Treatment Of Chronic Pelvic Pain Research Articles

Acupoint Catgut Embedding for Treatment of Chronic Pelvic Pain due to the Sequelae of Pelvic Inflammatory Disease.

Chronic pelvic pain caused by the sequelae of inflammatory pelvic disease is a common clinical condition of pelvic pain in women. At present, the main challenges in its treatment are the limited effectiveness of pain relief and the frequent recurrence of symptoms, which significantly impact patients' quality of life and impose a considerable psychological burden on them. It is a clinically challenging disease. After summarizing years of treatment experience, the author's team discovered that acupoint catgut embedding demonstrated notable clinical efficacy in managing chronic pelvic pain stemming from pelvic inflammatory disease sequelae. Compared to existing Western medicine treatment methods, acupoint catgut embedding offers advantages such as a good analgesic effect, lower recurrence rate, economic benefits, and a relatively straightforward procedure. This article provides a comprehensive guide on embedding absorbable catgut into patients' acupoints for the treatment of chronic pelvic pain in females resulting from the sequelae of pelvic inflammatory disease.

Clinical usability study of a home-based self-administration transcranial direct current stimulation for primary dysmenorrhea: A randomized controlled trial.

This study tested the usability of a home-based self-administration transcranial direct current stimulation (tDCS) device designed specifically for women's health needs. This is a single center triple blinded clinical usability study for a new wireless, Bluetooth-controlled wearable tDCS device for women's health. The study aims to evaluate the usability and effective blinding of a home-based tDCS system. A total of forty-nine women of reproductive age were randomly allocated (1:1) to receive one session of active tDCS (n = 24) or sham tDCS (n = 25) over the motor and dorsolateral prefrontal cortex. Each participant self-administered one 20-minute session without supervision following guidance on a software application alone. The System Usability Scale (SUS) and the Patient Global Impression of Change (PGIC) were used to evaluate the usability of the system. Regardless of sham or active conditions, all users found the system easy to use without the support of researchers. Usability scores were considered to be "excellent" in both groups and no significant difference was found between sham and active groups showing effective blinding of the device (Active group: 93.7 (83.1-97.5); Sham group 90 (86.2-95) p = 0.79) and PGIC (Active group: 2 (1-2.75); Sham group 2 (1-2) p = 0.99) using an unpaired t-test or non-parametric statistical tests accordingly. The new Bluetooth-controlled wearable tDCS device is easy, safe to use and completely controlled by a smartphone app. This device is focused on women's health and will be tested as an alternative treatment for chronic pelvic pain and mood disturbance associated with menstrual cycles in further research.

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.

Cannabidiol therapy prevalence for the treatment of chronic pelvic pain

Cannabidiol therapy prevalence for the treatment of chronic pelvic pain

Analysis of the Effect and Efficiency of Transcutaneous Acupoint Electrical Stimulation in the Treatment of Chronic Pelvic Pain in the Sequelae of Pelvic Inflammatory Diseases

Objective: To analyze the effect of transcutaneous acupoint electrical stimulation in the treatment of chronic pelvic pain following sequelae of pelvic inflammatory diseases. Methods: Fifty cases of chronic pelvic pain patients with sequelae of pelvic inflammatory diseases, who visited the hospital between June 2022 and June 2023, were selected and randomly divided into the experimental group and control group using a computerized lottery method. The control group received treatment with painkillers, while the experimental group underwent transcutaneous acupoint electrical stimulation. Symptoms, signs, and pain levels were observed before and after the treatment, and clinical effects between the two groups were compared. Results: Patients in the experimental group exhibited lower PPI, VAS, PRI, and other pain scores compared to the control group (P < 0.05). Moreover, symptoms and signs scores in the experimental group were lower than those in the control group (P < 0.05). Following treatment, the quality-of-life scores for patients in the experimental group were higher than those in the control group (P < 0.05). The experimental group had a higher overall treatment effective rate of 96% as compared to the control group (76%; P < 0.05). Conclusion: The application of transcutaneous acupoint electrical stimulation significantly reduced the degree of pelvic pain in patients with sequelae of pelvic inflammatory diseases. This intervention enhanced the overall clinical effect and promoted an improvement in the patient’s quality of life.

