1
|
Chiarle G, Allais G, Sinigaglia S, Airola G, Rolando S, Bergandi F, Micalef S, Benedetto C. Acupuncture for pain and pain-related disability in deep infiltrating endometriosis. Front Pain Res (Lausanne) 2024; 5:1279312. [PMID: 38524269 PMCID: PMC10957595 DOI: 10.3389/fpain.2024.1279312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
Objectives To evaluate the efficacy of acupuncture in relieving symptoms (dysmenorrhea, dyspareunia, pelvic pain and dyschezia) intensity, improving functional disability, reducing the number of days per months of dysmenorrhea, the frequency and the efficacy of analgesic use in deep infiltrating endometriosis (DIE). The safety profile was also evaluated. Methods The study sample was 34 patients with DIE; for 2 months (T-2, T-1) the women recorded diary notes on the numbers of days of menstruation, the presence, intensity, and disability related to dysmenorrhea, dyspareunia, pelvic pain, and dyschezia. They then received a total of 15 acupuncture treatments over 6 months (T1-T6; once a week for 12 weeks, then once a month for 3 months). Results Dysmenorrhea intensity was decreased during treatment. A decrease of at least 50% in number of days of dysmenorrhea, and a decrease in moderate-to-severe disability starting from T1 to T6 was recorded for 58.6% of patients. Dyspareunia intensity steadily decreased starting at T2; the percentage of women with moderate-to-severe disability declined from 73.3% at T-2, to 36.9% at T3, T4, and T5. A decrease in pelvic pain score was noted starting at T1; the percentage of disability decreased from 83.3% at T-2 to 33.3% at T3 and T6. The intensity of dyschezia decreased from T-2 to T3 and T4 and then increased slightly. Analgesic drug use was lower during treatment and its efficacy appeared to be greater. Conclusions The limitations notwithstanding our study-findings show that acupuncture was safe and effective in reducing pain intensity and symptoms-related disability. Larger-scale studies are needed to compare acupuncture and pharmacotherapy for endometriosis-related pain.
Collapse
Affiliation(s)
- Giulia Chiarle
- Women’s Headache Center, Gynaecology and Obstetrics Unit, Sant’Anna Hospital, University of Turin, Turin, Italy
- Department of Gynaecology and Obstetrics, University of Turin, Turin, Italy
- Gynaecology and Obstetrics Unit, Sant’Anna Hospital, University of Turin, Turin, Italy
| | - Gianni Allais
- Women’s Headache Center, Gynaecology and Obstetrics Unit, Sant’Anna Hospital, University of Turin, Turin, Italy
- Department of Gynaecology and Obstetrics, University of Turin, Turin, Italy
| | - Silvia Sinigaglia
- Women’s Headache Center, Gynaecology and Obstetrics Unit, Sant’Anna Hospital, University of Turin, Turin, Italy
- Department of Gynaecology and Obstetrics, University of Turin, Turin, Italy
| | - Gisella Airola
- Women’s Headache Center, Gynaecology and Obstetrics Unit, Sant’Anna Hospital, University of Turin, Turin, Italy
- Department of Gynaecology and Obstetrics, University of Turin, Turin, Italy
| | - Sara Rolando
- Women’s Headache Center, Gynaecology and Obstetrics Unit, Sant’Anna Hospital, University of Turin, Turin, Italy
| | - Fabiola Bergandi
- Women’s Headache Center, Gynaecology and Obstetrics Unit, Sant’Anna Hospital, University of Turin, Turin, Italy
| | - Salvatore Micalef
- Gynaecology and Obstetrics Unit, Sant’Anna Hospital, University of Turin, Turin, Italy
| | - Chiara Benedetto
- Women’s Headache Center, Gynaecology and Obstetrics Unit, Sant’Anna Hospital, University of Turin, Turin, Italy
- Gynaecology and Obstetrics Unit, Sant’Anna Hospital, University of Turin, Turin, Italy
| |
Collapse
|
2
|
Allais G, Chiarle G, Sinigaglia S, Mollo EM, Perin G, Pizzino F, Benedetto C. New onset headache during delivery and postpartum: Clinical characteristics of a case series. Front Neurol 2022; 13:1065939. [DOI: 10.3389/fneur.2022.1065939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/14/2022] [Indexed: 11/30/2022] Open
Abstract
IntroductionThere are abundant studies on headache and migraine in women but few or none about their occurrence during labor, delivery, and postpartum (2 hours after delivery) owing to the low incidence. A headache attack can be debilitating when a woman is trying to manage labor pain. Research at our Women's Headache Center within the Department of Gynecology and Obstetrics has begun to shed light on this potential association.MethodsFor the present study 474 women with singleton pregnancy were enrolled. A headache questionnaire was administered at two time points. Headache history was investigated on admission to prenatal care at 36 weeks gestation. The women were followed by a midwife who monitored labor progression and recorded the onset and features of headache pain. During examination before hospital discharge at 3 days post-delivery, the headache questionnaire was reviewed by a headache specialist who differentiated headache type according to International Classification of Headache Disorders (3rd edition) criteria.ResultsData analysis showed that 145/474 women had a history of headache: 65/145 (44.82%) reported a diagnosis of migraine. Eight reported experiencing a probable migraine attack (4 with aura) and one reported probable tension-type headache during labor or postpartum. All nine women who reported migraine/headache attack during labor had no previous history of headache or neurological illness. All had vaginal delivery. No onset of headache pain in patients with a previous history of headache was noted during delivery and postpartum.DiscussionThe onset of a headache attack during labor in women who usually do not experience headache suggests other pathogenic mechanisms underlying the attack and merits further study.
