Management Of Chronic Pelvic Pain Research Articles

Pain in the enthesis of levator ani muscle: A novel source of chronic pelvic pain.

Managing chronic pelvic pain (CPP) remains a challenge due to its diverse range of causes. A newly identified anatomical entity known as the enthesis of the levator ani muscle (LAM) and its associated disorders might play a role. This paper describes a novel insight into CPP's origin, aiming to improve accurate diagnosis and treatment. Data were collected from medical records (paper or electronic) retrospectively. The study included 112 patients meeting the criteria, divided into CPP and non-CPP groups. Clinical symptoms, including location of LAM enthesis, referred pain from pain in LAM enthesis, and related lower urinary tract symptoms (LUTSs) were discussed. To identify differences in symptoms between the groups, a Chi-squared test and descriptive analyses were conducted. Bimanual examination revealed tender sites in the attachment of the LAM to the pubic bone. LAM enthesis pain presumably caused referred pain in at least 10 areas, primarily in the lower abdominal quadrate (40.2%-47.3%) followed by the inguinal area (8.9%-15.1%). Multiple LUTSs were observed, including urinary frequency (72.3%), urgency (42.9%), nocturia (53.6%), residual urine sensation (64.3%), urinary incontinence (30.3%), painful bladder (34.8%), and weak urine stream (47.9%). Patients in the CPP groups experienced significant residual urine sensation (53.6%) and bearing-down sensation (42%) compared to the non-CPP group. Pain in LAM enthesis is a novel cause of pelvic pain and LUTSs that warrants attention for the evaluation and management of CPP.

App-Mohedo®: A mobile app for the management of chronic pelvic pain. A design and development study

BackgroundChronic Pelvic Pain (CPP) has been described as a public health priority worldwide, and it is among the most prevalent and costly healthcare problems. Graded motor imagery (GMI) is a therapeutic tool that has been successfully used to improve pain in several chronic conditions. GMI therapy is divided into three stages: laterality training (LRJT, Left Right Judgement Task), imagined movements, and mirror therapy. No tool that allows working with LRJT in pelvic floor has been developed to date. ObjectiveThis research aims to describe the process followed for the development of a highly usable, multi-language and multi-platform mobile application using GMI with LRJT to improve the treatment of patients with CPP. In addition, this will require achieving two other goals: firstly, to generate 550 pelvic floor images and, subsequently, to carry out an empirical study to objectively classify them into different difficulty levels of. This will allow the app to properly organize and plan the different therapy sessions to be followed by each patient. MethodologyFor the design, evaluation and development of the app, an open methodology of user-centered design (MPIu + a) was applied. Furthermore, to classify and establish the pelvic floor images of the app in different difficulty levels, an observational, cross-sectional study was conducted with 132 volunteers through non-probabilistic sampling. ResultsOn one hand, applying MPIu+a, a total of 5 phases were required to generate an easy-to-use mobile application. On the other hand, the 550 pelvic floor images were classified into 3 difficulty levels (based on the percentage of correct answers and response time used by the participants in the classification process of each image): Level 1 (191 images with Accuracy = 100 % and RT = [0–2.5] seconds); Level 2 (208 images with Accuracy = 75–100 % and RT = [2.5–5] seconds); and Level 3 (151 images with Accuracy = 50–75 % and RT > 5 s). ConclusionApp-Mohedo® is the first multi-platform, multi-language and easy-to-use mobile application that, through GMI with LRJT, and with an adequate bank of images classified into three levels of difficulty, can be used as a complementary therapeutic tool in the treatment of patients with CPP. This work can also serve as an example, model or guide when applying a user-centered methodology, as MPIu + a, to the development of other apps, especially in the field of health.

Effectiveness of Endovascular Management of Chronic Pelvic Pain in Pelvic Congestion Syndrome Type I

Effectiveness of Endovascular Management of Chronic Pelvic Pain in Pelvic Congestion Syndrome Type I

Chronic Pelvic Pain, Vulvar Pain Disorders, and Proteomics Profiles: New Discoveries, New Hopes.

