Diagnosis Of Chronic Pelvic Pain Research Articles

Chronic pelvic pain of "unknown origin" in the female.

The remit of this review is confined to the experimental scientific works and surgeries based on the Integral Theory Paradigm (ITP). Chronic pelvic pain (CPP) is a major societal problem which is said to occur in up to 20% of women. The pathogenesis of CPP of "unknown origin" is said to be unknown and CPP is said to be incurable. According to the ITP, however, CPP is said to be mainly caused by the inability of loose or weak uterosacral ligaments (USLs) to mechanically support visceral nerve plexuses (VPs), T11-L2 and S2-4. These fire off de novo impulses, interpreted by the cortex as pain coming from the end organs. CPP, when it occurs simultaneously in multiple pelvic sites, is associated with uterine/apical prolapse (often minimal) and bladder symptoms such as overactive bladder (OAB), nocturia, retention. This combination of symptoms was described in 1993 as the "posterior fornix syndrome" (PFS). As such, CPP when associated with the PFS, is potentially curable by surgical repair of USLs. However, patients with CPP generally complain only of one symptom, CPP. This is known as the "Pescatori iceberg" effect. Other PFS symptoms are "under the surface" and must be sought out by direct questioning. The diagnostic algorithm is helpful in locating other associated symptoms. Definitive diagnosis of CPP, caused by USL laxity, is immediate alleviation of pain by mechanical support of USLs by using the speculum test or by tampons in the posterior fornix. Treatment of CPP can be non-surgical, by strengthening USLs by squatting exercises, supporting USLs mechanically with tampons or USL surgery. Coexisting bladder symptoms are (variously) improved or cured. URL for CPP https://www.pelviperineology.org/volume/36/issue/3.

Analysis of diagnostic and treatment measures for chronic pelvic pain in women in routine clinical practice

Chronic pelvic pain (CPP) for a long time remains one of the important medical and social problems due to the variability of clinical manifestations, negative impact on reproductive health and quality of patient’s life. Epidemiological studies indicate that CPP occurs in 15-20% of women of reproductive age. According to many authors, diagnosis and treatment of CPP is not an easy task due to unclear diagnostic criteria, variety of symptoms, insufficient diagnostic tools, etc.The objective: to analyze the diagnostic and therapeutic measures of women with pelvic pain syndrome in routine clinical practice.Materials and methods. A retrospective study of the medical patient’s cards of 557 women of reproductive age (19–49 years old) who were consulted by a gynecologist for CPP was conducted.Results. A significant prevalence of pelvic pain syndrome in patients under 30 years of age (51.2%) was revealed. In 290 women with complaints only for CPP, in 15.9% of cases, in the absence of gynecological pathology, were diagnosed the following pathologies: interstitial cystitis (19.6%), diverticulitis and dolichosigma (17.4%), irritable bowel syndrome (23.9%), myofascial pain (15.2%), pathology of the lumbosacral spine (10.9%). In the same group of women the following gynecological pathologies were found: malformations of the genitourinary system (3.3%), anomalies of the development of the uterus (9.3%), endometriosis (24.2%), adenomyosis (8.8%), leiomyoma of the uterus (8.4%), combined proliferative benign diseases of the genitals (14.9%), pelvic inflammatory diseases (7.9%), pelvic adhesive process (9.8%), pelvic floor dysfunction (13.5%). The diagnosis of CPP was established in 10.0% of women in the absence of gynecological and non-gynecological pathology.Conclusions. Identifying the CPP reasons in women is a difficult diagnostic process, as it can be caused by the presence of endometriosis, combined proliferative benign diseases of the genital organs, anomalies of genitourinary system, adenomyosis, pelvic inflammatory diseases, pelvic adhesions, pelvic floor dysfunction, venocongestion. CPP in women is often a result of non-gynecological pathology or a combination of such with gynecological diseases, which determines the need for an interdisciplinary approach to both diagnosis and treatment of such patients. In routine clinical practice, not enough attention is paid to determine the intensity and characteristics of the pain syndrome, which is often combined with late referral of patients for examination. In more than half of the analyzed cases (51.5%), the reason for women’s referral for examination is not pelvic pain syndrome as such, but a pathology that could be related to or a consequence of diseases causing CPP (abnormal uterine bleeding, infertility, etc.).

