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    Botulinum Toxin A Injections Into Pelvic Floor Muscles Under Electromyographic Guidance for Women With Refractory High-Tone Pelvic Floor Dysfunction: A 6-Month Prospective Pilot Study. Morrissey Darlene,El-Khawand Dominique,Ginzburg Natasha,Wehbe Salim,O'Hare Peter,Whitmore Kristene Female pelvic medicine & reconstructive surgery OBJECTIVES:High-tone pelvic floor dysfunction (HTPFD) is a debilitating chronic pain disorder for many women with significant impact on their quality of life (QoL). Our objective was to determine the efficacy of electromyography-guided onabotulinumtoxinA (Botox; Allergan, Irvine, Calif) injections in treating patient's perception of pelvic pain and improving QoL measurement scores. METHODS:This is a prospective pilot open-label study of women with chronic pelvic pain and HTPFD who have failed conventional therapy between January 2011 and August 2013. Botox injections (up to 300 U) were done using needle electromyography guidance, from a transperineal approach, to localize spastic pelvic floor muscles (PFMs). Data were collected at baseline, 4, 8, 12, and 24 weeks after injections. This included demographics; Visual Analog Scale (VAS) scores for pain and dyspareunia; validated questionnaires for symptoms, QoL, and sexual function; Global Response Assessment scale for pelvic pain; digital examination of PFM for tone and tenderness; and vaginal manometry. Side effects were also recorded. RESULTS:Out of 28 women who enrolled in the study, 21 completed the 6-month follow-up and qualified for analysis. The mean (SD) age was 35.1 (9.4) years (range, 22-50 years), and the mean (SD) body mass index was 25 (4.4). Comorbidities included interstitial cystitis/bladder pain syndrome (42.9%) and vulvodynia (66.7%). Overall, 61.9% of subjects reported improvement on Global Response Assessment at 4 weeks and 80.9% at 8, 12, and 24 weeks post injection, compared with baseline. Of the subjects who were sexually active at baseline, 58.8% (10/17), 68.8% (11/16), 80% (12/15), and 83.3% (15/18) reported less dyspareunia at 4, 8, 12, and 24 weeks, respectively. Dyspareunia Visual Analog Scale score significantly improved at weeks 12 (5.6, P = 0.011) and 24 (5.4, P = 0.004) compared with baseline (7.8). Two of the 4 patients who avoided sexual activity at baseline secondary to dyspareunia resumed and tolerated intercourse after Botox. Sexual dysfunction as measured by the Female Sexual Distress Scale significantly improved at 8 weeks (27.6, P = 0.005), 12 weeks (27.9, P = 0.006), and 24 weeks (22.6, P < 0.001) compared with baseline (34.5). The Short-Form 12 Health Survey (SF-12) showed improved QoL in the physical composite score at all post injections visits (42.9, 44, 43.1, and 45.5 vs 40 at baseline; P < 0.05), and in the mental composite score at both 12 and 24 weeks (44.3 and 47.8 vs 38.5, P = 0.012). Vaginal manometry demonstrated significant decrease in resting pressures and in maximum contraction pressures at all follow-up visits (P < 0.05). Digital assessment of PFM (on a scale from 0 to 4) showed decreased tenderness on all visits (mean of 1.9, 1.7, 1.8, 1.9; P < 0.001) compared with baseline (2.8). Reported postinjection adverse effects included worsening of the following preexisting conditions: constipation (28.6%), stress urinary incontinence (4.8%), fecal incontinence (4.8%), and new onset stress urinary incontinence (4.8%). CONCLUSIONS:Electromyography-guided Botox injection into PFM could be beneficial for women with refractory HTPFD who have failed conservative therapy. 10.1097/SPV.0000000000000177
    A double-blind randomised controlled trial of laparoscopic uterine nerve ablation for women with chronic pelvic pain. Johnson N P,Farquhar C M,Crossley S,Yu Y,Van Peperstraten A M,Sprecher M,Suckling J BJOG : an international journal of obstetrics and gynaecology OBJECTIVE:To determine the effectiveness of laparoscopic uterine nerve ablation (LUNA) for chronic pelvic pain in women with endometriosis and women with no laparoscopic evidence of endometriosis. DESIGN:A prospective double-blind randomised controlled trial (RCT). SETTING:Single-centre, secondary-level gynaecology outpatient service and tertiary-level pelvic pain and endometriosis outpatient service in Auckland, New Zealand. POPULATION:One hundred and twenty-three women undergoing laparoscopy for investigation and management of chronic pelvic pain, 56 with no laparoscopic