Chronic pelvic pain (CPP) is generally defined as non-cyclic pain perceived in the pelvic area that has persisted from three to six months or longer and is unrelated to pregnancy. The etiology of CPP is complex, multifactorial, with heterogeneous presentation, and includes several diseases such as endometriosis, adenomyosis, and interstitial cystitis/bladder pain syndrome. It may also be associated with sexual dysfunction, musculoskeletal disorders, and comorbid psychiatric symptoms. Vulvar pain disorders (VPDs) are typically categorized separately from chronic pelvic pain; among all VPDs, vulvodynia is a chronic vulvar pain of unknown etiology, lasting at least 3 months and that might be associated with other potentially linked factors. Proteomics represents a useful approach to study the proteome profiles of clinical samples. In this review, we have considered a selection of articles that have analyzed the protein abundance and novel protein species from various biological samples, including eutopic/ectopic endometrium, urine, serum, follicular, peritoneal fluid, and cervical mucus, potentially involved in the pathogenesis and progression of CPP and VPDs. These findings could represent valuable targets for paving the way for the differential diagnosis and therapeutic management of CPP and VDPs, thereby optimizing both the prevention and treatment of these conditions.

Cut-off scores of the Depression Anxiety Stress Scale-8: Implications for improving the management of chronic pain.

Mental distress, non-specific symptoms of depression and anxiety, is common in chronic pelvic pain (CPP). It contributes to poor recovery. Women's health nurses operate in multidisciplinary teams to facilitate the assessment and treatment of CPP. However, valid cut-off points for identifying highly distressed patients are lacking, entailing a gap in CPP management. This instrumental cross-sectional study identified a statistically derived cut-off score for the Depression Anxiety Stress Scale-8 (DASS-8) among 214 Australian women with CPP (mean age = 33.3, SD = 12.4, range = 13-71 years). Receiver operator characteristic curve, decision trees and K-means clustering techniques were used to examine the predictive capacity of the DASS-8 for psychiatric comorbidity, pain severity, any medication intake, analgesic intake and sexual abuse. The study is prepared according to the STROBE checklist. Cut-off points resulting from the analysis were ordered ascendingly. The median (13.0) was chosen as an optimal cut-off score for predicting key outcomes. Women with DASS-8 scores below 15.5 had higher analgesic intake. CPP women with a DASS-8 score above 13.0 express greater pain severity, psychiatric comorbidity and polypharmacy. Thus, they may be a specific target for nursing interventions dedicated to alleviating pain through the management of associated co-morbidities. At a cut-off point of 13.0, the DASS-8 may be a practical instrument for recommending a thorough clinician-based examination for psychiatric comorbidity to facilitate adequate CPP management. It may be useful for evaluating patients' response to nursing pain management efforts. Replications of the study in different populations/countries are warranted.

Evaluation and Medical Management of Chronic Pelvic Pain.

Chronic pelvic pain (CPP) is a challenging condition affecting an estimated 15% of females in the United States. Multiorgan system dysfunction results in the complex clinical pain presentation. Similar to other chronic pain syndromes, CPP is influenced by biopsychosocial factors and requires a multimodal approach for optimal pain management. This review summarizes the clinical evaluation and medical management of CPP with a comprehensive approach.

Pelvic Venous Disorders: An Update in Terminology, Diagnosis, and Treatment.

Pelvic venous disorder (PeVD) is a term that encompasses all the interrelated causes of chronic pelvic pain (CPP) and perineal/lower extremity varicose veins of pelvic venous origin historically known as nutcracker syndrome, pelvic congestion syndrome, and May-Thurner syndrome, resulting in a more precise diagnosis that accounts for the underlying pathophysiology and anatomy. PeVD manifests as CPP with associated vulvar and lower-extremity varicosities, left flank pain and hematuria, and lower extremity pain and swelling secondary to obstruction or reflux in the left renal, ovarian, or iliac veins. This article will focus specifically on the most current nomenclature, evaluation, and management of CPP of venous origin.

Pain Reduction with an Immersive Digital Therapeutic in Women Living with Endometriosis-Related Pelvic Pain: at-home self administered randomized controlled trial.