Collapse
|
3
|
Allais G, Chiarle G, Sinigaglia S, Airola G, Schiapparelli P, Bergandi F, Benedetto C. Acupuncture treatment of migraine, nausea, and vomiting in pregnancy. Neurol Sci 2019; 40:213-215. [PMID: 30835003 DOI: 10.1007/s10072-019-03799-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Gianni Allais
- Women's Headache Center, Department of Surgical Sciences, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy. .,CSTNF - Center for the Study of Natural and Physical Therapies, Turin, Italy.
| | - Giulia Chiarle
- Women's Headache Center, Department of Surgical Sciences, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy.,CSTNF - Center for the Study of Natural and Physical Therapies, Turin, Italy
| | - Silvia Sinigaglia
- Women's Headache Center, Department of Surgical Sciences, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy.,CSTNF - Center for the Study of Natural and Physical Therapies, Turin, Italy
| | - Gisella Airola
- Women's Headache Center, Department of Surgical Sciences, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy.,CSTNF - Center for the Study of Natural and Physical Therapies, Turin, Italy
| | - Paola Schiapparelli
- Women's Headache Center, Department of Surgical Sciences, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy.,CSTNF - Center for the Study of Natural and Physical Therapies, Turin, Italy
| | - Fabiola Bergandi
- Women's Headache Center, Department of Surgical Sciences, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy
| | - Chiara Benedetto
- Women's Headache Center, Department of Surgical Sciences, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy
| |
Collapse
|
4
|
Abstract
At least 18% of women suffers from migraine. Clinically, there are two main forms of migraine: migraine with aura (MA) and migraine without aura (MO) and more than 50% of MO is strongly correlated to the menstrual cycle. The high prevalence of migraine in females, its correlation with the menstrual cycle and with the use of combined hormonal contraceptives (CHCs) suggest that the estrogen drop is implicated in the pathogenesis of the attacks. Although CHCs may trigger or worsen migraine, their correct use may even prevent or reduce some forms of migraine, like estrogen withdrawal headache. Evidence suggested that stable estrogen levels have a positive effect, minimising or eliminating the estrogenic drop. Several contraceptive strategies may act in this way: extended-cycle CHCs, CHCs with shortened hormone-free interval (HFI), progestogen-only contraceptives, CHCs containing new generation estrogens and estrogen supplementation during the HFI.
Collapse
Affiliation(s)
- Gianni Allais
- Department of Surgical Sciences, Women's Headache Center, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy.
| | - Giulia Chiarle
- Department of Surgical Sciences, Women's Headache Center, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy
| | - Silvia Sinigaglia
- Department of Surgical Sciences, Women's Headache Center, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy
| | - Gisella Airola
- Department of Surgical Sciences, Women's Headache Center, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy
| | - Paola Schiapparelli
- Department of Surgical Sciences, Women's Headache Center, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy
| | - Fabiola Bergandi
- Department of Surgical Sciences, Women's Headache Center, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy
| | - Chiara Benedetto
- Department of Surgical Sciences, Women's Headache Center, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy
| |
Collapse
|
5
|
Abstract
INTRODUCTION Migraine is one of the most common neurological disorders in the general population. It affects 18% of women and 6% of men. In more than 50% of women migraineurs the occurrence of migraine attacks correlates strongly with the perimenstrual period. Menstrual migraine is highly debilitating, less responsive to therapy, and attacks are longer than those not correlated with menses. Menstrual migraine requires accurate evaluation and targeted therapy, that we aim to recommend in this review. AREAS COVERED This review of the literature provides an overview of currently available pharmacological therapies (especially with triptans, anti-inflammatory drugs, hormonal strategies) and drugs in development (in particular those acting on calcitonin gene-related peptide) for the treatment of acute migraine attacks and the prophylaxis of menstrual migraine. The studies reviewed here were retrieved from the Medline database as of June 2017. EXPERT OPINION The treatment of menstrual migraine is highly complex. Accurate evaluation of its characteristics is prerequisite to selecting appropriate therapy. An integrated approach involving neurologists and gynecologists is essential for patient management and for continuous updating on new therapies under development.