evidence of endometriosis and 67 with endometriosis. METHODS:Women were randomised from the two populations, firstly those with no evidence of endometriosis and secondly those undergoing laparoscopic surgical treatment for endometriosis, to receive LUNA or no LUNA. Participant and assessor blinding was employed. Follow up for pain outcomes was undertaken at 24 hours, 3 months and 12 months. MAIN OUTCOME MEASURES:Changes in non-menstrual pelvic pain, dysmenorrhoea, deep dyspareunia and dyschezia were assessed primarily by whether there was a decrease in visual analogue score for these types of pain of 50% or more from baseline and additionally whether there was a significantly different change in median visual analogue score. The numbers requiring further surgery or starting a new medical treatment for pelvic pain and complications were also measured. RESULTS:There was a significant reduction in dysmenorrhoea at 12 month follow up in women with chronic pelvic pain in the absence of endometriosis who underwent LUNA (median change in visual analogue scale (VAS) from baseline -4.8 versus-0.8 (P= 0.039), 42.1%versus 14.3% experiencing a successful treatment defined as a 50% or greater reduction in visual analogue pain scale for dysmenorrhoea (P= 0.045). There was no significant difference in non-menstrual pelvic pain, deep dyspareunia or dyschezia in women with no endometriosis undergoing LUNA versus no LUNA. The addition of LUNA to laparoscopic surgical treatment of endometriosis was not associated with a significant difference in any pain outcomes. CONCLUSIONS:LUNA is effective for dysmenorrhoea in the absence of endometriosis, although there is no evidence of effectiveness of LUNA for non-dysmenorrhoeic chronic pelvic pain or for any type of chronic pelvic pain related to endometriosis. 10.1111/j.1471-0528.2004.00233.x
    Diagnosis, treatment and follow up of women undergoing conscious pain mapping for chronic pelvic pain: a prospective cohort study. Swanton A,Iyer L,Reginald P W BJOG : an international journal of obstetrics and gynaecology OBJECTIVE:To assess the efficacy of conscious pain mapping in diagnosing and treating chronic pelvic pain (CPP). DESIGN:Prospective cohort study. Setting Gynaecology Department, UK District General Hospital. POPULATION:Forty-three women diagnosed with CPP. METHODS:The cohort was followed up for 18-24 months after diagnosis and treatment based on conscious pain mapping. MAIN OUTCOME MEASURES:Improvement of pain assessed by using visual analogue scale (VAS) pain scores at 6-month follow up. RESULTS:Thirty-nine women had successful conscious pain mapping. Pelvic pathology was identified in 18, pelvic congestion in 13 and 8 women had normal pelvic organs. In 35 women (90%), conscious pain mapping identified the cause of pain. Five out of eight women (63%) who were judged to have a normal pelvis had positive findings at pain mapping. VAS scores fell significantly from pre-treatment to post-treatment values at 6-month follow up (P < 0.01). Overall, 26 women (74%) felt that their symptoms had improved after treatment based on findings at pain mapping. However, we concluded that pain mapping only contributed to the diagnosis and treatment in seven women (27%), who may not have received appropriate diagnosis and treatment if they had a laparoscopy under general anaesthetic. Conclusions CONSCIOUS: pain mapping is a useful additional investigation in the management of women with CPP. It can be employed in women with a negative laparoscopy or with visible pathology where the conventional treatment has failed. 10.1111/j.1471-0528.2006.00976.x
    Postoperative medical treatment of chronic pelvic pain related to severe endometriosis: levonorgestrel-releasing intrauterine system versus gonadotropin-releasing hormone analogue. Bayoglu Tekin Yesim,Dilbaz Berna,Altinbas Sadiman Kiykac,Dilbaz Serdar Fertility and sterility OBJECTIVE:To compare efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS; Mirena) with depot GnRH analogue (GnRH-a; gosareline acetate; Zoladex) on endometriosis-related chronic pelvic pain (CPP) in patients with severe endometriosis during 12 months. DESIGN:Prospective, randomized, controlled study. SETTING:The reproductive endocrinology unit of a tertiary, research and education hospital. PATIENT(S):Forty women with severe endometriosis (revised The American Fertility Society [AFS] classification >40) and endometriosis-related CPP and control groups were enrolled in the