Functional-neurosurgical treatment options for functional pelvic floor disorders : Value of sacral neuromodulation

Sacral neuromodulation is an established minimally invasive therapy indicated for the treatment of functional pelvic floor disorders. While it received its original US Food and Drug Administration (FDA) approval for the treatment of overactive bladder symptoms, it is now regarded as atherapeutic option to treat both urinary/fecal incontinence and retention. In addition, it has proven to be avaluable tool in the treatment of chronic pelvic pain, and preliminary results indicate apotential to elicit improvements in sexual functioning. This article serves to provide asummary of the therapy and its applications. Selective literature review. Sacral neuromodulation implants allow for the controlled shifting of the autonomic control of bladder and rectum towards an inhibition or facilitation of voiding, dependent on the patient's needs and under the patient's control. At the same time and depending on the applied stimulation, the implants can interfere with the nerve's conduction of pain signals. This makes them atherapeutic option for pelvic pain that fails to respond to conventional treatment. Finally, there have been first reports suggesting improvements in sexual dysfunction under sacral neuromodulation, thus, potentially opening up anew line of therapy for those disorders. Sacral neuromodulation is aflexible and efficient form of therapy for functional disorders of the pelvic floor. Specifically, the same intervention can treat seemingly contradictory disorders such as urinary/fecal incontinence and retention as well as chronic pain.

Sacral neuromodulation in endometriosis - A promising treatment option for chronic pelvic pain.

Chronic pelvic pain (CPP) affects over one fifth of women worldwide, and endometriosis is one of the most common causes. In the present study, we examined whether sacral neuromodulation (SNM) is effective in the treatment of refractory chronic pelvic pain in women with endometriosis. This multicenter prospective pilot study was started in 2017 and includes patients with chronic pelvic pain with no other obvious pathology than endometriosis. Other treatment options have been tried or they are unsuitable. Patients underwent SNM implantation. The main outcome was postoperative pain reduction and secondary outcome was quality of life. The following questionnaires were used to assess the outcomes: Brief pain inventory (BPI), clinical global impression - improvement (CGI-I), 15D-measure of health-related quality of life, and Biberoglu and Behrman (B&B) score. A total of 35 patients underwent the SNM procedure and, at the time of analysis, 15 patients had returned one-year questionnaires. The patients had a history of endometriosis for a median of 5.5 (interquartile range 2-9) years, with no correlation between the severity of symptoms and the duration of the disease (p = 0.158). A total of 31 patients (89%) were implanted with the internal pulse generator. There were statistically significant changes in BPI pain-related items. Worst experienced daily pain decreased among those who returned 12-month questionnaires from median 9 to 5 (p = 0.006), average daily pain from 6 to 3.5 (p = 0.004), and least daily pain from 3 to 1 (p = 0.004). Based on the CGI questionnaire (n = 14), at 12 months nine patients (60%) experienced great improvement in their symptoms, three patients (20%) much improvement and two patients (13%) minimal improvement. None of the patients experienced worsening of their symptoms. There was a statistically significant change in overall 15D score at 1 month (p < 0.001), 6 months (p = 0.001) and 12 months (p = 0.018), when the results were compared to baseline values. Median B&B score also improved significantly and decreased from a baseline value of 8 (4-12) to 4.5 (0-6), p = 0.002. Based on the preliminary findings of our study, SNM might be a promising treatment of CPP in endometriosis patients.

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.).

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.

Successful use of a phage endolysin for treatment of chronic pelvic pain syndrome/chronic bacterial prostatitis.

Chronic prostatitis (CP) is a common inflammatory condition of the prostate that is estimated to effect 2%-10% of the world's male population. It can manifest as perineal, suprapubic, or lower back pain and urinary symptoms occurring with either recurrent bacterial infection [chronic bacterial prostatitis (CBP)] or in the absence of evidence of bacterial infection [chronic pelvic pain syndrome (CPPS)]. Here, in the case of a 39 years-old CBP patient, we report the first successful use of a bacteriophage-derived muralytic enzyme (endolysin) to treat and resolve the disease. Bacteriological analysis of the patient's prostatic secretion and semen samples revealed a chronic Enterococcus faecalis prostate infection, supporting a diagnosis of CBP. The patient's E. faecalis strain was resistant to several antibiotics and developed resistance to others during the course of treatment. Previous treatment with multiple courses of antibiotics, bacteriophages, probiotics, and immunologic stimulation had failed to achieve long term eradication of the infection or lasting mitigation of the symptoms. A cloned endolysin gene, encoded by E. faecalis bacteriophage ϕEf11, was expressed, and the resulting gene product was purified to electrophoretic homogeneity. A seven-day course of treatment with the endolysin resulted in the elimination of the E. faecalis infection to below culturally detectable levels, and the abatement of symptoms to near normal levels. Furthermore, during the endolysin treatment, the patient experienced no untoward reactions. The present report demonstrates the effectiveness of an endolysin as a novel modality in managing a recalcitrant infection that could not be controlled by conventional antibiotic therapy.

Editorial Expression of Concern: The efficacy of Implanon for the treatment of chronic pelvic pain associated with pelvic congestion: 1-year randomized controlled pilot study.

Editorial Expression of Concern: The efficacy of Implanon for the treatment of chronic pelvic pain associated with pelvic congestion: 1-year randomized controlled pilot study.