Chronic Pelvic Pain; a tragic miss

Chronic pelvic pain is defined as pain in the perineal region that can be somatic or visceral in origin which persists for more than 6 months duration and is unresponsive to analgesic therapy. Its diagnosis is made on the basis of patient’s history, detailed physical examination and radiological studies. One of the important, rare and mostly missed cause of this pain is coccydynia either traumatic or atraumatic. The treatment of coccydynia includes supportive care, analgesic therapy as well as ganglion impar neurolysis.
 Here, we report a case of a 42-year-old female suffering from severe chronic pelvic pain for past 15 years for which she had taken multiple analgesics including opiates and underwent multiple surgeries without any relief.
 She was a misdiagnosed case of coccygeal fracture which was causing chronic pelvic pain for the past 15 years which when treated with ganglion impar neurolysis gave her complete pain relief.
 After 1 month of the intervention, on follow up in the pain clinic the patient was absolutely pain free with NRS 1/10.Coccydynia must be considered in differential diagnosis of chronic pelvic pain especially in females of child bearing age.

The Diagnosis of Chronic Pelvic Pain: How Can We Detect Urological Pain?

Chronic pelvic pain (CPP) refers to pain perceived in the pelvic region for over 6 months. It is described more specifically according to the organs involved. The diagnosis and classification of CPP are not easy because of the vague diagnostic criteria, variety of presenting symptoms, absence of diagnostic tools, and coexisting symptoms due to accompanying other diseases. This concise review aims to help urologists diagnose CPP by focusing on identifying urological pain.

PD44-06 PUDENDAL BLOCK ANALGESIA WITH VAGINAL SURGERY: A RANDOMIZED, DOUBLE-BLIND, PLACEBO CONTROLLED TRIAL

You have accessJournal of UrologyCME1 May 2022PD44-06 PUDENDAL BLOCK ANALGESIA WITH VAGINAL SURGERY: A RANDOMIZED, DOUBLE-BLIND, PLACEBO CONTROLLED TRIAL Emily Slopnick, Graham Chapman, David D. Sheyn, Sarah Sears, Megan Abrams, Kasey M. Roberts, Robert Pollard, and Jeffrey Mangel Emily SlopnickEmily Slopnick More articles by this author , Graham ChapmanGraham Chapman More articles by this author , David D. SheynDavid D. Sheyn More articles by this author , Sarah SearsSarah Sears More articles by this author , Megan AbramsMegan Abrams More articles by this author , Kasey M. RobertsKasey M. Roberts More articles by this author , Robert PollardRobert Pollard More articles by this author , and Jeffrey MangelJeffrey Mangel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002605.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Effective opioid-sparing postoperative analgesia often requires a multimodal approach, which may include regional nerve blocks. The objective of this randomized controlled trial is to determine whether a pudendal nerve block is associated with improved postoperative pain control and decreased opioid consumption compared to a sham injection at the time of vaginal pelvic reconstructive surgery (PRS). METHODS: In this randomized, double-blind, placebo controlled trial, we enrolled women undergoing benign vaginal PRS at a single academic institution. Exclusion criteria included patients with a diagnosis of chronic pelvic pain, inability to receive non-narcotic analgesia, or any concurrent abdominal procedure. Patients were randomized to receive a transvaginal pudendal nerve block (9mL 0.25% bupivacaine + 1mL 40mg/mL triamcinolone) or a sham injection (10mL normal saline) at the conclusion of surgery. The injection syringe was wrapped by pharmacy to blind the surgeon. Postoperatively, all patients received routine care. Primary endpoints were visual analog pain scores (VAS) and postoperative opioid requirement, measured in the post-anesthesia recovery unit (PACU) and on post-operative days (POD) 1 and 4. A power calculation determined 60 patients were required to show a mean difference of 20mm on a 100mm VAS. Opioid administration was standardized as morphine milligram equivalents (MME), and VAS scores were compared with Wilcoxon-Mann-Whitney analysis. RESULTS: We randomized 71 patients: 36 pudendal block and 35 sham injection. The study groups were well matched with no differences in baseline characteristics or type of surgery performed. Pelvic organ prolapse repairs were the most common procedures (n=63, 87.5%). There was no difference in anesthetic dose or operative time between groups. Pain scores were equivalent between groups in the PACU (mean VAS 53.1 block vs 56.4 sham, p=0.517) and on POD 4 (mean VAS 26.7 block vs 35.5 sham, p=0.131). On POD 1, the intervention group did report less pain than the sham group (mean VAS 29.2 vs 42.5, p=0.047). Patients who received a pudendal block took fewer opioid medications than those in the sham group at all time points, but this difference did not meet statistical significance (PACU 5 vs 7.8 MME, POD1 7.5 vs 11.25 MME, POD4 7.5 vs 21.25 MME, all p>0.05). CONCLUSIONS: Pudendal nerve block resulted in decreased pain reported in the immediate postoperative period and less opioid use, though not statistically significant. Pudendal block may be an additional tool for non-narcotic perioperative analgesia with vaginal PRS. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e710 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Emily Slopnick More articles by this author Graham Chapman More articles by this author David D. Sheyn More articles by this author Sarah Sears More articles by this author Megan Abrams More articles by this author Kasey M. Roberts More articles by this author Robert Pollard More articles by this author Jeffrey Mangel More articles by this author Expand All Advertisement PDF DownloadLoading ...