study. INTERVENTION(S):The patients were treated with either LNG-IUS (n = 20) or GnRH-a (n = 20). The GnRH-a dose was repeated every 4 weeks for 24 weeks. MAIN OUTCOME MEASURE(S):Scores of CPP were evaluated using a visual analogue scale (VAS) and total endometriosis severity profile (TESP). RESULT(S):The TESP score decreased in the LNG-IUS group at first, third, and sixth month follow-up visits, whereas at the 12th month follow-up visit, the TESP scores were increased to values similar to pretreatment values. Although the VAS score had no significant alteration during the follow-up period in the LNG-IUS group, the GnRH-a group showed a significant decrease in the VAS score and TESP score at the end of 1 year. The LNG-IUS treatment showed a lower patient satisfaction. CONCLUSION(S):Both treatment modalities showed comparable effectiveness in the treatment of CPP-related endometriosis. 10.1016/j.fertnstert.2010.08.042
    Effectiveness of complementary pain treatment for women with deep endometriosis through Transcutaneous Electrical Nerve Stimulation (TENS): randomized controlled trial. Mira Ticiana A A,Giraldo Paulo C,Yela Daniela A,Benetti-Pinto Cristina L European journal of obstetrics, gynecology, and reproductive biology OBJECTIVE:Evaluate TENS effectiveness as a complementary treatment of chronic pelvic pain and deep dyspareunia in women with deep endometriosis. STUDY DESIGN:This randomized controlled trial was performed in a tertiary health care center, including twenty-two women with deep endometriosis undergoing hormone therapy with persistent pelvic pain and/or deep dyspareunia. This study was registered in the Brazilian Record of Clinical Trials (ReBEC), under n RBR-3rndh6. TENS application for 8 weeks followed a randomized allocation into two groups: Group 1 - acupuncture-like TENS (Frequency: 8Hz, pulse duration: 250μs) - VIF (n=11) and Group 2 - self-applied TENS (Frequency: 85Hz, pulse duration: 75μs) (n=11). The intensity applied was "strong, but comfortable". We evaluated patients before and after treatment by the use of the Visual Analogue Scale, Deep Dyspareunia Scale and Endometriosis Quality of Life Questionnaire. We used the Wilcoxon and Mann-Whitney tests to compare before and after treatment conditions. RESULTS:Despite the use of hormone therapy for 1.65±2.08 years, the 22 women with deep endometriosis sustained pelvic pain complaints (VAS=5.95±2.13 and 2.45±2.42, p<.001) and/or deep dyspareunia (DDS=2.29±0.46 and 1.20±1.01, p=.001). We observed significant improvement for chronic pelvic pain, deep dyspareunia and quality of life by the use of TENS. Both application types of TENS were effective for improving the evaluated types of pain. CONCLUSIONS:Both resources (acupuncture-like TENS and self-applied TENS) demonstrated effectiveness as a complementary treatment of pelvic pain and deep dyspareunia, improving quality of life in women with deep endometriosis regardless of the device used for treatment. 10.1016/j.ejogrb.2015.07.009
    Use of intravaginal electrical stimulation for the treatment of chronic pelvic pain: a randomized, double-blind, crossover clinical trial. de Bernardes Nicole Oliveira,Marques Andrea,Ganunny Camila,Bahamondes Luis The Journal of reproductive medicine OBJECTIVE:To assess the efficacy of intravaginal electrical stimulation (IVES) or placebo in women with chronic pelvic pain (CPP) with no apparent cause. STUDY DESIGN:A double-blind, crossover, randomized clinical trial in which 26 women were randomly allocated to active (group I, n = 15) or placebo (group II, n = 11) IVES. All women underwent 10 30-minute, twice-weekly sessions. The groups were then crossed over for a further 10 sessions. Pain was evaluated using a visual analog scale (VAS) before and after each series. RESULTS:At the end of the first series, 5 of 11 women who initiated with the placebo had a VAS pain score > 3 (p = 0.0253); however, when they crossed over to active IVES, only 1 had a VAS pain score > 3 at the end of the series (p = 0.0143). In the 15 women who initiated with active IVES, 2 had a score > 3 at the end of the series (p = 0.0005); however, when they crossed over to the placebo, 3 had a VAS pain score > 3 at the end of treatment (p = 0.0833). After the 2 sessions, 54.6% who initiated with placebo and 80% who initiated with active IVES had a VAS pain score < 3. CONCLUSION:Intravaginal electrical stimulation was more effective than a placebo in alleviating pain in women with CPP.
