Alternative Treatment Modality Research Articles

The effect of injectable platelet rich fibrin as a nonsurgical treatment of the female stress urinary incontinence.

The complications of surgical treatments of stress urinary incontinence have led to the search for less invasive and safer treatment procedures. We aimed to investigate the efficacy of locally administered injectable platelet-rich fibrin (i-PRF), an autologous material that plays an important role in tissue regeneration, in women with stress urinary incontinence. Thirty-four women were included in this prospective, single-center, and interventional study, suffering from stress urinary incontinence refractory to conservative treatment. Three consecutive i-PRF injections were applied to the mid-urethra localization at anterior vaginal wall with an interval of 1month. ICIQ-SF, UDI-6, IIQ-7 and POPDI-6 questionnaires were used to measure pre‑treatment, 1month and 6months post‑treatment symptom severity and the clinical outcomes were recorded. The mean age of the patients was 51.5 ± 9.8years. ICIQ-SF, UDI-6, IIQ-7 and POPDI-6 questionnaires results revealed significant clinical improvement of stress urinary incontinence severity afer the administration of i-PRF (p < 0.001). The results at 1 and 6months after treatment did not change statistically significantly. This study demonstrated that locally administiration of i-PRF is efective in relieving SUI symptoms with high success rates without any adverse effects reported. i-PRF injection may have the potential to be a novel, minimally invasive, and low-risk procedure, that could be an alternative and simple treatment modality to surgery for female patients with stress urinary incontinence. Additionally, it may create new avenues for research on therapeutic implementation of i-PRF.

Is percutaneous tibial nerve stimulation (PTNS) effective for fecal incontinence (FI) in adults compared with sham electrical stimulation? A meta-analysis.

Sacral nerve neuromodulation (SNM) has been considered the optimal second-line treatment for fecal incontinence (FI). However, SNM involves high cost and requires highly skilled operators. Percutaneous tibial nerve stimulation (PTNS) has emerged as an alternative treatment modality for FI, yielding varying clinical outcomes. We conducted this meta-analysis to evaluate the effectiveness and safety of PTNS compared to sham electrical stimulation for FI. PubMed, Embase, Web of Science, and the Cochrane Library were searched for studies from May12, 2012 to May12, 2022. Four randomized controlled studies were included in this review, involving a total of 439 adult patients with FI (300 in the PTNS group and 194 in the sham electrical stimulation group). Our meta-analysis revealed that PTNS demonstrated superior efficacy in reducing weekly episodes of FI compared to the control groups (MD - 1.6, 95%CI - 2.94 to - 0.26, p = 0.02, I2 = 30%). Furthermore, a greater proportion of patients in the PTNS group reported more than a 50% reduction in FI episodes per week (RR 0.73, 95%CI 0.57-0.94, p = 0.02, I2 = 6%). However, no significant differences were observed in any domains of the FI Quality of Life (QoL) and St Mark's incontinence scores (MD -2.41, 95%CI -5.1 to 0.27, p = 0.08, I2 = 67%). Importantly, no severe adverse events related to PTNS were reported in any of the participants. Our meta-analysis revealed that PTNS was more effective than sham stimulation in reducing FI episodes and led to a higher proportion of patients reporting more than a 50% reduction in weekly FI episodes.

Effectiveness of Homoeopathic Treatment in the Management of Headache- A Retrospective Observational Study

Headache is one of the most common complaint that most people experience in their lives. It is a pain or discomfort in head. Headache is mainly categorized into two types: primary and secondary headache. The cause of headache is mostly stress, anxiety, depression, injury or trauma, infections, climate changes etc. It creates a burden on people’s quality of life and more suffering due to regular use of pain-killers. As an alternative mode of treatment, Homoeopathy is the safest way to relieve headaches without any side-effects. The aim of the study was to know the effectiveness of homoeopathic treatment in management of headache.