Osteopathic Manipulative Treatment of Chronic Pelvic Pain due to High-Tone Pelvic Floor Dysfunction

Context: Chronic pelvic pain syndrome (CPPS) is a complex pain syndrome that affects 15%–30% of people of childbearing age (~10–20 million, US). Etiologies range from musculoskeletal conditions and visceral disease to neurological and psychological disorders. The interplay of many systems and disorders can manifest into a complex pathophysiology that is difficult to diagnose and treat. Dysfunction of the musculoskeletal system is often involved in patients with CPPS, either as the cause of pain or the result of underlying disease or dysfunction. Hypertonicity of pelvic floor muscles, myofascial trigger points, and dysfunctional shortening of the levator ani group of muscles contribute to the structural and functional abnormalities involved in CPPS. Osteopathic physicians are in a unique position to directly address this somatic dysfunction with a nonpharmacologic, nonsurgical approach: osteopathic manipulative treatment (OMT).Objectives: The purpose of this article is to review the literature on manual treatment efficacy for high-tone pelvic floor dysfunction (HTPFD) and the standardization of diagnosis to provide rational, medically based treatments. The second purpose is to elucidate the steps that the medical, and specifically the osteopathic profession can take to standardize pelvic floor evaluation, diagnosis, and treatment in the primary care setting.&#x0D; Methods: A search was conducted on the US National Library of Medicine’s PubMed database for studies involving manual therapy treatment for HTPFD. The authors excluded studies that described manual therapy interventions aimed at increasing pelvic floor muscle tone in patients with urinary incontinence and/or pelvic organ prolapse.Results: For perspective, the initial search using the keywords “chronic pelvic pain syndrome” led to 2,281 publications since 1974; the addition of “osteopathic” led to 10 results since 2009. The search for “high-tone pelvic floor dysfunction” led to 30 publications since 1992; the addition of “osteopathic” yielded no results. To evaluate the efficacy of manual therapy for HTPFD, the search was expanded to include any manual therapy protocols. While the consensus in the literature is that manual treatment for chronic pelvic pain (CPP) is efficacious, the finding is limited by the lack of a comprehensive protocol to appropriately diagnose and treat the patient. The authors propose a system to standardize the assessment of a patient with CPP in the primary care setting by an appropriately trained physician so that pelvic floor dysfunction is recognized, properly diagnosed and treated, or referred to specialized care.Conclusion: The literature supports that manual therapy is an effective treatment for CPP, and as primary care providers, osteopathic physicians are uniquely placed to recognize and treat patients with HTPFD, providing an empathetic, patient-centered approach. Standardization of the diagnosis and manual treatment of HTPFD is required to assess and monitor patients systematically. Development of an advanced training program for clinicians to learn diagnostic approaches and OMTfor the pelvic floor should be required since the techniques addressing the pelvic floor musculature are often not included in traditional training.

ID: 205005 Dorsal Root Ganglion Stimulation at L1 & L2 for Post- Ilioinguinal, Iliohypogastric, and Genitofemoral Neurectomy

We present a case report of a 36-year-old female that underwent neurectomy of ilioinguinal, iliohypogastric and genitofemoral nerves at an outside hospital and presented with severe left-sided groin pain. Patient developed chronic pain, post-cesarean section and the subsequent neurectomies worsened the symptoms. Dorsal root ganglion stimulation (DRGS) has emerged as novel treatment option for refractory chronic pelvic pain (CPP). DRGS delivers targeted target to focal areas and is able to reliably capture body parts like the pelvis making it an ideal modality for the treatment of CPP. We present successful resolution of symptoms once DRGS leads were placed at L1, and L2 neuroforamen.

Dorsal root ganglion stimulation for the treatment of chronic pelvic pain: A systematic review.

Chronic pelvic pain (CPP) is a difficult condition to treat. Due to complex pelvic innervation, dorsal column spinal cord stimulation (SCS) has not been shown to produce the same effect as dorsal root ganglion stimulation (DRGS) given emerging evidence suggesting that applying DRGS may result in favorable outcomes for individuals with CPP. The aim of this systematic review is to investigate the clinical use and effectiveness of DRGS for patients with CPP. A systematic review of clinical studies demonstrating the use of DRGS for CPP. Searches were conducted using four electronic databases (PubMed, EMBASE, CINAHL, and Web of Science) across August and September 2022. A total of nine studies comprising 65 total patients with variable pelvic pain etiologies met the inclusion criteria. The majority of subjects implanted with DRGS reported >50% mean pain reduction at variable times of follow-up. Secondary outcomes reported throughout studies including quality of life (QOL) and pain medication consumption were reported to be significantly improved. Dorsal root ganglion stimulation for CPP continues to lack supportive evidence from well-designed, high-quality studies and recommendations from consensus committee experts. However, we present consistent evidence from level IV studies showing success with the use of DRGS for CPP in reducing pain symptoms along with reports of improved QOL through periods as short as 2 months to as long as 3 years. Because the available studies at this time are of low quality with a high risk of bias, we strongly recommend the facilitation of high-quality studies with larger sample sizes in order to better ascertain the utility of DRGS for this specific patient population. At the same time, from a clinical perspective, it may be reasonable and appropriate to evaluate patients for DRGS candidacy on a case-by-case basis, especially those patients who report CPP symptoms that are refractory to noninterventional measures and who may not be ideal candidates for other forms of neuromodulation.