    Laparoscopic uterosacral nerve ablation for alleviating chronic pelvic pain: a randomized controlled trial. Daniels Jane,Gray Richard,Hills Robert K,Latthe Pallavi,Buckley Laura,Gupta Janesh,Selman Tara,Adey Elizabeth,Xiong Tengbin,Champaneria Rita,Lilford Richard,Khan Khalid S, JAMA CONTEXT:Chronic pelvic pain is a common condition with a major effect on health-related quality of life, work productivity, and health care use. Operative interruption of nerve trunks in the uterosacral ligaments by laparoscopic uterosacral nerve ablation (LUNA) is a treatment option for patients with chronic pelvic pain. OBJECTIVE:To assess the effectiveness of LUNA in patients with chronic pelvic pain. DESIGN, SETTING, AND PARTICIPANTS:Randomized controlled trial of 487 women with chronic pelvic pain lasting longer than 6 months without or with minimal endometriosis, adhesions, or pelvic inflammatory disease, who were recruited to the study by consultant gynecological surgeons from 18 UK hospitals between February 1998 and December 2005. Follow-up was conducted by questionnaires mailed at 3 and 6 months and at 1, 2, 3, and 5 years. INTERVENTION:Bilateral LUNA or laparoscopy without pelvic denervation (no LUNA); participants were blinded to the treatment allocation. MAIN OUTCOME MEASURES:The primary outcome was pain, which was assessed by a visual analogue scale. Data concerning the 3 types of pain (noncyclical pain, dysmenorrhea, and dyspareunia) were analyzed separately as was the worst pain level experienced from any of these 3 types of pain. The secondary outcome was health-related quality of life, which was measured using a generic instrument (EuroQoL EQ-5D and EQ-VAS). RESULTS:After a median follow-up of 69 months, there were no significant differences reported on the visual analogue pain scales for the worst pain (mean difference between the LUNA group and the no LUNA group, -0.04 cm [95% confidence interval {CI}, -0.33 to 0.25 cm]; P = .80), noncyclical pain (-0.11 cm [95% CI, -0.50 to 0.29 cm]; P = .60), dysmenorrhea (-0.09 cm [95% CI, -0.49 to 0.30 cm]; P = .60), or dyspareunia (0.18 cm [95% CI, -0.22 to 0.62 cm]; P = .40). No differences were observed between the LUNA group and the no LUNA group for quality of life. CONCLUSION:Among women with chronic pelvic pain, LUNA did not result in improvements in pain, dysmenorrhea, dyspareunia, or quality of life compared with laparoscopy without pelvic denervation. TRIAL REGISTRATION:controlled-trials.com Identifier: ISRCTN41196151. 10.1001/jama.2009.1268
    Salivary cortisol concentrations, stress and quality of life in women with endometriosis and chronic pelvic pain. Petrelluzzi K F S,Garcia M C,Petta C A,Grassi-Kassisse D M,Spadari-Bratfisch R C Stress (Amsterdam, Netherlands) The objective of this study was to evaluate the perceived stress index, quality of life, and hypothalamus-pituitary-adrenal axis activity in women with endometriosis and chronic pelvic pain. For the study, 93 women with endometriosis and 82 healthy women volunteered. The visual analogue scale (VAS) (0=no pain; 10=severe pain) was used to determine pain intensity; the perceived stress questionnaire (PSQ) defined stress index, and the health-related quality-of-life (HRQOL)-SF-36 questionnaire was used to evaluate quality of life. Salivary cortisol was measured at 0800, 1600, and 2000 h and the awakening cortisol response was assessed to evaluate the hypothalamus-pituitary-adrenal axis activity. The results show that women with endometriosis and chronic pelvic pain of moderate intensity (4.1+/-0.58, mean+/-SEM) have higher levels of perceived stress (0.55+/-0.01 versus 0.42+/-0.01, p<0.05), a poorer quality of life expressed as lower scores for all items of the inventory and hypocortisolism. Lower levels of salivary cortisol were observed in all three samples collected, as well as in the awakening cortisol response, for women with endometriosis (0.19+/-0.09 microg/dl) when compared with controls (0.78+/-0.08 microg/dl, p<0.05 l), and it was independent of pain intensity and Mental health (MH) scores in SF-36. We concluded that women with endometriosis and chronic pelvic pain show low concentrations of salivary cortisol and a high level of perceived stress, associated with a poor quality of life. Whether the hypocortisolism was an adaptive response to the aversive symptoms of the disorder or a feature related to the etiology of endometriosis remains to be elucidated. 10.1080/10253890701840610