A physiatrist's understanding and application of the current literature on chronic pelvic pain: a narrative review.

Chronic pelvic pain (CPP) is a highly prevalent condition which is underdiagnosed and poorly understood. The purpose of this review is to outline the various aspects of the nature of CPP, including its etiologies, clinical presentation, and nonoperative treatment options. For data collection, a PubMed search was conducted using indexing terms such as chronic pelvic pain and pelvic pain. Literature reviews and studies focusing on etiologies, clinical presentation, and/or the diagnosis of CPP were compiled for review by a team of 3 physiatrists. Studies investigating conservative treatments, medications, and interventional procedures for CPP and related conditions with comparable etiologies were also included. Of the 502 articles retrieved, 116 were deemed suitable by the team for this study. Although CPP is a complex, multifaceted condition, a particular susceptibility to nociceptive stimuli was demonstrated as an underlying theme in its evolution. There are many treatment options currently used; however, more robust evidence, such as randomized controlled trials, are needed before creating comprehensive guidelines for treating CPP.

Medical and social aspects in women of reproductive age with chronic pelvic pain

The objective: a study of the medical and social characteristics of women in reproductive age with chronic pelvic pain on the basis of retrospective analysis.Materials and methods. The analysis of medical documentation of 314 patients in reproductive age with a verified diagnosis of chronic pelvic pain (CPP) was performed on the basis of studying of case histories and outpatient cards. Data were analyzed: anthropometric data, age, body mass index, place of residence, gynecological pathology, duration and nature of the menstrual cycle, comorbidities, previous treatment, disease duration, pain intensity, bad habits, number of pregnancies and births, reproductive plans and other methods examination.Results. It was found that more than a third of women, who were treated for pathologies that cause CPP, need medical help again. 58 % of patients sought help for CPP for the first time, 42 % had already received treatment for CPP. Concomitant non-gynecological pathology is more often observed in such patients (48.7 %).The most commonly diagnosed were interstitial cystitis (42 %) and irritable bowel syndrome (34 %). The combination of gynecological, urological and surgical pathology was found in 22 % of patients. Patients with CPP had deficiency in vitamin D (68 % of the 162 patients tested for vitamin D) and had subjectively more severe pain. At the same time, the lack of routine examination of thyroid function and vitamin D status attracted attention. Simultaneously, women with CPP are much more likely than the general population to have infertility (56.4 %), and the incidence of miscarriage is twice as high as the population, with a tendency to recurrent pregnancy loss.Conclusions. Concomitant non-gynecological pathology, infertility, miscarriage, vitamin D deficiency and subjectively more severe pain are more common in women with chronic pelvic pain. However, the level of diagnosing thyroid pathology and determining the concentration of vitamin D in such patients is insufficient.