Usage of rotational atherectomy and drug-coated balloon angioplasty for isolated popliteal artery lesions: two-year results of a retrospective study

Objectives In this study, perioperative properties and early and mid-term clinical outcomes of endovascular revascularization with a combined usage of rotational atherectomy (RA) and drug-coated balloon angioplasty (DCB) angioplasty for isolated popliteal artery lesion were reported. Methods A total of 28 patients with isolated popliteal artery stenosis who underwent combined RA and DCB angioplasty between December 2018 and September 2022 were analyzed retrospectively. Temren atherectomy system (Invamed, Ankara, Turkey) and Extender paclitaxel-coated drug-coated balloon catheter (Invamed, Ankara, Turkey) were used in all cases. The main outcome was primary patency; secondary outcomes were technical success, freedom from amputation, and mortality. Results The mean age of patients was 64.2 ± 9.1 years and the majority of the patients were male (n = 20; 71.4%). Types of the lesions were total occlusion in 24 limbs and critical stenosis in 4 limbs. The mean total occlusion length was 65.2 ± 14.2 mm. Flow-limiting dissection was seen in lesions of 2 patients (7.1%) and treated with prolonged balloon dilatation without bail-out stenting requirement. Technical success defined as an adequate vascular lumen (less than 30% stenosis) was achieved in 26 (92.8%) with a mean follow-up of 17.2 ± 8.2 months. The mean primary patency rates at 12 months and 24 months were 92.3% ± 3.2 and 81.2% ± 3.2, respectively. Complications included 1 distal embolization following RA, 2 flow-limiting dissections, and 3 puncture site hematomas. Conclusions Endovascular procedures using combined RA and DCB angioplasty seem to be effective alternative treatment modalities for the treatment of popliteal artery lesions with high rates of primary patency and freedom from TLR.

A trinuclear Zn (II) schiff base dicyanamide complex attenuates bacterial biofilm formation by ROS generation and membrane damage and exhibits anticancer activity

A trinuclear Zn (II) complex, [(ZnL{N(CN)2})2Zn], termed complex 1 has been synthesized by the reaction of an aqueous solution of sodium dicyanamide to the methanolic solution of Zn (CH3COO)2, 2H2O and corresponding Schiff base (H2L) which is derived from 1:2 condensation of 1, 4 butane diamine with 3-ethoxy salicylaldehyde. Complex 1 is characterized by elemental analysis, IR, UV and Single X-ray diffraction study. Drug resistance is a growing global public health concern that has prompted researchers to look into advanced alternative treatment modalities. In this context, complex 1 has shown promising antibacterial and antibiofilm efficacy against gram-positive Staphylococcus aureus and Methicillin-resistant Staphylococcus aureus strains. Complex 1 attenuated Staphylococcal biofilm formation by reducing several virulence factors including the formation of extracellular polysaccharide matrix, slime, haemolysin, staphyloxanthin, auto-aggregation, cell surface hydrophobicity, and motility. Notably, complex 1 mechanistically potentiated Reactive Oxygen Species (ROS) generation within the bacterial cells, leading to the damage of bacterial cell membrane followed by DNA leakage and thereby impeding the growth of Staphylococcus aureus. Furthermore, complex 1 significantly exhibited anticancer activity by reducing the growth of prostate adenocarcinoma cells. It obstructed the migration of cancer cells by potentiating apoptosis and arresting the cell cycle at the G2/M phase. In summary, complex 1 could act as a potent candidate for the generation of novel antibacterial, antibiofilm as well as anticancer treatment regimens for the management of drug-resistant biofilm-mediated Staphylococcus aureus infection and lethal prostate malignancy.

Clinical Evaluation of Mahanarayana Taila Matra Basti in Anidra (Primary Insomnia)

Sleep is a naturally recurring state of mind and body. Insomnia disorder is defined as a subjective perception or complaint of inadequate or poor-quality sleep. Anidra has been described in detail by Acharyas in various contexts like Vata Nanatmaja Vikara, Vataja Jwara etc. Panchkarma therapies like Shirodhara, Shirobasti, Shiroabhyang, Shiropichu, Padaabhyang is very useful in treatment of Anidra. Insomnia is the most commonly encountered sleep disorder and occurs 10-50% of the population. Worldwide epidemiological studies assessed the prevalence of insomnia without restrictive criteria as 33% in general population. In Ayurveda, insomnia is described as Anidra and Nidranash under the heading of different disorders and conditions. Allopathic hypnotic drugs are useful for short term treatment in insomnia which is due to acute stage. Long term uses of certain classes of sedatives cause physical dependence, Ayurvedic approach in the disease is by pacifying the Doshas, paying special attention to Vata- Shamana, Santarpana and Srotoshodhak. Hence, with the aim of identifying and establishing an alternative, safer, effective and long-lasting treatment modality, the study entitled “Clinical Evaluation of Mahanarayana Taila Matra Basti in Anidra (Primary Insomnia)” was conducted in 56 patients. They were selected on the basis of standard inclusion and exclusion criteria and randomly allocated to two different treatment groups; Group- A (Mahanarayana Taila Matra Basti) and Group- B (Zolpidem). Total duration of the treatment was of 14 days along with a follow up period of 1 month. Both the interventions were almost equally effective, but in overall improvement of the patients “Group A” had better results than Group B. For better scientific validation, further research studies and clinical trials should be carried out with large sample size and longer duration of treatment.

