The clinical effect of traditional chinese medicine on middle-aged women with Interstitial Cystitis: Protocol for a randomized controlled trial

INTRODUCTION

Interstitial cystitis (IC), as a common disease in urology, is prolonged and repeated. IC has caused great harm to the patient's physical and psychological. Traditional Chinese medicine (TCM) is characterized by overall concepts and dialectical treatment. It provides clinicians with safer and more reliable alternatives in terms of clinical prescriptions and prepared medicines, and also improves the quality of life of patients with IC. Therefore, in this study, we will use the research method of randomized controlled trials to explore the effects of TCM combined with western medicine on renal function and urine metabolism on middle-aged women with IC.

METHODS/DESIGN

Use randomized controlled trials. According to the proposed diagnostic, inclusion, and exclusion criteria. Sixty patients with interstitial bladder inflammation that met the criteria were randomized into a treatment group and a control group of 30 cases each. The intervention group was treated with integrated traditional Chinese and western medicine. The control group was given conventional Western medicine treatment. The course of treatment is 8 weeks. Interstitial bladder inflammation symptoms score (ICS worker), problem score (worker CPI), pelvic pain and urinary urgency symptoms, and urodynamics were used as the evaluation criteria.

DISCUSSION

This trial may provide evidence regarding the clinical effectiveness, safety, and cost-effectiveness of TCM for patients with IC.

TRIAL REGISTRATION

ClinicalTrials.gov, ChiCTR2000029971, Registered on 17 February 2020.

Laparoscopic implantation of electrodes for bilateral neuromodulation of the pudendal nerves and S3 nerve roots for treating pelvic pain and voiding dysfunction

INTRODUCTION AND HYPOTHESIS

The objective of this video is to describe the technique for laparoscopic implantation of electrodes for bilateral neuromodulation of S3 and pudendal nerves. We report a successful case of a 48-year-old woman with spina bifida occulta referred with a 14-year history of intense acyclic pelvic pain, urinary hesitancy, and intermittent flow refractory to various conservative measures.

METHODS

The procedure began with the removal of two previously placed InterStims. A quadripolar electrode was then laparoscopically inserted into Alcock's canal and attached to the pelvic pectineal line. Another lead was placed juxtaneurally to S3. Lead contacts were then exteriorized, and the peritoneum closed. The same procedure was then performed on the contralateral side. The leads were connected to a 16-pole rechargeable pulse generator. Postoperatively, the patient developed an acute dissection and partial thrombosis of the external iliac artery, which was treated endovascularly.

RESULTS

Complete pain resolution was observed with simultaneous S3 and pudendal stimulation, with pudendal stimulation turned off for voiding.

CONCLUSIONS

We conclude that laparoscopic implantation of neuromodulation electrodes allows simultaneous stimulation of S3 and pudendal nerves, providing more programming options and possibly increasing success rates in complex pelvic floor dysfunction cases.

MMPI-2-RF characteristics of individuals with interstitial cystitis

OBJECTIVES

This study aimed to describe the psychological functioning of interstitial cystitis/bladder pain syndrome patients utilizing MMPI-2-RF scoring.

METHODS

The MMPI-2 was administered to 60 individuals who reported a diagnosis of IC. Responses were scored in the MMPI-2-RF format. Fifty-one protocols were deemed valid.

RESULTS

Elevations were discovered on scales FBS-r (symptom validity), RC1 (somatic complaints), and MLS (malaise). Participants were split into two groups based on extreme elevations on RC1; the high RC1 group produced higher scores on 39 scales including clinically significant elevations on 17 scales.

CONCLUSION

Over 25% of this sample had an emotional component to their physical concerns. This knowledge about the psychological characteristics of IC patients may have clinical utility for physicians and other treatment providers. The results argue strongly for psychological evaluation as a component of IC diagnosis and treatment. Those with significant emotional overlay to their somatic complaints may be best managed through psychological interventions and minimally invasive treatments.

