Psychosomatic group treatment helps women with chronic pelvic pain

A systematic review on isolated coil embolization for pelvic venous reflux

OBJECTIVE

Pelvic venous reflux (PVR) can present with symptoms such as chronic pelvic pain, dysmenorrhea, and dyspareunia, resulting in a decreased quality of life among those affected. Percutaneous coil embolization (CE) is a common intervention for PVR; however, the efficacy and safety of its use in isolation has yet to be reviewed.

METHODS

The MEDLINE and EMBASE databases were systematically searched from 1990 to July 20, 2020, for studies reporting on adult patients undergoing isolated CE for PVR. Articles not in English, case reports, studies reporting on pediatric patients, and studies not performing isolated CE were excluded. Search, review, and data extraction were performed by two independent reviewers (S.S. and M.T.). Changes in pain before and after CE was evaluated through a pooled analysis of visual analogue scale scores in seven studies.

RESULTS

A total of 970 patients (range, 3-218, 100% female) undergoing isolated ovarian vein or mixed veins embolization from 20 studies were included. Pooled analysis revealed mean improvements of 5.47 points (95% CI, 4.77-6.16) on the visual analogue scale. Common symptoms such as urinary urgency and dyspareunia reported significant improvements of 78-100% and 60-89.5% respectively. Complications were rare, with coil migration (n = 19) being the most common. Recurrence rates differed based on the varying symptoms and studies, with recurrence in pain 1-2 years after CE ranging from 5.9-25%. Two randomized controlled trials revealed improved clinical outcomes with CE as compared with vascular plugs and hysterectomy.

CONCLUSIONS

The current data suggests that isolated CE is technically effective and can result in clinical improvement among patients with PVR. However, further trials are required to ascertain its long-term effects.

Predictors of Psychological Outcomes and the Effectiveness and Experience of Psychological Interventions for Adult Women with Chronic Pelvic Pain: A Scoping Review

Objective

CPP affects approximately 15% of women worldwide and has significant psychological, physical and financial impact on the lives of sufferers. Psychological interventions are often recommended as adjuncts to medical treatment for women with chronic pelvic pain (CPP). This is as women with CPP experience higher rates of mental health concerns and difficulties coping with their pain.. However, recent systematic reviews have highlighted that the efficacy of psychological interventions is not conclusive in this population. This review aimed to identify predictors of mental health outcomes and effective psychological techniques and interventions in women with CPP to inform the development of future psychological therapies.

Methods

Scoping review using the method outlined by Arskey & O'Malley (2005). Relevant databases, reference lists and grey literature were searched to identify effective mental health interventions and predictors of psychological outcomes for women with CPP.

Results

Methodological concerns made identifying predictors of mental health outcomes and effective psychological interventions difficult. However, cognitive behavioural therapy and Mensendieck therapy emerged as therapeutic interventions with the best evidence for women with CPP. A number of useful predictors of mental health outcomes and techniques included in effective interventions were identified.

Conclusion

The evidence provided in this review has the potential to inform future research directions and the development of targeted psychological interventions for women with CPP.

A systematic review of grounded theory studies in physiotherapy

Aim: This systematic review aimed at appraising the methodological rigor of grounded theory research published in the field of physiotherapy to assess how the methodology is understood and applied. A secondary aim was to provide research implications drawn from the findings to guide future grounded theory methodology (GTM) research. Methods: A systematic search was conducted in MEDLINE, CINHAL, SPORT Discus, Science Direct, PubMed, Scopus, and Web of Science to identify studies in the field of physiotherapy that reported using GTM and/or methods in the study title and/or abstract. The descriptive characteristics and methodological quality of eligible studies were examined using grounded theory methodology assessment guidelines. Findings: The review included 68 studies conducted between 1998 and 2017. The findings showed that GTM is becoming increasingly used by physiotherapy researchers. Thirty-six studies (53%) demonstrated a good understanding and appropriate application of GTM. Thirty-two studies (47%) presented descriptive findings and were considered to be of poor methodological quality. Conclusions: There are several key tenets of GTM that are integral to the iterative process of qualitative theorizing and need to be applied throughout all research practices including sampling, data collection, and analysis.