Are We Using Ezetimibe As Much As We Should?

Lipid-lowering therapies, particularly non-statin regimens, are underutilized as ~2/3 of patients with atherosclerotic cardiovascular (CV) disease (CVD) are not optimally managed, and do not attain target low-density lipoprotein cholesterol (LDL-C) concentrations, despite statin treatment. Statins have been the mainstay of hypolipidemic therapies; however, they are plagued by adverse effects, which have partly hindered their more widespread use. Ezetimibe is often the first added mode of treatment to attain LDL-C goals as it is efficacious and also allows the use of a smaller dose of statin, while the need for more expensive therapies is obviated. We herein provide a comprehensive review of the effects of ezetimibe in lipid lowering and reducing CV events and improving outcomes. Of the hypolipidemic therapies, oral ezetimibe, in contrast to newer agents, is the most convenient and/or affordable regimen to be utilized as mono- or combined therapy supported by data from CV outcomes studies attesting to its efficacy in reducing CVD risk and events. When combined with a statin, the statin dose could be lower, thus curtailing side-effects, while the hypolipidemic effect is enhanced (by ~20%) as the percentage of patients with target level LDL-C (<70 mg/dL) is higher with combined treatment versus a high-intensity statin. Ezetimibe could also serve as an alternative treatment in cases of statin intolerance. In conclusion, ezetimibe has an excellent safety/tolerability profile; it is the first added treatment to a statin that can attain LDL-C targets. In the combined therapy, the hypolipidemic effect is enhanced while the dose of statin could be lower, thus limiting the occurrence of side-effects. Ezetimibe could also serve as an alternative mode of treatment in cases of statin intolerance.

The Ability of Injections Versus Needle Insertion to Decrease the Severity and Frequency of Symptoms for Patients With Chronic Headaches: A Critically Appraised Topic

Clinical Scenario: Headaches can be categorized as tension-type headaches, migraine, trigeminal autonomic cephalgia, and other primary headache disorders according to the Third International Classification of Headache Disorders. Headaches are one of the most common disorders within the nervous system and have a prevalence of &gt;48% within the general population. Nerve blocks are a type of nerve stimulation that is believed to help reduce the frequency and severity of headaches. The physiological effect of the greater occipital nerve block on headaches is thought to be due to the central nervous system connections of the greater occipital nerve and trigeminal and cervical afferent fibers, which is believed to be the prime origin of migraine headaches. Nerve blocks can contain a variety of drug regimens including steroids, local anesthetics, or a mixture of both. Trigger point injections (TPIs) are an invasive therapy where a needle is guided directly into a trigger point that has been previously identified upon examination. Botulinum toxin A is an alternative treatment modality that can be injected with TPIs. Botulinum toxin A is a potent naturally occurring toxin that causes dose-dependent muscular relaxation by inhibiting the release of acetylcholine at the neuromuscular junction. Summary of Key Findings: (1) Both greater occipital nerve blocks and TPIs have been shown to reduce headache frequency and severity in the short term; however, it appears to be due to the needle injected into the soft tissue structures and not due to the type of solution injected. (2) Ultrasound guidance allows for a more accurate and effective technique than a blind injection as it allows for accurate injection into the targeted muscles, thereby minimizing complications and increasing the chance of success. (3) Once symptoms have been alleviated, clinicians should evaluate the patient’s mechanics in the upper trunk to determine whether there are any mechanical abnormalities leading to the formation of myofascial pain and/or trigger points causing the headache symptoms. If identified and treated appropriately, this can allow for a long-term solution in correcting the cause rather than the symptoms alone. (4) Participants receiving a greater occipital nerve block or TPI, despite the drug regimen or dosage, experienced similar benefits with no statistical significance. In deciding which treatment approach to take, the clinician should speak with the patient to educate them on the available options and allow the patient to be part of the decision-making process to best meet their needs and include a rehabilitation plan with all the treatment approaches. Clinical Question: In patients who experience chronic headaches, was there a greater decrease in headache frequency and severity with a greater occipital nerve block or TPI? Clinical Bottom Line: Needles into the supraclavicular region for headaches lead to decreased severity and frequency of headaches in the short term but will not lead to headache resolution. Strength of Recommendation: B.