Pelvic pain: a pathway for care developed for both men and women by the British Pain Society

This paper aims to explain the key points and highlight some of the controversies in the development of the British Pain Society's pelvic pain patient pathway map. Many clinicians lack experience and confidence with this group of patients, and this issue is highlighted. Additionally, the difficulties of classification and definitions in this area are discussed in detail. These are historical causes of disagreement among specialists which can lead to confused clinical care. This group of patients have multiple issues that cross many professional boundaries; they are best managed by the co-ordinated involvement of multiple teams. Patients suffer from significant distress and disability that often needs specialist assessment and intervention (interdisciplinary). This suggests that an integrated approach is required across the historic boundaries of primary and secondary care. A variety of interventions, including opioids and neuromodulation are recommended in the pathway and the controversies surrounding these inclusions are aired in detail.

Neuromodulation of pelvic visceral pain: review of the literature and case series of potential novel targets for treatment

Chronic pelvic pain (CPP) is complex and often resistant to treatment. While the exact pathophysiology is unknown, the pain states resultant from conditions such as interstitial cystitis and the like yield patients with a presentation that bears a striking similarity to neuropathic syndromes that are known to respond to neuromodulation. While there has been past success using the sacral region as a target for spinal cord stimulation (SCS) to treat these patients, there remains to be a consensus on the optimal location for lead placement. In this article, the authors discuss the potential etiology of CPP, examine the current literature on lead placement for SCS as a method of treatment, as well as present several cases where novel lead placement was successfully employed.

Vulvodynia: a psychophysiological profile based on electromyographic assessment

The objective of this study was to explore the relationship between psychological and physiological processes and how these interact in the case of vulvodynia. The study design consisted of a retrospective review of predominantly premenopausal women presenting with vulvodynia via analyses of questionnaires, psychometric tests, sexual history, surface electromyographic (sEMG) assessments, and clinical notes. Five hundred and twenty-nine patients with vulvodynia (mean age 27.7 years) were studied. The average age of symptom onset was 22.8 years and the average duration of symptoms was 5.0 years. Patients scored higher than the comparison group on global dimensions of the Symptom Checklist-90 Revised (SCL-90R), with anxiety and depression scores showing a significant but modest correlation with severity of pain. sEMG data confirmed an association with pelvic muscle dysfunction but there was no correlation with severity of vulvar pain. A negative correlation between sEMG readings and duration of pain was noted and may be due to progressive time-related quieting of electrical activity in muscle tissues, which is commonly associated with the development of a functional muscle contracture. In conclusion, it is important to view chronic pain syndromes like vulvodynia from a psychophysiological perspective which recognizes the potential contribution of psychological and physiological variables in the aetiology of chronic vulvar pain.

Treatment of chronic pelvic pain in men and women

Chronic pelvic pain syndrome (CPPS) is a common condition that is encountered by a variety of healthcare professionals. Unfortunately, physicians often misdiagnose this problem or recommend inappropriate and sometimes dangerous treatments that offer little hope of successful outcome. In addition, CPPS is typically a multifaceted disorder, simultaneously compromising psychological, peripheral nerve, autonomic, central nervous, visceral, connective tissue, hormonal and other systems. Thus, solo practitioners who may correctly diagnose CPSS are often ill-equipped to provide adequate comprehensive, multidisciplinary treatment. This article is intended as an overview of the most recent literature in support of various treatment modalities for chronic pelvic pain in men and women. We advocate a team-oriented approach in the treatment of CPPS, which employs the coordinated efforts of multiple practitioners, ideally in a subspecialty care setting.

Interstitial cystitis pathogenesis and treatment

PURPOSE OF REVIEW

Interstitial cystitis remains an idiopathic illness characterized by urinary frequency, urgency and pelvic pain with substantial morbidity in those affected. There is significant variability in the presentation, severity of symptoms and response to therapy. This review focuses on recent findings on the possible pathogenesis and potential treatments for this disease.

RECENT FINDINGS

Interstitial cystitis is manifested by sensory hypersensitivity. A small volume of urine will be associated with an exaggerated sensation of pain or pressure and urinary urgency. There is continued research regarding how this process is initiated and maintained and to what extent systemic dysfunction of the immune or autonomic nervous system may play a role. The urothelial lining has been demonstrated to be capable of secreting a large number of potential signaling molecules that may be significant factors in the disease.

SUMMARY

The pathogenesis of interstitial cystitis remains uncertain and the illness has significant diversity. Additional research is needed to establish subtypes that share common processes that can be targeted for treatment as a single effective therapy for the condition remains elusive.