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.

Gynecological prerequisites for the development of chronic pelvic pain syndrome – diagnosis and treatment (Literature review)

Chronic pelvic pain syndrome is a complex process and mostly includes several organ systems. The gynecologic aspects of chronic pelvic pain syndrome can be divided into four distinct components: intra-abdominal pain, vaginal pain, pelvic floor pain, and sexual pain. The сommon gynecological causes of chronic pelvic pain are endometriosis, adenomyosis, vulvovaginal pain syndrome, pelvic floor muscle dysfunction, and sexual pain in women.This article describes the gynecological examination of patients with chronic pelvic pain and discusses the most common gynecological diseases and methods of their treatment. A review of the literature was conducted, which included the recommendations of the International Society for Urinary Incontinence, the European Association of Urology, and the International Association for the Study of Pain.Gynecological examination of patients with chronic pelvic pain begins with a history taking and physical examination. Laboratory tests, imaging examinations, and diagnostic procedures can be used additional methods to make a more accurate diagnosis. Treatment methods include physical therapy, medication, trigger point injections, and surgery.Because the diagnosis and treatment of chronic pelvic pain can be complex, it is important that physicians know the various aspects of this syndrome to be able to provide appropriate care for patients. Detailed history taking and physical examination for identifying the cause of the pain can help to determine the next step in evaluation and treatment. However, gynecological pathology is one of many, but not the only, that can be associated with chronic pelvic pain. This, it is necessary to perform a multimodal and multidisciplinary approach in the management of patients with chronic pelvic pain.

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.

Responding flexibly to the complex problem of chronic pelvic pain: Incorporating patient needs into program development.

Chronic pelvic pain (CPP) in women is both common and disabling, and access to interdisciplinary care is limited. Patient education programs may represent a pragmatic approach to delivering interdisciplinary care, but to date the specific educational needs of patients with CPP are unknown. We surveyed 136 patients at a tertiary CPP treatment center to identify their educational needs and preferences; 71 (52%) completed surveys. Based on the results, we developed an interdisciplinary educational program, including expert presentations and an extensive participant handbook. We modified our program to a webinar format following the advent of COVID-19. Participants registered for the webinar only or for our study involving completion of three measures of pain-related functioning before and 2 months after the webinar. Our survey results indicated that CPP patients were most interested in learning about the diagnosis and treatment of CPP, coping with CPP, and diet and exercise in the context of CPP; patients also indicated a preference for brief, one-time programs. Of the 164 webinar participants, 64 (39%) enrolled in the study and completed baseline measures; 20 (31%) of those returned follow-up measures 2 months after the webinars. Participants who completed follow-up measures reported significant reduction in pain-related interference; no other significant differences were observed. Participants who completed feedback surveys were positive in their evaluation of the program. Patients with CPP desire more knowledge about their complex symptoms. Addressing their specific needs through educational supports may enhance their ability to manage their symptoms independently. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Interventional Pain Management in the Treatment of Chronic Pelvic Pain.

Chronic pelvic pain syndrome (CPPS) is a common yet complex disease in the field of urology, gynecology, and pain management. This review article summarizes the anatomy and physiology of CPP with an in-depth discussion of established and emerging interventional treatment options. Though psychosocial variables play a significant role in the development and propagation of CPPS, interventional treatment strategies are available to ameliorate symptoms. Sympathetic and peripheral nerve blocks along with chemical and radiofrequency denervation are conventional, evidence-based treatments. Recent advances in spinal cord stimulation and dorsal root ganglion stimulation offer novel and effective therapeutic options to treat CPPS. A biopsychosocial model should be employed for effective management of CPPS with advances in neuromodulation offering newfound hope in alleviating symptoms and restoring function.

Progress of Chinese and Western Medicine Research on Chronic Pelvic Pain in Gynecology

Chronic pelvic pain is a syndrome of non-cyclical pelvic pain caused by a variety of causes lasting more than 6 months with organic or functional causes, which involves a wide range of systems, unclear etiology, complex species, high incidence, difficult diagnosis, and poor treatment, and seriously affects the quality of life of patients. Gynecologic factors are common causes among many etiologies. This article reviews the etiology, diagnosis and treatment of chronic pelvic pain caused by gynecological factors, with a view to providing a certain reference basis for the clinical diagnosis and treatment of chronic pelvic pain.