Is Botulinum Toxin Injection an Effective Treatment Option for Management of Chronic Anal Fissure

Chronic anal fissure (CAF) is a common disease of the anoderm treated by colorectal surgeons. Pharmacological treatment is considered first-line therapy. An alternative treatment modality is injection of botulinum toxin (BT). However, there is a lack of consensus on the administration of BT among colorectal surgeons for the treatment of CAF. A standardised protocol has been used to write a best-evidence topic. The discussion focused on whether injection of BT is effective for chronic anal fissure. For an electronic search of the relevant literature, the databases MEDLINE, the Cochrane Library, Scopus, and the Web of Science were used. We found 65 articles. Out of these, only eight studies were found to be appropriate to answer the question. The outcome assessed was healing of the ulcer. The best evidence shows that botulinum toxin is safe and effective in the treatment of chronic anal fissure and can be safely used as an alternative to surgery.

Safety and efficacy of carbamazepine in the treatment of trigeminal neuralgia: A metanalysis in biomedicine.

Trigeminal neuralgia is a debilitating condition characterized by severe facial pain. Carbamazepine has been widely used as a first-line treatment option for trigeminal neuralgia, but there is a need to evaluate its safety and efficacy based on existing evidence. This meta-analysis aims to systematically assess the available literature and provide a comprehensive evaluation of the safety and efficacy of carbamazepine in the treatment of trigeminal neuralgia. A thorough search of electronic databases yielded a total of 15 relevant studies that met the inclusion criteria. The pooled analysis of these studies revealed that carbamazepine demonstrated significant efficacy in reducing pain intensity and frequency in patients with trigeminal neuralgia. Moreover, the drug was generally well-tolerated, with the most common adverse events being mild and transient. Subgroup analyses based on different dosages and treatment durations further supported the overall findings. However, caution should be exercised in patients with certain comorbidities or specific populations, as some rare but severe adverse events were reported. In conclusion, this meta-analysis provides strong evidence supporting the safety and efficacy of carbamazepine as a valuable therapeutic option for the management of trigeminal neuralgia. These results can guide clinicians in making informed decisions regarding the use of carbamazepine and contribute to optimizing treatment strategies for patients with trigeminal neuralgia. Further research is warranted to explore long-term safety and efficacy outcomes, as well as to compare carbamazepine with alternative treatment modalities.

Synthesis strategies and cancer therapy applications of PEDOT nanoparticles

PEDOT nanoparticles combine controlled drug release, and photothermal ablation due to their electrical and thermal properties. This review delves into their synthesis methods, characterization and potential in targeted cancer therapies.

Beyond the Scalpel: Advancing Strategic Approaches and Targeted Therapies in Nonexcisable Melanomas.

Melanoma in challenging anatomical locations such as the face, acral surfaces, and mucosal areas presents unique hurdles for surgical excision. This review examines alternative nonsurgical treatment modalities in the context of these complexities, addressing the gaps in current guidelines and the varied efficacy of existing therapies. A comprehensive literature search was conducted using PubMed, Embase, and Web of Science databases. The review focuses on peer-reviewed articles discussing nonsurgical treatment options for melanoma in complex anatomical locations. Articles were screened by three independent researchers, ensuring a broad analysis of topical agents, immunotherapies, radiotherapies, and targeted therapies. The review highlights significant advancements in localized treatments such as imiquimod and intralesional therapy with talimogene laherparepvec (T-VEC), which show promise in managing nonexcisable melanomas. BRAF and MEK inhibitors, as well as checkpoint inhibitors targeting CTLA-4 and PD-1/PD-L1 pathways, demonstrate improved survival rates but pose challenges with resistance and systemic side effects. Radiotherapy serves as an adjunctive strategy due to melanoma's inherent radioresistant properties. Despite advancements, there is a notable absence of comprehensive, evidence-based protocols to guide the treatment of melanoma in these critical areas. This paper underscores the need for standardized treatment guidelines that account for the efficacy, side effects, and psychosocial impacts of therapies. Future research should focus on refining existing treatments and exploring innovative modalities to enhance patient outcomes in the management of nonexcisable melanomas. Comprehensive guidelines and long-term efficacy studies are essential to optimize care and improve the quality of life for patients afflicted with melanoma in challenging anatomical locations.