The management of chronic pelvic pain in women with endometriosis is complex and includes long-term use of opioids. Patients not fully responsive to drugs, or ineligible for surgical treatments need efficient alternatives to improve their quality of life and avoid long-term sequelae. This randomized controlled trial, software under test (Endocare) vs. sham, aimed to assess the effects of repeated at home administrations of a 20-minutes virtual reality (VR) solution on pain in women experiencing pelvic pain due to endometriosis. Patients were instructed to use VR headsets twice daily during at least 2 days and up to 5 days starting on their first day of painful periods. Pain perception was measured using a numerical scale (0 - 10) before and 60, 120, 180 minutes after each treatment administration. General pain, stress, fatigue, medication intake and quality of life were daily reported by patients. 102 patients were included in the final analysis (Endocare: n=51/102, 50%; Sham: n= 51/102; 50%). The mean age was 32.88 years (SD 6.96) and the mean pain intensity before treatment was 6.53 (SD 1.74) and 6.22 (SD 1.69) for the Endocare group and the control group (P=.48). Pain intensity decreased in both groups from day 1 to day 5 as well as medication use. Maximum pain intensity reduction was 51.58% (SD 35.33) at D2.T120 and 27.37% (SD 27.23) at D3.T180 for the Endocare group and the control group respectively. The Endocare was significantly superior to the sham on day 1 (T120, P=.037; T180, P=.001), day 2 (T0, P=.022; T60, T120, T180, all P<.0001) and day 3 (T60, P=.014; T120, P=.005; T180, P=.001). Similarly, the mean perceived pain relief was significantly higher with Endocare on day 1 (T120, T180) and day 2 (T60, T120, T180) compared to the control (All P<.01). No adverse event was reported. This study confirmed the effectiveness and safety of self-repeated administrations of a virtual reality immersive treatment used at home while reducing overall pain medication intake in women diagnosed with endometriosis experiencing moderate-to-severe pelvic pain and supports. Registration: Clinicaltrials.gov NCT05172492, https://clinicaltrials.gov/ct2/show/NCT05172492.

Effectiveness of laparoscopic removal of isolated superficial peritoneal endometriosis for the management of chronic pelvic pain in women (ESPriT2): protocol for a multi-centre randomised controlled trial

BackgroundEndometriosis affects 190 million women and those assigned female at birth worldwide. For some, it is associated with debilitating chronic pelvic pain. Diagnosis of endometriosis is often achieved through diagnostic laparoscopy. However, when isolated superficial peritoneal endometriosis (SPE), the most common endometriosis subtype, is identified during laparoscopy, limited evidence exists to support the common decision to surgically remove it via excision or ablation. Improved understanding of the impact of surgical removal of isolated SPE for the management of chronic pelvic pain in women is required. Here, we describe our protocol for a multi-centre trial to determine the effectiveness of surgical removal of isolated SPE for the management of endometriosis-associated pain.MethodsWe plan to undertake a multi-centre participant-blind parallel-group randomised controlled clinical and cost-effectiveness trial with internal pilot. We plan to randomise 400 participants from up to 70 National Health Service Hospitals in the UK. Participants with chronic pelvic pain awaiting diagnostic laparoscopy for suspected endometriosis will be consented by the clinical research team. If isolated SPE is identified at laparoscopy, and deep or ovarian endometriosis is not seen, participants will be randomised intraoperatively (1:1) to surgical removal (by excision or ablation or both, according to surgeons’ preference) versus diagnostic laparoscopy alone. Randomisation with block-stratification will be used. Participants will be given a diagnosis but will not be informed of the procedure they received until 12 months post-randomisation, unless required. Post-operative medical treatment will be according to participants’ preference. Participants will be asked to complete validated pain and quality of life questionnaires at 3, 6 and 12 months after randomisation. Our primary outcome is the pain domain of the Endometriosis Health Profile-30 (EHP-30), via a between randomised group comparison of adjusted means at 12 months. Assuming a standard deviation of 22 points around the pain score, 90% power, 5% significance and 20% missing data, 400 participants are required to be randomised to detect an 8-point pain score difference.DiscussionThis trial aims to provide high quality evidence of the clinical and cost-effectiveness of surgical removal of isolated SPE.Trial registrationISRCTN registry ISRCTN27244948. Registered 6 April 2021.