[Chronic pelvic pain in women]

BACKGROUND

Chronic pelvic pain in women represents a difficult diagnostic and therapeutic problem in the gynecological practice which is always a challenge when dealing with affected women.

GYNECOLOGICAL CAUSES

Possible gynecological causes are endometriosis, adhesions and/or pelvic inflammatory disease (PID), pelvic varicosis and ovarian retention syndrome/ovarian remnant syndrome. Other somatic causes are irritable bowel syndrome, bladder pain syndrome, interstitial cystitis and fibromyalgia.

PSYCHOSOCIAL FACTORS

Psychosocial causes contributing to chronic pelvic pain are a high comorbidity with psychological factors, such as anxiety disorders and substance abuse or depression but the influence of social factors is less certain. The association with physical and sexual abuse also remains unclear.

DIAGNOSTICS AND THERAPY

Important diagnostic steps are recording the patient history, a gynecological examination and laparoscopy. Multidisciplinary therapeutic approaches are considered to be very promising. Basic psychosomatic care and psychotherapy should be integrated into the therapeutic concept at an early stage.

Does evidence support physiotherapy management of adult female chronic pelvic pain? A systematic review

Background and purpose Chronic pelvic pain (CPP) is a debilitating condition among women with a major impact on health-related quality of life, work productivity and health care utilisation. The exact prevalence of chronic pelvic pain is not known, but 3.8% is commonly suggested. Musculoskeletal dysfunction is frequently cited as a possible aetiology. Physiotherapy is therefore recommended as one treatment modality. The aim of this systematic review was to source and critically evaluate the evidence for an effect of physiotherapy on pain, physical activity and quality of life in the treatment of female CPP. Methods Electronic databases, conference proceedings, text books and clinical guidelines were searched for quantitative, observational, and prospective clinical intervention studies of female chronic pelvic pain where physiotherapy was a sole or significant component of the intervention. Trial inclusion, data extraction according to predefined criteria and risk of bias assessment were performed by two independent authors. Methodological quality of the included clinical intervention studies was assessed using The Cochrane Collaboration's tool for assessing risk of bias. Review Manager (RevMan) version 5.0 was used for data analysis. Effect estimates (relative risk, mean difference and mean change) with 95% confidence intervals were calculated for the above outcomes. For significant outcomes the numbers needed to treat were calculated. Results The search strategy identified 3469 potential articles. Of these, 11 articles, representing 10 studies, met the inclusion criteria. There were 6 randomised clinical trials, 1 cohort study and 3 case series. Methodological quality was dependent on study type. Accordingly, level of evidence was judged higher in randomised clinical trials than in the other study types. Physiotherapy treatments varied between studies and were provided in combination with psychotherapeutic modalities and medical management. This did not allow for the 'stand-alone' value of physiotherapy to be determined. Heterogeneity across the studies, with respect to participants, interventions, outcome measures and times of follow-up, prevented meta-analysis. Narrative synthesis of the results, based on effect estimates and clinically relevant pain improvement, disclosed some evidence to support an effect of multidisciplinary intervention and Mensendieck somatocognitive therapy on female chronic pelvic pain. Conclusion Chronic pelvic pain in women is a major health care problem with no specific therapies and poor prognosis. There seems to be some evidence to support the use of a multidisciplinary intervention in the management of female chronic pelvic pain. Somatocognitive therapy is a new approach that appears to be promising and randomised clinical trials are underway in order to establish its evidence base. Implications Based on the findings of this review, recommendations for physiotherapy in chronic pelvic pain clinical guidelines, textbooks and narrative reviews should be interpreted with caution due to the lack of a sufficient evidence base. Only small and largely non-randomised studies have been undertaken of physiotherapeutic interventions and this greatly limits the available evidence on which to base clinical practice. High quality randomised clinical trials are therefore urgently needed.

Do dialogues about concepts of pain reduce immigrant patients' reported spread of pain? A comparison between two consultation methods in primary care

OBJECTIVES

Do dialogues about concepts of pain reduce the reported spread of pain more than the usual consultations?