Advances in Drug Therapy for Metastatic Pancreatic Ductal Adenocarcinoma.

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive disease with a notably poor prognosis. A large number of patients with PDAC develop metastases before they are diagnosed with metastatic pancreatic cancer (mPDAC). For mPDAC, FOLFIRINOX or gemcitabine plus nab-paclitaxel are the current first-line treatments. It is important to note, however, that many patients will fail chemotherapy because of drug resistance. ​Heterogeneous tumors and complex tumor microenvironments are key factors. As a result, clinical researchers are exploring a variety of alternative treatment modalities. Current understanding of the molecular signature and immune landscape of PDAC has motivated the emergence of different targeted and immune-based therapeutic approaches, some of which have shown promising results. The purpose of this review is to discuss the new targets and new drugs for mPDAC in terms of specific pathogenic factors such as metabolic vulnerability, DNA damage repair system, tumor microenvironment and immune system, in order to identify potential vulnerabilities in mPDAC patients and hopefully improve the prognosis of mPDAC patients.

Tolerability of Current Treatments for Dry Eye Disease: A Review of Approved and Investigational Therapies.

Dry eye disease (DED) is a common, multifactorial ocular disease impacting 5% to 20% of people in Western countries and 45% to 70% in Asian countries. Despite the prevalence of DED and the number of treatment approaches available, signs and symptoms of the disease continue to limit the quality of life for many patients. Standard over-the-counter treatment approaches and behavior/environmental modifications may help some cases but more persistent forms often require pharmacological interventions. Approved and investigational pharmaceutical approaches attempt to treat the signs and symptoms of DED in different ways and tend to have varying tolerability among patients. While several pharmacological approaches are the standard for persistent and severe disease, mechanical options provide alternate treatment modalities that attempt to balance efficacy and comfort. Newer approaches target the causes of DED, utilizing novel delivery methods to minimize irritation and adverse events. Here, we review approved and investigational approaches to treating DED and compare patient tolerability.

Knowledge and Attitude of Hypertension Patients towards Traditional Medicines: A Cross-sectional Study at Public Health Center, Siak, Riau

Hypertension is a significant global concern associated with severe cardiovascular ailments, including stroke, myocardial infarction, cardiac insufficiency, and renal dysfunction. Traditional medicines (TM) represent a potential alternative treatment modality for the management of hypertension. Hence, this study aims to establish the relationship between individuals' knowledge and attitudes about using TM among hypertension patients. This observational research utilizes a descriptive-analytic approach with a cross-sectional design. Validated questionnaires were used to collect the knowledge and attitudes data of respondents. The correlation between knowledge and attitudes was analyzed with the Spearman test using SPSS version 24. A total of 102 respondents were successfully acquired using purposive non-probability sampling. The results of this study indicate a significant statistical relationship between the knowledge and attitudes of hypertensive patients regarding the utilization of TM (p-value 0.000). Furthermore, a moderate positive correlation (rs 0.493) was observed, suggesting that an improvement in knowledge is associated with a corresponding enhancement in the attitude of hypertensive patients towards TM.

Neurosurgical treatment and outcome patterns in patients with meningioma in South Moravian region-a population-based study.

Meningiomas are usually slow-growing tumours, constituting about one third of all primary intracranial tumours. They occur more frequently in women. Clinical manifestation of meningiomas depends on their location, tumour size and growth rate. In most cases, surgical treatment is the procedure of choice. The success of this treatment is, however, associated with the radicality of the resection. Radiotherapy represents an additional or alternative treatment modality. Gamma knife surgery is another notable treatment method, especially in small and/or slow-growing tumours in eloquent areas or in elderly patients. Authors describe their experience with the diagnosis, treatment and outcome of the patients with meningioma (n = 857). Furthermore, they also assess the postoperative morbidity/mortality and recurrence rate. In view of the benign histology of meningiomas, the success of the treatment largely depends (besides the tumour grading) on the radicality of the resection. The emphasis is also put on appropriate follow-up of the patients. In certain patients, the watch and wait strategy should be also considered as a suitable treatment method.

Role of Fecal Microbiota Transplantation in Managing Clostridium Difficile Infection and Inflammatory Bowel Disease: A Narrative Review.