Pelvic Congestion Syndrome: A Missed Opportunity.

Background/Aims Chronic pelvic pain (CPP) is pelvic pain for greater than 6 months with many potential causes one being pelvic congestion syndrome (PCS). PCS is diagnosed by clinical symptoms, exclusion of other etiologies, and imaging. Given the complex nature and diagnosis of CPP, we examined ordering and referral patterns in our local population to understand how the imaging findings of PCS correlate with patient symptoms and referral and treatment. Materials and Methods After IRB approval, we searched all 18 to 70-year-old females with CT of the pelvis between March 2015 and March 2018 with the terms “pelvic” plus “congestion,” “varices,” or “vein dilation” in the dictation. Via electronic medical record and image review we collected data regarding demographics, clinical presentation, symptoms, imaging findings, ordering provider, and any follow-up/referrals or interventions regarding PCS. Results A total of 96 patients were included of the 197 studies, with an average age of 47 years and average body mass index of 19.3 ( n = 93) at the time of imaging. The reason for imaging was often acute abdominal or flank pain ( n = 22) with 38% of cases ordered from the emergency room. Only 72 patients had documentation of clinical evaluation for symptoms of PCS. Notably, only 20 were referred for their symptoms, and only two patients were referred to IR. Both patients underwent successful endovascular intervention. Conclusion CPP is a common cause of morbidity with PCS representing an underdiagnosed cause. We demonstrate that while imaging findings may be incidental, we are failing to capture and triage patients with clinical symptoms of PCS. Radiologists can play a key role in the care of these patients.

Healthcare utilization following minimally invasive apical prolapse repair in a large integrated healthcare system.

We sought to describe healthcare utilization (HU) following minimally invasive apical prolapse repair (MIAR) and its association with duration of hospital stay, patient characteristics, and perioperative factors. This retrospective study included women undergoing MIAR within a large managed care organization between January 1, 2011, and June 30, 2018, and aimed to quantify HU within 30days of surgery. HU was dichotomized into two groups: normal and high, based on typical postoperative utilization of healthcare resources. The primary outcome was the rate of normal versus high HU overall and by duration of hospital stay [discharge home on day of surgery versus postoperative day (POD) 1-2]. Multivariable logistic regression was performed to identify factors predictive of high HU. A p value of < 0.05 was considered statistically significant. Of the 4208 patients in our final cohort, 17% had high HU, while 83% were normal utilizers. High utilizers were more likely to have multiple comorbidities (p < 0.01) and a diagnosis of chronic pelvic pain (p = 0.02) and were less likely to be discharged on day of surgery (p < 0.01). A higher burden of disease, a concurrent mid-urethral sling or posterior colporrhaphy, and discharge on POD 1-2 were independently predictive of high HU. Within the high HU cohort, the most common type of unanticipated healthcare encounter was emergency department visit for urinary retention or pain. Same-day discharge after MIAR does not result in increased HU, even after adjusting for relevant demographic and clinical characteristics. Pre-existing chronic pain diagnoses, multiple comorbidities, and concurrent mid-urethral sling are associated with high HU in this population.

Imaging of Pelvic Venous Disorders (PeVD); Should Every Patient Get an MRI?

Pelvic venous disease (PeVD) is part of the broad differential diagnosis of chronic pelvic pain with a challenging diagnosis and clinical workup to identify those patients that are most likely to benefit from intervention. Ultrasound, MRI, CT, venography, and intravascular ultrasound can all provide information to aid in the diagnostic algorithm. The purpose of this article is to review imaging as a component of the outpatient workup of patients with chronic pelvic pain to guide appropriate understanding and use of imaging modalities to accurately identify patients suffering from PeVD. A favored approach is to begin with transabdominal sonography with selective use of MRI/MRV in specific patient populations.

A Comprehensive Update of the Superior Hypogastric Block for the Management of Chronic Pelvic Pain.