ID: 217176 Conus Medullaris Stimulation Versus Thoracic Spinal Cord Stimulation for the Management of Chronic Pelvic Pain

While spinal cord stimulation has been well studied for the treatment of chronic neuropathic pain for the upper and lower extremities, few reports exist for the utility of spinal cord stimulation for the management of chronic pelvic pain. Furthermore, of the studies that describe spinal cord stimulation for pelvic pain, few are able to effectively compare the efficacy of thoracic spinal cord stimulation versus other stimulation modalities in the same patient. Pelvic sympathetic viscera are innervated by fibers at T12-L2 roots, while parasympathetic roots are at S1-S4. Evidence suggests that pelvic pain is well covered with conus stimulation as it captures the S2-S5 segment.

(342) An Analysis of the Relationship between Female Sexual Dysfunction and Opioid Use for the Management of Chronic Pelvic Pain

Abstract Introduction The burden of suffering in women with chronic pelvic pain is often times debilitating. Women with chronic pelvic pain often have a symptomatology that is poorly understood. Sexual function and desire are both a multi-system phenomenon involving the nervous, vascular, and endocrine systems and sexual dysfunction can a detrimental effect on women’s physical and emotional health. There is currently limited studies and awareness about the long-term effects of tramadol and other opioids on the endocrine system, sexual desire, and sexual dysfunction in women. Objective The purpose of this study was to assess the role that use of tramadol and other opioids has in sexual function and desire in women with chronic pelvic pain. The sexual dysfunction should be substance induced, the symptoms must occur after or during the use or dependence of the substance, symptoms must cease after cessation of substance use, and the medication must demonstrate an etiology that can lead to sexual disfunction. Methods The methods for this systematic literature search have been developed according to the recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements. PubMed as well as 7 key electronic databases (including MEDLINE, Ovid, and ScienceDirect), and up-to-date editions of pertinent journals and organizational websites were searched. Criteria for including studies consisted of randomized control trials, cohort studies, and studies that had relevance to criteria for chronic pelvic pain, female sexual disfunction, opioids, tramadol, healthcare inequities, and hypoactive sexual desire disorder. The studies were assessed for value, author, and how data from the included studies were obtained, investigated, evaluated, and synthesized. Results Currently, there is very limited literature on the incidence of sexual dysfunctions, especially in women. There are no scientifically defined norms for sexual behavior, emotions, or desire. Life demands, marital troubles, sickness, medicine, weariness, or boredom can all contribute to a decrease in sexual interest. Treatments for psychiatric disorders have been proved to be effective, but there is little published research on how drugs interact with female sexual function. Conclusions We will also evaluate the proposed solutions that can be developed for practitioners to better treat patients suffering from chronic pelvic pain and female sexual dysfunction. Women’s health practitioners should use the FSIS along with other scoring modalities for sexual disfunction to discuss benefits, risks, and treatment plans for patients who are also on concurrent opioid therapies. Providing healthcare professionals with information concerning sexual behavior may overcome useless and sometimes dangerous barriers and improve patient management, since sexual well-being is considered one of the most important aspects of one's wellbeing and quality of life. Examining the effects of tramadol and other opioids on sexual desire and function in women who do not have chronic pelvic pain is an issue in sexual health that needs more research so that practitioners can better treat their patients holistically. Disclosure No

Barriers in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) management: perspectives from health practitioners.

Chronic prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a complex condition which causes a significant burden on the diagnosed individuals. Assessment and management are perplexing, often resulting in unsatisfactory outcomes. Existing research has only focused on patients' perspectives of pain experiences, but scant evidence is available to understand the barriers that undermine effective pain management. Using an exploratory approach, this study examined these barriers from practitioners' perspectives. Twelve semi-structured interviews were conducted with practitioners across disciplines who have experience in chronic pelvic pain management in males. Practitioners expressed their views and experiences in supporting men with CP/CPPS and what barriers they perceived when providing treatment for patients. Data were analysed using reflexive thematic analysis supported by NVivo software. Five broad and interrelated themes were identified: (1) Where to Start, (2) Insufficient Resources, (3) Prioritisation, (4) Training and Confident Practice and (5) Constraints in Help-Seeking. Practitioners value multimodal management using a biopsychosocial approach; however, practical challenges prevent practitioners from choosing and applying this approach in clinical practice. The findings also identified some unique challenges faced by men with CP/CPPS consistent with previous evidence from patient perspective. Refining terminology, developing specific resources, and increasing psychosocial treatment options are urgently needed.