    The effect of chronic pelvic pain scoring on pre-term delivery rate. Bayram C,Osmanağaoğlu M A,Aran T,Güven S,Bozkaya H Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology A total of 57 pregnant women, who were admitted to the outpatient clinic having high visual analogue scale (VAS) and a history of chronic pelvic pain before pregnancy, were evaluated with the international pelvic pain assessment form (IPPAF). Gynaecological disorders, pain at ovulation, dysmenorrhoea, level of cramps with period and suspicion of endometriosis were determined to be higher in the pre-term group (p < 0.05). Regarding urological disorders, pain when the bladder was full, pain with urination, a positive answer to the question, 'Does your urgency bother you?' and suspicion of interstitial cystitis were also determined to be higher in the pre-term group (p < 0.05). Thus, the total IPPAF scores were significantly higher in the pre-term group (p < 0.05). The pregnant women with a higher total IPPAF score before pregnancy may thus have a higher probability of pre-term labour. 10.3109/01443615.2012.727044
    Effects of yogic intervention on pain scores and quality of life in females with chronic pelvic pain. Saxena Rahul,Gupta Manish,Shankar Nilima,Jain Sandhya,Saxena Arushi International journal of yoga CONTEXT:Chronic pelvic pain (CPP) is a common condition of women of the reproductive age group. It has a negative impact on a woman's personal health and quality of life (QOL). Practicing yoga has shown numerous benefits in various chronic painful conditions. AIM:To study the effects of yogic intervention on pain scores and quality of life in females of reproductive age group with CPP, on conventional therapy. SETTINGS AND DESIGN:It is a follow-up, randomized case-control study done in a tertiary care hospital. SUBJECTS AND METHODS:Sixty female patients of CPP in the age group of 18-45 years were randomly divided into Group I ( = 30) and Group II ( = 30). Group I received only conventional therapy in the form of NSAIDS and Group II received yoga therapy in the form of asanas, pranayama, and relaxation along with the conventional therapy for 8 weeks. They were assessed twice (pre- and post-treatment) for pain scores through visual analog scale (VAS) score and QOL by the World Health Organization quality of life-BREF (WHOQOL-BREF) questionnaire. STATISTICAL ANALYSIS USED:Repeated measure ANOVA followed by Tukey's test. < 0.05 was considered significant. RESULTS:After 8 weeks of yogic intervention, Group II patients showed a significant decrease in intensity of pain seen by a decrease in VAS score ( < 0.001) and improvement in the quality of life with a significant increase ( < 0.001) in physical, psychological, social, and environmental domain scores of WHOQOL-BREF. CONCLUSIONS:The practice of yoga causes a reduction in the pain intensity and improves the quality of life in patients with chronic pelvic pain. 10.4103/0973-6131.186155
    Effect of Acupuncture on Chronic Pelvic Pain Secondary to Abdominal Myofascial Syndrome Not Responsive to Local Anesthetic Block: A Pilot Study. Mitidieri Andréia Moreira de Souza,Gurian Maria Beatriz Ferreira,da Silva Ana Paula Moreira,Poli-Neto Omero Benedicto,Nogueira Antônio Alberto,Candido-Dos-Reis Francisco José,Rosa-E-Silva Júlio César Medical acupuncture Strong evidence shows that 85% of women with chronic pelvic pain (CPP) have musculoskeletal disorders, such as abdominal myofascial pain syndrome (AMPS). The aim of this research was to assess the efficacy of local acupuncture treatment for women with CPP secondary to AMPS unresponsive to treatment with trigger-point injection. This pilot study involved 17 women with moderate-to-severe AMPS-related CPP. Acupuncture treatments were given at abdominal-wall trigger points once per week for 10 consecutive weeks. Pain relief was assessed with a visual analogue scale (VAS), the McGill questionnaire, and pressure dynamometer. Quality of life and psychosocial function (risk for anxiety and depression) were evaluated using the Short-Form-36 questionnaire and the Hospital Anxiety and Depression scale. Assessments were performed at baseline and after 1, 3, and 6 months of treatment. Both the VAS and McGill pain questionnaire showed significantly decreased pain intensity (VAS,  < 0.001; and McGill, 0.049), and the effects were sustained even at 6 months after treatment. Acupuncture treatment was effective for the women who participated in this study, and the current authors believe that these preliminary results suffice to recommend performing randomized controlled trials. 10.1089/acu.2017.1248