This is a comprehensive review of the superior hypogastric block for the management of chronic pelvic pain. It reviews the background, including etiology, epidemiology, and current treatment available for chronic pelvic pain. It then presents the superior hypogastric block and reviews the seminal and most recent evidence about its use in chronic pelvic pain. Several definitions exist for chronic pelvic pain (CPP), making the diagnosis more challenging for the clinician; however, they commonly describe continuous pain lasting 6months in the pelvis, with an overwhelming majority of patients being reproductive-aged women. This pain is often one of mechanical, inflammatory, or neuropathic. It is generally underdiagnosed and affects anywhere between 5 and 26% of women. The diagnosis of chronic pelvic pain is clinical, consisting of mainly of a thorough history and physical and ruling out other causes. The pathophysiology is often endometriosis (70%) and also includes PID, adhesions, adenomyosis, uterine fibroids, chronic processes of the GI and urinary tracts, as well as pelvic-intrinsic musculoskeletal causes. Treatment includes physical therapy, cognitive behavioral therapy, and oral and parenteral opioids. Interventional techniques provide an added tier of treatment and may help to reduce the requirement for chronic opioid use. Superior hypogastric plexus block is one of the available interventional techniques; first described in 1990, it has been shown to provide long-lasting relief in 50-70% of patients who underwent the procedure. Two approaches described so far, both under fluoroscopy, have seen similar results. More recently, ultrasound and CT-guided procedures have also been described with similar success. The injectate includes local anesthetic, steroids, and neurolytic agents such as phenol or ethanol. CPP is a common debilitating condition. It is diagnosed clinically and is underdiagnosed globally. Current treatments can be helpful at times but may fall short of satisfactory pain relief. Interventional techniques provide an added layer of treatment as well as reduce the requirement for opioids. Superior hypogastric plexus block provides long-lasting relief in many patients, regardless of approach. Evidence level is limited, and further RCTs could help provide better tools for evaluation and patient selection.

Analysis of Body Composition and Pain Intensity in Women with Chronic Pelvic Pain Secondary to Endometriosis.

To determine the average body composition (percentage of body fat), the anthropometric markers, and the intensity of clinical pain in women with a clinical diagnosis of chronic pelvic pain (CPP) secondary to endometriosis. A case-control study performed with 91 women, 46 of whom with CPP secondary to endometriosis and 45 of whom with CPP secondary to other causes. They underwent an evaluation of the anthropometric parameters by means of the body mass index (BMI), the perimeters (waist, abdomen, hip), and the percentage of body fat (%BF), which were assessed on a body composition monitor by bioimpedance; the intensity of the clinical pain was evaluated using the visual analog scale (VAS), and the symptoms of anxiety and depression, using the hospital's anxiety and depression scale (HAD). The groups did not differ in terms of mean age, BMI, %BF or regarding the available waist-to-hip ratio (WHR). The mean intensity of the clinical pain by the VAS was of 7.2 ± 2.06 in the group with CPP secondary to endometriosis, and of 5.93 ± 2.64 in the group with CPP secondary to other causes (p = 0.03), revealing significant differences between the groups. We concluded that, despite the difference in the pain score assessed between the two groups, there was no difference regarding body composition and anthropometry.

Роль мышечно-фасциального синдрома и дисфункции в развитии синдрома хронической тазовой боли у женщин (Обзор литературы)

