian tube and contrast agents dosage. Pain was evaluated during and after TV 4D-HyCoSy. The time point of peak pain was evaluated and the influencing factors of moderate/severe pain were analyzed. RESULTS The highest pain occurred at contrast instillation. The independent influencing factors of moderate/severe pain were age (P = 0.021), dysmenorrhea score (P = 0.003) and tubal patency (P < 0.001). Further analysis showed that age affected the pain score when TV 4D-HyCoSy started and the peak pain occurred. Dysmenorrhea score and tubal patency affect the pain score at most time points. CONCLUSION Age, dysmenorrhea score and tubal patency are factors influencing the severity of pain during TV 4D-HyCoSy.
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Affiliation(s)
- Ning Zhang
- Department of Ultrasonography, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yu Liu
- Department of Ultrasonography, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yanni He
- Department of Ultrasonography, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jiayao Shi
- Department of Ultrasonography, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Meijun Zhou
- Department of Ultrasonography, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Hongmei Liu
- Department of Ultrasonography, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
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48
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Sachedina A, ABU Bakar M, Dunford AM, Morris A, NUR Azurah AG, Grover SR. Dysmenorrhea in young people: Experiences from a tertiary center with a focus on conservative management. J Obstet Gynaecol Res 2020; 47:352-358. [DOI: 10.1111/jog.14532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 09/23/2020] [Accepted: 09/30/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Aalia Sachedina
- Department of Gynaecology The Royal Children's Hospital Melbourne Victoria Australia
| | - Mardiha ABU Bakar
- General Practice Creswick and Clunes Medical Centre Melbourne Victoria Australia
| | - Angela M. Dunford
- Department of Gynaecology and Women's Health John Hunter Hospital Newcastle New South Wales Australia
| | - Amanda Morris
- Pediatric and Adolescent Gynecology, Department of Obstetrics, Gynecology & Reproductive Sciences University of Manitoba Winnipeg Manitoba Canada
| | - Abdul Ghani NUR Azurah
- Department of Obstetrics and Gynaecology Universiti Kebangsaan Malaysia Kuala Lumpur Malaysia
| | - Sonia R. Grover
- Department of Gynaecology The Royal Children's Hospital Melbourne Victoria Australia
- Department of Obstetrics and Gynaecology Universiti Kebangsaan Malaysia Kuala Lumpur Malaysia
- Department of Paediatrics University of Melbourne Melbourne Victoria Australia
- Murdoch Children's Research Institute Melbourne Victoria Australia
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Nirgianakis K, Vaineau C, Agliati L, McKinnon B, Gasparri ML, Mueller MD. Risk factors for non-response and discontinuation of Dienogest in endometriosis patients: A cohort study. Acta Obstet Gynecol Scand 2020; 100:30-40. [PMID: 32767677 DOI: 10.1111/aogs.13969] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/18/2020] [Accepted: 07/30/2020] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Progestins are commonly prescribed first-line drugs for endometriosis. High rates of non-response and intolerance to these drugs have been previously reported. However, no study to date has investigated the characteristics and comorbidities of patients taking progestins in relation to treatment outcomes, so identifying which patients will respond to or tolerate the treatment is currently impossible. The purpose of this study, therefore, was to identify risk factors for non-response and discontinuation of Dienogest (DNG) in women with endometriosis. MATERIAL AND METHODS This is a retrospective cohort study including women currently taking, or newly prescribed, DNG for endometriosis-associated pain presenting in the Endometriosis Clinic of the University Hospital of Bern between January 2017 and May 2018. Women with initiation of treatment directly after surgery for endometriosis were excluded. For all participants the symptoms and comorbidities were documented. Effectiveness, tolerability and discontinuation of DNG were the primary end points. Univariate and multivariate binary logistic regression models were carried out to identify risk factors for non-response, intolerance and discontinuation of DNG. RESULTS A sufficient or excellent treatment response was reported by 85/125 (68%) participants. Genital bleeding during the DNG treatment was negatively (OR 0.185, 95% CI 0.056-0.610, P = .006) and rASRM endometriosis stages III and IV were positively (OR 3.876, 95% CI 1.202-12.498, P = .023) correlated with the DNG response. When accounting for exclusively pretreatment factors, primary dysmenorrhea (OR 0.236, 95% CI 0.090-0.615, P = .003) and suspicion of adenomyosis (OR 0.347, 95% CI 0.135-0.894, P = .028) were inversely correlated with DNG response, and the latter was also correlated with treatment discontinuation (OR 3.189, 95% CI 1.247-8.153, P = .015). CONCLUSIONS Genital bleeding during the DNG treatment and low rASRM stages are independent risk factors for DNG non-response. Before treatment initiation, primary dysmenorrhea and suspicion of adenomyosis correlate with DNG non-response. The results could assist the clinician first to provide detailed information to women before treatment initiation, second to identify and possibly modify in-therapy factors correlated to treatment effectiveness and lastly to switch treatment on time if needed.
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Affiliation(s)
- Konstantinos Nirgianakis
- Department of Gynecology and Gynecological Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Cloé Vaineau
- Department of Gynecology and Gynecological Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lia Agliati
- Department of Gynecology and Gynecological Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Brett McKinnon
- Department of Gynecology and Gynecological Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Maria L Gasparri
- Department of Obstetrics and Gynecology, Lugano Regional Hospital, Ente Ospedaliero Cantonale, Università della Svizzera italiana, Lugano, Switzerland
| | - Michael D Mueller
- Department of Gynecology and Gynecological Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department for BioMedical Research, University of Bern, Bern, Switzerland
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Affiliation(s)
- Michelle M. Gagnon
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Randa Elgendy
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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