    The efficacy of Implanon for the treatment of chronic pelvic pain associated with pelvic congestion: 1-year randomized controlled pilot study. Shokeir Tarek,Amr Mostafa,Abdelshaheed Mahmoud Archives of gynecology and obstetrics OBJECTIVE:To evaluate the beneficial effects of Implanon on pelvic pain in women with pelvic congestion syndrome (PCS). The efficacy of pain control, amount and frequency of menstrual loss, degree of patient's satisfaction and objective pelvic venography scores were investigated. METHODS:In a prospective open-labelled study, 25 consecutive women complaining of chronic pelvic pain were recruited. Pretreatment objective peruterine venography and diagnostic laparoscopy of pure PCS together with subjective pelvic pain scores, prefilled questionnaire of Hospital Anxiety and Depression Scale (HADS), visual analogue scale (VAS), verbal rating scale (VRS) and quantified menstrual loss using the pictorial blood loss chart were documented in all cases. After identification, 23 subjects with pure PCS were randomly assigned to have either Implanon inserted subcutaneously (12 cases) or no treatment (11 cases). Patients were followed up at 1, 3, 6, 9 and 12 months. A symptom diary for side effects, VAS, VRS and menstrual scores were used to assess the subjective response to treatment. At the end of the study, all patients underwent repeat venography to assess the long-term objective response. After 12 months, subjects having Implanon inserted were requested to rate their overall degree of satisfaction with therapy. RESULTS:All 25 women recruited in the study completed follow-up. Two cases were excluded from the study and referred to the psychiatry department after a negative evaluation for disease and HADS scores relevant for depression. An improvement in symptoms was observed throughout the 12 months amongst the Implanon group versus no treatment. The greatest changes in pain assessed using either the VAS or VRS were between the pretreatment scores and those after 6 months (7.7 +/- 1.3 vs. 4.6 +/- 3.0 for VAS, P < 0.001; and 25 +/- 13.8 vs. 19 +/- 18.9 for VRS, P < 0.002). The monthly quantified blood loss fell from 204 (196) pretreatment to 90 (157) at 6 months (P < 0.001) and then to 64 (32) at 9 months (P < 0.002). Objective repeat venography score was reduced significantly at 1 year after treatment compared with the baseline evaluation as well as with the control group (4.5 +/- 1.2 vs. 8.6 +/- 0.5; P = 0.001 and 4.2 +/- 0.9 vs. 8.5 +/- 0.6; P = 0.0002, respectively). At final satisfaction assessment, 2 (17%) women were very satisfied 8 (66%) were satisfied, and 2 (17%) were uncertain. The implant was retained by all women at the end of the study. CONCLUSION:Implanon seems to be an effective hormonal alternative for long-term treatment of properly selected patients with pure PCS-related pelvic pain. 10.1007/s00404-009-0951-1
    [Chronic pelvic pain in patients with endometriosis: results of laparoscopic treatment]. Teodoro M C,Genovese F,Rubbino G,Palumbo M,Zarbo G Minerva ginecologica AIM:The chronic pelvic pain (CPP) linked to endometriosis, relatively frequent condition in women of reproductive age, often represents the main complaint for which the patient seeks medical advice. The purpose of this prospective study was to evaluate if and to which extent systematic ablation of endometriotic lesions causes an improvement and/or disappearance of pain in patients with ascertained endometriosis and in whom the main preoperative symptom is chronic pelvic pain. METHODS:This study examined 109 patients, affected by chronic pelvic pain secondary to endometriosis, underwent laparoscopic treatment. All patients in the preoperative phase and only the 92 coming back for follow up, were asked both to fill out an anonymous questionnaire about their quality of life and to indicate on a numeric visual analogue scale (VAS) the intensity of the perceived pain. RESULTS:Overall the median of the VAS score for pain decreased from 7.5 before surgery to 2.5 at one-year postoperative-follow up, which was consistent (Wilcoxon test) with a statistically significant regression (P<0.0001) of the intensity of perceived pain (disappearance or marked reduction) in the operated patients, independently from the stage of the disease and the type of pain; also data on quality of life during work and social activity indicated a relevant improvement respectively in 82% and in 83% of patients following the laparoscopic procedure. CONCLUSION:For this reason and as suggested by the present international guidelines, when the medical therapy against pain fails and/or in the presence of an adnexal mass (chocolate cyst) or deep endometriotic lesion, it is generally correct to rely on surgical ablation of the lesions preferably by laparoscopy.