According to the classification of chronic pain syndromes proposed by the International Association for the Study of Pain (IASP) and due to the high clinical significance, chronic pelvic pain (CPP) represents an independent nosological structure and is defined as pain in the pelvic region (in the lower abdomen and the lower back), mainly between the navel and the pubic symphysis, which lasts for at least six months and disrupts the normal functioning of the body. Myofascial pelvic pain syndrome (MPPS) in English literature is included in the subgroup of etiology of CPP. Myofascial pelvic pain syndrome itself is not a direct threat to life and health and does not require urgent help. But today it is almost not diagnosed and is not considered as a source of chronic pain and dysfunction in the pelvic region. Such patients, unfortunately, are left without appropriate treatment and cannot get rid of the oppressive pain. They often receive unnecessary treatment, including surgical interventions. This problem causes neurosis, depression, sexual dysfunction and, as a result, leads to the deterioration in the quality of life. CPP can often have multiple causes and should be evaluated in terms of the pathology of various physiological systems, including reproductive, urogenital, gastrointestinal, musculoskeletal and nervous system. Based on a full picture of the multifactorial nature of CPP, the treatment of this category of patients requires an integrated approach involving specialists in various fields. Particular attention in the differential diagnosis of chronic pelvic pain in women should be paid to abdominal myofascial pain syndrome, the role of which is currently underestimated. Therefore, doctors should be aware of the main directions of diagnosis and treatment of CPP due to myofascial pain syndrome. Keywords: chronic pelvic pain, myofascial syndrome, nidling, post-isometric relaxation of muscles, relising.

An Optimized Procedure for Non-Contrast Magnetic Resonance Imaging in the Diagnosis of Chronic Pelvic Pain in Women

Objective. To optimize a pelvic and lower abdominal cavity MRI protocol in the diagnosis of chronic pelvic pain (CPP) in women.Material and methods. A total of 57 reproductive-aged women with complaints of CPP were examined. The first stage of all patients after clinical and laboratory examination for clinical indications was performed ultrasound of the pelvis and abdominal cavity with dopplerometry. In the second stage, all the patients underwent an MRI using the standard Protocol, and then a modified Protocol. The final diagnosis was based on the results of a comprehensive examination, which included a clinical and neurological examination, gynecological examination, pelvic and abdominal ultrasound, radiography of the ileosacral joints and lumbosacral spine, fibrocolonoscopy and laparoscopy with morphological examination of the operating material (according to indications).Results. Forty-six (81%) patients were found to have gynecological factors for the development of CPP; 16 (28%) had extragenital factors. The examination results were verified by the data of surgical intervention (n = 16 (28%)), hysteroscopy (n = 21 (37%)), and laparoscopy (n = 9 (16%)) with morphological examination of biopsy specimens or surgical material.Comparing with the standard pelvic MR protocol provided evidence for the high diagnostic value of the modified protocol statistically significantly (p &lt; 0.05): 99.2% sensitivity and 99.6% specificity.Conclusion. The developed non-contrast 1.5T MRI protocol for the pelvis permits MR images of the pelvis and adjacent anatomical areas to be obtained during one study without increasing time expenditures and upgrading equipment and software. The use of the protocol makes it possible to improve the quality of radiation diagnosis of gynecological and extragenital diseases in CPP and to recommend that the protocol in combination with other clinical and instrumental studies be introduced in clinical practice.

Pathologic findings in fallopian tubes of women with chronic pelvic pain after Essure placement

Background: Pelvic pain has been associated with Essure, a permanent contraceptive implant. Here we describe histopathologic findings in long-term Essure users with chronic pelvic pain. Methods: We descriptively evaluated and compared histopathologic features of hysterectomy specimens removed for a primary diagnosis of chronic pelvic pain from women with (n = 3) and without (n = 3) prior placement of Essure coils (mean of 8.6 years prior). Results: Interstitial fallopian tubes of Essure patients demonstrated fibrosis. Two cases had flattening of ampullary epithelial folds. Tubes of Essure users showed no acute inflammation, but 2/3 showed focal chronic inflammation. All patients had additional findings, such as endometriosis, adenomyosis or leiomyomas, that could be associated with pain. Conclusions: Given the minimal and bland inflammation in Essure cases, symptoms may more plausibly be ascribed to confounding gynecologic conditions or other mechanisms.