Fecal microbiota transplantation (FMT) has been emerging as an alternate treatment modality in the management of patients with dysbiosis by restoring abnormal gut microbiota composition through the transplantation of normal fecal microbiota from healthy donors. This technique has lately gained a lot of attention in the treatment of recurrent or refractory Clostridium difficile infection (CDI) owing to its high success rates combined with its favorable safety profile. FMT has also been attracting the interest of clinicians as a new treatment option for inflammatory bowel diseases (IBD). Here, we reviewed most of the recent advancements in the use of FMT for CDI as well as its use in the treatment of IBD.

Factors Influencing a Favorable Outcome for RFA of Huge Benign Thyroid Nodules: Preliminary Results and Short-Term Evaluation.

This study aimed to investigate potentially favorable factors influencing the therapeutic success of radiofrequency ablation (RFA) of huge benign thyroid nodules (BTNs) (volume >100 ml) and to evaluate the feasibility of RFA as an alternative treatment modality for patients unable or unwilling to undergo surgery. This retrospective study evaluated a total of 868 patients, of which 22 patients had huge BTNs who underwent ultrasound-guided moving shot RFA treatment between May 2017 and January 2022. The huge BTNs were categorized into two groups according to a post-RFA treatment volume reduction ratio (VRR) of >80% and <80% at 6 months. Factors influencing these huge BTNs were reviewed, analyzed, and correlated with treatment effectiveness between the two groups. The factors influencing an effective VRR included huge BTNs located on the left side (OR 7.875, p = 0.03), predominant solid/spongiform nodules (OR 7.875, p = 0.03), and higher initial ablation rate (IAR) (p = 0.028). Multivariable logistic regression revealed predominant solid/spongiform nodule and the higher IAR were associated with the advanced VRR. RFA was effective at decreasing the volume of huge BTNs with an acceptable complication rate. The BTN characteristics correlated with a better VRR at the 6-month short-term follow-up were predominant solid/spongiform BTNs and those with the first time ablation treatment initial ablation rate. Nevertheless, regarding the higher regrowth rate of these groups of patients who may need to be treated more times, RFA can only be a feasible alternative treatment modality for patients unable or unwilling to undergo operation.

Neuromodulation of the median nerve in carpal tunnel syndrome, a single-blind, randomized controlled study.

This study aimed to evaluate the efficacy of pulsed radiofrequency applied using transcutaneous electrodes in carpal tunnel syndrome (CTS). After randomization, the patients received two cycles of noninvasive pulsed radiofrequency (NiPRF), once weekly, or splinting (the control group) for three months. Clinical evaluations were recorded at baseline and weeks 4 and 8. The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was used to determine the functional status and symptom severity. Sixty-two patients were followed up for three months. There was no difference between the groups in the BCTQ scores before and after treatment. The NiPRF group found a significant difference between the BCTQ measurements at all time intervals (paired sample t -test; P < 0.001). In the splint group, there was a significant difference only between the basal-1st month and basal-3rd month (paired samples t -test; P < 0.001). The main effect of the time variable was statistically significant (ANOVA; P < 0.001), but the group variable was not. There was no correlation between the BCTQ results measured at any time and the electroneuromyelogragphy findings in either group. NiPRF effectively improves symptoms and functionality in patients with CTS for up to 3 months. Thus, NiPRF can be considered an easy, safe, and useful alternative treatment modality for CTS.

Pelvic venous disease; knowledge gap

Good quality data is lacking for pelvic venous disease (PeVD) and there are knowledge gaps in several topics. While we know that multiple pregnancies, hormonal factors and compression syndromes are risk factors, less is known about environmental and lifestyle factors. Most studies investigated the effect of coil embolization in relation to pain, but outcomes missing are quality of life (QOL), recurrence, complications, cost- effectiveness and predictors of a good response. There are no studies comparing different embolization techniques and hardly any studies on alternative treatment modalities or pharmacological treatment. It is important to distinguish different symptoms PeVD can cause when reporting patient related outcomes. Most studies use VAS scores, however, there is more to PeVD than pain. Concomitant diseases are common and may impact QoL by itself and must be taken into consideration as well. Finally, there are gaps in patient education and awareness. A scoring system would help in identifying patients. Recently, such a screening score was proposed. In conclusion, research in the field of PeVD is still in its infancy creating gaps in knowledge and awareness. Closing these gaps is essential for PeVD diagnosis and treatment.