Collapse
Affiliation(s)
- G Allais
- a Department of Gynecology and Obstetrics , University of Turin, Women's Headache Center , Turin , Italy
| | - Giulia Chiarle
- a Department of Gynecology and Obstetrics , University of Turin, Women's Headache Center , Turin , Italy
| | - Silvia Sinigaglia
- a Department of Gynecology and Obstetrics , University of Turin, Women's Headache Center , Turin , Italy
| | - Chiara Benedetto
- a Department of Gynecology and Obstetrics , University of Turin, Women's Headache Center , Turin , Italy
| |
Collapse
|
6
|
Abstract
Migraine is a debilitating neurovascular disorder which is estimated to affect 18% of women and 6% of men. Two main forms of this neurological disorder must be considered: Migraine without Aura and Migraine with Aura. Migraine without aura often has a strict menstrual relationship: the International Headache Society classification gives criteria for Pure Menstrual Migraine and Menstrually Related Migraine. The higher prevalence of migraine among women suggests that this sex difference probably results from the trigger of fluctuating hormones during the menstrual cycle. Safe and effective contraception is essential for all women of childbearing age, but Combined Oral Contraceptives have been associated with worsening of attacks and cardiovascular risk in these patients. We analyzed characteristics, effects and benefits of progestogen-only pill, a possible alternative for contraception in women with migraine.
Collapse
Affiliation(s)
- Gianni Allais
- a Department of Surgical Sciences, Women's Headache Center , University of Turin , Turin , Italy
| | - Giulia Chiarle
- a Department of Surgical Sciences, Women's Headache Center , University of Turin , Turin , Italy
| | - Fabiola Bergandi
- a Department of Surgical Sciences, Women's Headache Center , University of Turin , Turin , Italy
| | - Chiara Benedetto
- a Department of Surgical Sciences, Women's Headache Center , University of Turin , Turin , Italy
| |
Collapse
|
7
|
Battista Allais G, Chiarle G, Bergandi F, Benedetto C. Migraine during perimenopause. J Headache Pain 2015; 16:A25. [PMID: 28132363 PMCID: PMC4759136 DOI: 10.1186/1129-2377-16-s1-a25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
8
|
Isoardo G, Morra I, Chiarle G, Audrito V, Deaglio S, Melcarne A, Junemann C, Naddeo M, Cogoni M, Valentini MC, Limberti A, Faccani F, Malavasi F, Faccani G. Different aquaporin-4 expression in glioblastoma multiforme patients with and without seizures. Mol Med 2012; 18:1147-51. [PMID: 22714714 DOI: 10.2119/molmed.2012.00015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 06/12/2012] [Indexed: 11/06/2022] Open
Abstract
Aquaporin-4 (AQP-4), the most important water channel in the brain, is expressed by astrocyte end feet abutting microvessels. Altered expression levels of AQP-4 and redistribution of the protein throughout the membranes of cells found in glioblastoma multiforme (GBM) lead to development of the edema often found surrounding the tumor mass. Dysregulation of AQP-4 also occurs in hippocampal sclerosis and cortical dysplasia in patients with refractory partial epilepsy. This work reports on analysis of the relationship between AQP-4 expression and the incidence of epileptic seizures in patients with GBM. Immunohistochemical and polymerase chain reaction techniques were used to evaluate AQP-4 in biopsy specimens from 19 patients with GBM, 10 of who had a history of seizures before surgery. AQP-4 mRNA levels were identical in the two groups of patients, but AQP-4 expression was more frequently detected on the GBM membranes from specimens of patients with seizures than from individuals without (10 versus 2, P < 0.001). We conclude that reduced expression of cell surface AQP-4 is characteristic of GBM patients without seizures, likely attributable to a posttranslational mechanism.
Collapse
Affiliation(s)
- Gianluca Isoardo
- Unit of Clinical Neurophysiology, Department of Neurosurgery, CTO Hospital, Torino, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|