SETTING

A 4-week programme in primary care for immigrants on sick-leave, aged 16-45 years, containing daily exercises and randomised to either four interviews and dialogues about pain with a female doctor (group A) or the usual consultations with a male doctor (group B).

METHODS

Two doctors made the first and the last evaluations (before and after the programme) containing diagnostics of tender-structure locations and depression (yes-no), and ratings of severity of psychosocial stressors. Anxiety about pain was noted (yes-no). The patients pointed to their painful areas and these were noted on pain drawings (0-18 fields). Median values were calculated, and non-parametric statistics were used to test for significant differences between groups and before-and-after values, and the correlation between the number of pain drawing fields and clinical variables.

RESULTS

Forty-five persons participated in the whole programme, Group A (8 men, 15 women), group B (7 men, 15 women). Many of them needed an interpreter. Participants in group A had more tender-structure locations (two vs. one in group B). Nearly half had depression and two-thirds had serious psychosocial stressors. Almost all reported anxiety about pain at the start, but afterwards significantly fewer in group A (22 vs. 16, p < 0.05). In both groups, the number of pain drawing fields decreased significantly from, in median, eight to four (p < 0.001), particularly among the women (A: p < 0.05 vs. B: p < 0.01). Some very distressed participants reported more spread of pain than at the start. Reduced spread of pain was not significantly correlated to any clinical variable.

CONCLUSIONS

Particularly the women in both consultation groups demonstrated much less spread of pain after treatment, despite similar clinical findings and less anxiety about pain in group A. The initially wide spread of pain may thus have been a way of communicating with the doctors.

Psychological therapies for chronic pelvic pain: systematic review of randomized controlled trials

Chronic pelvic pain (CPP), a common cause of disability in women, is a condition best viewed in the biopsychosocial framework. Psychological interventions are frequently considered alongside medical and surgical treatments. Our objective was to evaluate the effectiveness of psychological therapies for the treatment of CPP. Electronic literature searches were conducted in Medline, Embase, PsycInfo and DARE databases from database inception to April 2010. Reference lists of selected articles were searched for further articles. The studies selected were randomized controlled trials of psychological therapies in patients with CPP compared with no treatment, standard gynecological treatment or another form of psychological therapy. Two reviewers independently selected articles without language restrictions and extracted data covering study characteristics, study quality and results. Reduction in pain, measured using visual analog scales or other measurements, was the main outcome measure. Of the 107 citations identified, four studies satisfied the inclusion criteria. Compared with no psychological intervention, therapy produced a standardized mean pain score of -3.27 [95% confidence interval (CI) -4.52 to -2.02] and 1.11 (95% CI -0.05 to 2.27) at 3 months and -3.95 (95% CI -5.35 to -2.55) and 0.54 (95% CI -0.78 to 1.86) at 6 months and greater, based on a visual analog scale score of 0-10. The current evidence does not allow us to conclude whether psychological interventions have an effect on self-reported pain scores in women with CPP.

Qualitative research as the basis for a biopsychosocial approach to women with chronic pelvic pain

Chronic pelvic pain (CPP) is a highly prevalent clinical condition and is recognized as a public health problem. Although the number of qualitative studies related to the topic is increasing, it is essential that this knowledge be presented in a synthesized manner, grounded in the context of the care provided to patients with CPP, in order to increase the clinical and research applicability of the findings. Little attention is given to CPP in undergraduate courses and in meetings for the continuing education of health professionals, the approach to CPP typically being based on the biomedical model. We believe that qualitative research can provide insights into CPP and form the basis for a biopsychosocial approach to the condition, which can in turn lead to better results, including resolution of the pain and greater patient/health professional satisfaction. Therefore, we conducted a metasynthesis of seven qualitative studies of CPP, the principal themes of which were as follows: (a) coping with CPP versus secondary gain; (b) the great importance of determining the cause of the pain; (c) expectations regarding the doctor-patient relationship; and (d) gender issues. We hope that the present study can aid in restoring the humanistic aspects of CPP treatment.

Is patient responsibility for managing musculoskeletal disorders related to self-reported better outcome of physiotherapy treatment?