Comparing inpatient management of chronic pelvic pain flares before and after the COVID-19 pandemic.

Patients with chronic pelvic pain (CPP) may experience pain exacerbations requiring hospital admissions. Due to the effects of backlogged elective surgeries and outpatient gynaecology appointments resulting from the COVID-19 pandemic, we hypothesised that there would be an increased number of women admitted with CPP flares. We conducted a retrospective review of all acute gynaecology admissions at the Royal Infirmary of Edinburgh from July to December 2018 (pre-COVID) and 2021 (post-COVID lockdown). We collected information on the proportion of emergency admissions due to CPP, inpatient investigations and subsequent management. Average total indicative hospital inpatient costs for women with CPP were calculated using NHS National Cost Collection data guidance. There was no significant difference in the number of emergency admissions due to pelvic pain before (153/507) and after (160/461) the COVID-19 pandemic. As high as 33 and 31% had a background history of CPP, respectively. Across both timepoints, investigations in women with CPP had low diagnostic yield: <25% had abnormal imaging findings and 0% had positive vaginal swab cultures. Women with CPP received significantly more inpatient morphine, pain team reviews and were more likely to be discharged with strong opioids. Total yearly inpatient costs were £170,104 and £179,156 in 2018 and 2021, respectively. Overall, emergency admission rates for managing CPP flares was similar before and after the COVID-19 pandemic. Inpatient resource use for women with CPP remains high, investigations have low diagnostic yield and frequent instigation of opiates on discharge may risk dependence. Improved community care of CPP is needed to reduce emergency gynaecology resource utilisation. Existing treatments for chronic pelvic pain (CPP) and endometriosis focus on surgery or hormone medication, but these are often ineffective or associated with unacceptable side-effects. As a result, women continue to experience chronic pain and often have 'flares' of worsening pain that may lead to hospital admission. The COVID-19 pandemic resulted in backlogged gynaecology clinics and surgeries. The aim of this study was to compare the management of emergency pelvic pain admissions for women with CPP before and after COVID-19. We also aimed to better understand their in-hospital management and estimate their hospital length of stay costs. We did not find an increase in CPP patients admitted for pelvic pain flares after the COVID-19 lockdown. Women with CPP often undergo multiple hospital tests and are often prescribed with strong pain medications which can cause long-term problems. Efforts are needed to improve long-term pain management for women with CPP.

Letrozole, for the Management of Chronic Pelvic Pain Resulting from Endometriosis

Background: Letrozole, an aromatase inhibitor that inhibits the final step of the estrogen biosynthesis pathway to prevent estrogen synthesis, has been utilized in a variety of infertile scenarios. A common gynecological pain problem called endometriosis involves tissue that resembles the tissue that typically lines the inner layer of the uterus. It frequently results in fertility issues. According to the trials, the Letrozole medication continues to reduce the severity of persistent pelvic pain. According to reports, Letrozole therapy relieves pelvic pain brought on by endometriosis. Objective: In this study, we evaluated Letroszole's effectiveness in treating chronic pelvic discomfort associated with endometriosis. Study Design: A cross-sectional study Place and Duration: This study was conducted at Sandeman Provincial Hospital (SPH) / BMCH, Quetta Pakistan from December 2021 to December 2022. Methodology: A total of 60 patients with endometriosis were taken in this study. Patients with a past history of treatment for endometriosis with varying degrees of improvement were also included. Data was analyzed on SPSS version 24.0. Before starting the treatment, an initial diagnostic laparoscopy was used to diagnose and score endometriosis. Oral administration of Letrozole 2.5mg, celbex 200mg three times a day, calcium citrate 1000 mg, progestin norethisterone acetate 5 mg, and vitamin D (1000 IU) was given for 6 months Results: The mean age of the participants was30.9years. A total of 26 (43.3%) patients presented with dysmenorrhea. Out of 60 patients, 43 (71.6%) were nulliparous. The mean visual analogue scale which was 7.12 at the start of the therapy, dropped to 6.8 (p-value 0.02) in one month and dropped to 3.3 in six months of the therapy. Conclusion: Letrozole has been shown to be effective in treating pelvic pain related to endometriosis, with notable pain reduction and no recurrence of symptoms. Keywords: Letrozole, Endometriosis, pain score