Effects of a patient-centered program including the cumulative-complexity model in women with chronic pelvic pain: a randomized controlled trial

ObjectivesTo evaluate the effects of a patient-centered intervention including the cumulative-complexity model on quality of life related to health, coping behaviors, pain, self-perceived occupational performance and activity levels. Study designRandomized controlled trial. Forty-four women with a clinical diagnosis of chronic pelvic pain were randomized into two groups. Patients in the experimental group (n = 22) were included in a patient-centered intervention that involved relevant activities proposed by participants. Patients in the control group (n = 22) received a leaflet with information about chronic pelvic pain, physical activity, fear of movement, false beliefs, active lifestyle and behavioral advice. Main outcome measuresThe primary outcome measures were health-related quality of life assessed with the EuroQol-5D and coping behavior using the Coping Strategies Questionnaires. Secondary outcomes included severity of pain using a Visual Analogue Scale, self-perception of occupational performance using the Canadian Occupational Performance Measure and physical activity levels assessed by the International Physical Activity Questionnaire. ResultsAn analysis of variance with repeated measures showed, in the experimental group compared with the control group, significantly greater improvement from baseline to post-intervention in health-related quality of life (EuroQol-5D Visual Analog Scale values of 70.06 ± 16.44 vs. 57.38 ± 16.40, p = 0.026) and coping behavior (adaptive coping 113.00 ± 31.89 vs. 83.24 ± 16.69, p = 0.002). Pain, self-perception of performance and physical activity levels also significantly improved. ConclusionsA patient-centered intervention considering the workload of patients and their capacity for performing health behaviors provides benefits regarding quality of life and coping behavior. Additionally, pain, self-perceived performance of relevant tasks and physical activity levels improved.

Patient-Reported Use of Medical Cannabis for Management of Chronic Pelvic Pain [12H

INTRODUCTION: Chronic pelvic pain (CPP) affects up to 15% of women in the United States. The endocannabinoid system can be a pharmacological target for endometriosis-related pelvic pain, as cannabis receptors are highly expressed in the uterus and other non-reproductive tissues. We hypothesize that many patients with CPP use cannabis and report improvement in symptoms. METHODS: An anonymous, confidential, electronic survey was performed from March through August 2019. Patients aged 18 through 89 were included if they had a diagnosis of pelvic/perineal pain, dyspareunia, or endometriosis. Subjects were approached during outpatient appointments. Study approval was obtained from the Institutional Review Board. RESULTS: A total of 122 of 240 (50.8%) patients responded. Of these, 113 self-reported a diagnosis of CPP (92.6%). Twenty-six patients reported cannabis use (23%). Six (24%) used Cannabidiol (CBD), 3 (12%) used tetrahydrocannabinol (THC), and 15 (60%) used a combination of CBD and THC. Frequency of use varied, with the majority using at least once per week (n=18, 69.2%). Only 5 (19.2%) utilized a State Medical Cannabis Program to obtain a certification. Of users, 24 (92.3%) reported improvement in symptoms, including pain, cramping, muscle spasms, anxiety, depression, sleep disturbances, libido, and irritability. However, 21 (80.7%) reported side effects; the most common were dry mouth, sleepiness, and feeling “high.” CONCLUSION: Up to 23% of patients with CPP report use of cannabis as an adjunct to their prescribed therapy, and they use a variety of formulations and doses. Most report daily or weekly use. Although side effects are common, most users report improvement in symptoms.