Musculoskeletal disorders are prevalent and a major burden on individuals and society. Information on relationships of patient involvement and responsibility to outcome is limited. This study aimed to explore relationships between self-reported outcome of physiotherapy treatment and attitudes toward responsibility for musculoskeletal disorders. A cross-sectional postal survey design was used. Patients (n=615) from an outpatient physiotherapy clinic, who had finished their physiotherapy treatment within the last 6 months were sent a questionnaire that included the Attitudes regarding Responsibility for Musculoskeletal disorders instrument (ARM), self-reported outcome of treatment and sociodemographic data. A total of 279 (45%) completed forms were returned. Multiple logistic regression analysis was used. The patients' scores on the four dimensions of ARM ("responsibility self active," "responsibility out of my hands," "responsibility employer," and "responsibility medical professionals"), controlled for age, sex, education, and physical activity as well as for number of treatments, main treatment, and physiotherapist, were associated with the patients' self-reported treatment outcome. Patients who attributed responsibility more to themselves were more likely (OR 2.37 and over) to report considerable improvement as the outcome of physiotherapy treatment. Because this study was conducted at only one physiotherapy outpatient clinic and had a cross-sectional design, the results should be replicated in other settings. Because patients' attitudes regarding responsibility for musculoskeletal disorders can possibly affect the outcome of physiotherapy treatment, it might be useful to decide whether to systematically try to influence the person's attitude toward responsibility for the management of the disorder or to match treatment to attitude.

Continuing improvement of chronic pelvic pain in women after short-term Mensendieck somatocognitive therapy: results of a 1-year follow-up study

OBJECTIVES

Chronic pelvic pain is a common source of disability among women in the western world. Here we report that 3 months of Mensendieck somatocognitive intervention in chronic pelvic pain patients was followed by continued improvements of outcomes at 1-year follow-up in a randomized, controlled study design.

METHODS

Forty women with chronic pelvic pain unexplained by pelvic pathology were randomly assigned to 2 groups: (1) standard gynecologic treatment and (2) gynecologic treatment plus somatocognitive therapy aimed at reducing physical pain by changing posture, movement, and respiration patterns. A standardized Mensendieck test (SMT) of motor function (assessing posture, movement, gait, sitting posture, and respiration), a self-rating questionnaire assessing psychologic distress and general well-being (GHQ-30) and a visual analog score of pain (VAS) were obtained before, after 90 days of treatment and 1 year after inclusion.

RESULTS

Patients treated by standard gynecologic treatment/supervision did not improve significantly at 1-year follow-up in any of the test modalities. By contrast, those who in addition received somatocognitive therapy had improved scores for all motor functions and pain, as well as GHQ-30 scores for coping, and anxiety-insomnia-distress.

CONCLUSION

Mensendieck somatocognitive therapy combined with standard gynecologic care improves psychologic distress, pain experience, and motor functions of women with chronic pelvic pain better than gynecologic treatment alone. The effect lasted and even further improvement occurred 9 months after treatment.

Mensendieck somatocognitive therapy as treatment approach to chronic pelvic pain: results of a randomized controlled intervention study

OBJECTIVE

The etiology of chronic pelvic pain is disputed and multifactorial. We studied the effect of Mensendieck somatocognitive therapy aimed at reducing physical pain by changing posture, movement and respiration patterns combined with standard gynecological treatment.

STUDY DESIGN

Women with chronic pelvic pain unexplained by pelvic pathology were randomized into 2 groups: (1) standard gynecological treatment and (2) gynecological treatment plus somatocognitive therapy. A Mensendieck test of motor function (posture, movement, gait, sitting posture, respiration) and a visual analogue score of pain were obtained before and after the 90-day treatment period.

RESULTS

The test results of patients treated by standard gynecological measures were unchanged (nonsignificant). By contrast, the patients receiving somatocognitive therapy in addition improved scores by 25% to 60% for all motor functions (P < .01, largest improvement for respiration, up from average 2.98 [SEM 0.30] to 4.72 [0.37]), and pain scores reduced by 50% (down from 5.60 [0.40] to 2.89 [0.40], P < .01).

CONCLUSION

Mensendieck somatocognitive therapy combined with standard gynecological care improved pain experience and motor functions of women with chronic pelvic pain better than gynecological treatment alone.