Association Between Nociplastic Pain and Pain Severity and Impact in Women With Chronic Pelvic Pain

Exploring the relationship between nociplastic pain and the severity and impact of pelvic pain symptoms could lend insight into the heterogeneous symptom presentation and treatment response that complicates management of chronic pelvic pain. In this prospective cross-sectional study, we sought to evaluate relationships between degree of nociplastic pain, measured by the Fibromyalgia (FM) Survey Score, and multiple aspects of the chronic pelvic pain (CPP) experience, including severity, frequency, tenderness during pelvic myofascial exam, interference with daily life, and high-impact pain. The study included 303 women who presented to a tertiary referral clinic for chronic pelvic pain and endometriosis. Multiple measures of pelvic pain, including pain severity, frequency, interference, pelvic myofascial pain, and high-impact pain were examined in General Linear Models with FM Survey Score as the primary predictor of interest in models controlling for endometriosis, surgical history, use of opioids, body mass index, and patient age. Higher level of nociplastic pain was associated with greater pelvic pain severity, frequency, interference, and pelvic myofascial pain (all P < .05). For all models, degree of nociplastic pain was more strongly associated with pain outcomes than the presence of endometriosis, and use of opioids was the only stronger predictor of worse pain outcomes. The likelihood of high impact pain increased 7% for each additional point on the FM Survey Score. Degree of nociplastic pain was robustly associated with severity, frequency, and impact of pelvic pain, and was independent of the presence of endometriosis, history of surgical procedures for pelvic pain, age, and BMI.Trial registration: not applicable PerspectiveThis article evaluates the impact of nociplastic pain on symptoms and functional status in chronic pelvic pain. These findings raise the possibility that a simple screening tool for nociplastic pain might provide clinically actionable information without the need for deep neurobiological phenotyping and may inform development of personalized management strategies.

Analgesic Efficacy of Acupuncture on Chronic Pelvic Pain: A Systemic Review and Meta-Analysis Study

Chronic pelvic pain (CPP) is the pain occurred in the pelvic region longer than six months. The monotherapy of medicine may not adequate for the pain management of CPP and multidisciplinary approaches have been more recommended. The aim of this study is to evaluate the pain management efficacy of acupuncture compared with a control group on CPP. The articles of randomized controlled trial on CPP in PubMed and Embase databases were screened between January 2011 and September 2022 without language restriction to evaluate the treatment efficacy of acupuncture. The visual analogue scale/numerical rating scale (VAS/NRS) and total pain scores of National Institutes of Health-chronic prostatitis symptom index (NIH-CPSI) were served as outcome variables. Post-intervention mean scores were extracted and pooled for meta-analysis. Seventeen studies including 1455 patients were selected for meta-analysis. Both total pain scores of NIH-CPSI and VAS/NAS data revealed significant lower pain level in the acupuncture group than in the control group. Moreover, monotherapy with acupuncture revealed a significantly lower pain level than in the control group in both total pain scores of NIH-CPSI and VAS/NRS. These results indicated that acupuncture may have beneficial effects on pain management for CPP, even when administrated as a monotherapy.

Sacral neuromodulation in the management of chronic pelvic pain: A systematic review and meta-analysis.

Sacral neuromodulation (SNM) is a treatment approved for use in several conditions including refractory overactive bladder (OAB) and voiding dysfunction. Chronic pelvic pain (CPP) is a debilitating condition for which treatment is often challenging. SNM shows promising effect in patients with refractory CPP. However, there is a lack of clear evidence, especially in long-term outcomes. This systematic review will assess outcomes of SNM for treating CPP. A systematic search of MEDLINE, Embase, Cochrane Central and clinical trial databases was completed from database inception until January 14, 2022. Studies using original data investigating SNM in an adult population with CPP which recorded pre and posttreatment pain scores were selected. Primary outcome was numerical change in pain score. Secondary outcomes were quality of life assessment and change in medication use and all-time complications of SNM. Risk of bias was assessed using the Newcastle Ottawa Tool for cohort studies. Twenty-six of 1026 identified articles were selected evaluating 853 patients with CPP. The implantation rate after test-phase success was 64.3%. Significant improvement of pain scores was reported in 13 studies; three studies reported no significant change. WMD in pain scores on a 10-point scale was -4.64 (95% confidence interval [CI] = -5.32 to -3.95, p < 0.00001) across 20 studies which were quantitatively synthesized: effects were maintained at long-term follow-up. Mean follow-up was 42.5 months (0-59). Quality of life was measured by RAND SF-36 and EQ-5D questionnaires and all studies reported improvement in quality of life. One hundred and eighty-nine complications were reported in 1555 patients (Clavien-Dindo Grade I-IIIb). Risk of bias ranged from low to high risk. Studies were case series and bias stemmed from selection bias and loss to follow-up. Sacral Neuromodulation is a reasonably effective treatment of Chronic Pelvic Pain and significantly reduces pain and increases patients' quality of life with immediate to long-term effects.