2670 Laparoscopy in the Chronic Pelvic Pain Patient: Incidence and Outcomes of Subsequent Laparoscopies

Study Objective Our aim is to determine the incidence of multiple laparoscopies for chronic pelvic pain over 10 years and to compare outcomes between patients who underwent single vs multiple laparoscopies. Design Retrospective case-control study. Setting Urban based tertiary care medical center. Patients or Participants Women with diagnosis of chronic pelvic pain that underwent one laparoscopy in comparison with those who underwent multiple laparoscopies in a 10-year period. Interventions Multiple Laparoscopies. Measurements and Main Results Parametric, nonparametric and descriptive statistics were employed. 792 patients were managed with laparoscopy for a diagnosis of chronic pelvic pain (CPP), 14% of which had multiple laparoscopies. 678 controls with single laparoscopy and 114 cases with multiple laparoscopies were identified. 400 (59%) had medical management prior to first laparoscopy in the control group and 82 (72%) in the cases. 559 had diagnostic and 119 had extirpative laparoscopies in the single laparoscopy group vs 91 diagnostic and 23 extirpative laparoscopies in the multiple laparoscopy group. Of the patients with persistent pain after first laparoscopy in the control group, 52 underwent hysterectomy. Of the 37 who followed up, 26 reported pain response and 5 no response. The average number of laparoscopies in the multiple laparoscopy group was 2.27. In the multiple laparoscopy group, 38 patients underwent hysterectomy. Of the 26 that followed up, 22 reported pain response and 4 no response. Of the total patients who underwent hysterectomy and had follow-up, 80% (54 of 67) reported pain response. Of the 792 patients who underwent laparoscopy, 25 had pathologic evidence of endometriosis in the single laparoscopy group vs 32 in the multiple laparoscopy group. Conclusion Approximately 1 in 7 patients are subject to multiple laparoscopies for CPP. Despite clinical symptoms, endometriosis is a minor contributor to CPP. Management of CPP with laparoscopy poorly correlates with response to hysterectomy.

MP33-05 A 10 YEAR ANALYSIS OF CHRONIC PELVIC PAIN AND CHRONIC NARCOTIC USE IN THE MALE VETERAN POPULATION

INTRODUCTION AND OBJECTIVES:To compare chronic narcotic use (CNU) and average narcotic doses prescribed five years prior to and five years following the diagnosis of chronic pelvic pain (CPP). To evaluate patient characteristics associated with CNU and CPP.METHODS:We used the validated Veteran’s Health Administration corporate database warehouse. Time 0 was the first CPP diagnosis date by ICD-9 codes. Outpatient narcotic prescriptions were summed for the 5 years preceding and following CPP diagnosis; oral narcotics were converted to morphine equivalents (ME). CNU was defined as greater than 90 narcotic use days per year; drug abuse/overdose rates were defined by ICD-9 codes. An interrupted time series analysis was performed to model the impact of CPP on CNU.RESULTS:168,318 male Veterans met inclusion criteria of non-cancer CPP diagnosed between 2002-2012 with average age of 59.9 ± 14.1years; 17.9% of minority race, with an average BMI of 29.2± 5.4kg/m2 and 2.3% had a history of military sexual trauma. Oth...

Role of laparoscopy in the diagnosis of chronic pelvic pain

Introduction: Chronic pelvic pain (CPP) is noncyclic pain of 6 or more months' duration that localizes to the anatomical pelvis, anterior abdominal at or below the umbilicus, and the lumbosacral and is of sufficient severity to cause functional disability. Lower abdominal pain can be caused by chronic pelvic inflammatory disease, pelvic adhesions, certain ovarian cysts, pelvic vascular congestion, uterine fibroids, and adenomyosis, but pain arising from organs outside the pelvis may also radiate to the lower abdomen. Only 20%–25% of patients respond to conservative management. When such treatment fails, a diagnostic laparoscopy is usually performed. Aim: We aim to study the role of laparoscopy in the diagnosis of CPP. Objective: The objective was (1) to evaluate the causes of CPP by diagnostic laparoscopy and (2) to compare the clinical finding and ultrasound findings with laparoscopic findings. Materials and Methods: The present study includes fifty patients presented with lower abdominal pain of at least 6-month duration. A detailed history was taken about the pattern of the pain and its association with other problems. Gynecological examination included inspection of the vulva and perineum, speculum examination of the cervix and vagina, bimanual examination to assess the shape, size, direction, mobility of the uterus and adnexa, mass and tenderness of the urethra, vaginal fornix and cervical motion tenderness. The patients were further evaluated by ultrasound examination (transvaginal and abdominal) and diagnostic laparoscopy. Results: Most of the women were of the mean age group of 29.30 years. The pain was most commonly associated with dysmenorrhea in 76% of the patients. Nine patients out of 26 who showed normal findings on bimanual examination revealed abnormal findings on laparoscopy. Five patients out of 22 who showed normal findings on ultrasonography showed abnormal findings on laparoscopy. Conclusion: Laparoscopy is a gold standard tool in the evaluation of women with CPP because diagnosis and treatment can be done in the same sitting.