Incidence of Chronic Pelvic Pain in Females Attending a Gynaecology Outpatient Department

Background and Aims: Chronic pelvic pain (CPP) is a persistent pelvic pain that leads to reduced work performance and impaired quality of life in females. Nearly 15% of females report time off from paid work and around 45% report reduced work productivity. There is a paucity of studies to address the issue, especially with a multidisciplinary and multifactorial view. Various gynaecological disorders are associated with CPP such as endometriosis, adenomyosis, adhesions, chronic pelvic inflammatory disease, and pelvic congestion syndrome. The objective is to determine the frequency of CPP in females attending gynaecologic outpatient departments. Materials and Methods: A total of 201 patients aged 14–48 years attending the gynaecologic outpatient department for gynaecological disorders with complaints of lower abdominal pain were included in this study. Patients enrolled in the study were assessed by a detailed history and pelvic examination, and a structured questionnaire was filled out. Data were analysed using the statistical package for social sciences version 23.0 (International Business Machines Corporation, Armonk, New York, USA). Results: The mean age of the patients was 32.39±6.98 years. The frequency of CPP in females was observed as 95.52% (95% confidence interval: 91.67–97.93%) The rate of CPP was significantly high in females with parity ≤5 and those who had a duration of pain lower than 36 months. In multivariate analysis, adjusted odds ratio by stepwise logistic regression model showed that parity (parity 0–1) and duration of pain (≤36 months) were significantly associated with CPP in females. Conclusion: The study indicates that the most common gynaecological causes of CPP in females attending the outpatient department were those with endometriosis followed by adenomyosis. The management of CPP needs patient-centred care with a multidisciplinary approach. This will lead to early and effective management.

Fractured system, fractured care: The experiences of Canadian women with chronic pelvic pain waiting for interprofessional pain care

Background: Chronic pelvic pain (CPP) is a common disorder in women that includes complex interactions between biological, psychological, and social factors. Accessibility to interprofessional, biopsychosocial CPP care remains a challenge for many patients. There is a lack of knowledge regarding the experiences of women using health services for CPP care and the impact of waiting for interprofessional CPP care. This study explores the perceptions and experiences of Canadian women with CPP interacting with the health system while waiting for interprofessional CPP care. Methods: Our qualitative study included women with CPP waiting for interprofessional care in Ontario, Canada. Data were obtained through semi-structured interviews which were transcribed verbatim and analyzed inductively using established methods for thematic analysis. Results: Ten women (median age of 38.5 years, age range 28–57) participated in in-depth semi-structured interviews. Three main themes were identified: (1) feeling adrift in the health system, (2) feeling “On hold,” uncertain, and in need of guidance, and (3) feeling reliant on a system that does not understand. Within these themes, women with CPP describe tangible strategies and recommendations for improving health system navigation and care. Conclusion: Our study highlights the need for improved access to interprofessional CPP programs, enhanced and targeted training for health professionals in CPP management, and better health system navigation support. Specific recommendations were provided from the perspectives of women with CPP and included providing information on what to expect and prepare for their appointment and engaging patients in education resources while they wait.

Parâmetros e resultados da neuromodulação não invasiva no manejo da dor pélvica crônica: revisão integrativa da literatura

Parâmetros e resultados da neuromodulação não invasiva no manejo da dor pélvica crônica: revisão integrativa da literatura