    Continuing improvement of chronic pelvic pain in women after short-term Mensendieck somatocognitive therapy: results of a 1-year follow-up study. Haugstad Gro K,Haugstad Tor S,Kirste Unni M,Leganger Siv,Wojniusz Slawomir,Klemmetsen Inger,Malt Ulrik F American journal of obstetrics and gynecology OBJECTIVES:Chronic pelvic pain is a common source of disability among women in the western world. Here we report that 3 months of Mensendieck somatocognitive intervention in chronic pelvic pain patients was followed by continued improvements of outcomes at 1-year follow-up in a randomized, controlled study design. METHODS:Forty women with chronic pelvic pain unexplained by pelvic pathology were randomly assigned to 2 groups: (1) standard gynecologic treatment and (2) gynecologic treatment plus somatocognitive therapy aimed at reducing physical pain by changing posture, movement, and respiration patterns. A standardized Mensendieck test (SMT) of motor function (assessing posture, movement, gait, sitting posture, and respiration), a self-rating questionnaire assessing psychologic distress and general well-being (GHQ-30) and a visual analog score of pain (VAS) were obtained before, after 90 days of treatment and 1 year after inclusion. RESULTS:Patients treated by standard gynecologic treatment/supervision did not improve significantly at 1-year follow-up in any of the test modalities. By contrast, those who in addition received somatocognitive therapy had improved scores for all motor functions and pain, as well as GHQ-30 scores for coping, and anxiety-insomnia-distress. CONCLUSION:Mensendieck somatocognitive therapy combined with standard gynecologic care improves psychologic distress, pain experience, and motor functions of women with chronic pelvic pain better than gynecologic treatment alone. The effect lasted and even further improvement occurred 9 months after treatment. 10.1016/j.ajog.2008.06.019
    Ovarian vein incompetence: a potential cause of chronic pelvic pain in women. Tropeano Giovanna,Di Stasi Carmine,Amoroso Sonia,Cina Alessandro,Scambia Giovanni European journal of obstetrics, gynecology, and reproductive biology OBJECTIVE(S):To evaluate whether ovarian vein incompetence may be a source of chronic pelvic pain (CPP) in women. STUDY DESIGN:Twenty-two women, aged 19-50 years, with chronic pelvic pain, no laparoscopically detected pelvic pathology, and evidence of reflux in dilated pelvic veins on transvaginal color Doppler ultrasound underwent retrograde ovarian venography and sclerotherapy of the ovarian vein(s) if incompetent. The primary outcome was symptom change as assessed by a symptom questionnaire and visual analog pain scales (VAS) at 3, 6, and 12 months of follow-up. Changes in pelvic circulations after sclerotherapy procedure were also evaluated by serial ultrasound examinations. Differences between baseline and post-procedural VAS scores were analysed using the Wilcoxon signed-rank test. RESULTS:Twenty (91%) of the 22 women had venographic evidence of incompetent ovarian vein(s) and received sclerotherapy. There were no immediate or late complications. Variable symptom relief was observed in 17 (85%) of the 20 treated women, with follow-up at 12 months showing marked-to-complete relief in 15 patients and mild-to-moderate relief in the remaining 2 patients. Three (15%) women had no improvement in symptoms. Median VAS scores at 3 (2.0), 6 (2.5), and 12 months (3.0) were significantly lower than at baseline (8.0) (P<.001). Follow-up ultrasound examinations showed absence of pelvic venous reflux in all but 3 patients, in whom recurrence of reflux was seen at 3 months. CONCLUSION(S):Ovarian vein sclerotherapy provided symptomatic relief and improved pelvic circulation in most patients. These findings suggest that ovarian vein incompetence was the likely source of chronic pain in these women, and that sclerotherapy was a safe and effective treatment for this condition. CONDENSATION:Ovarian vein incompetence leading to pelvic circulatory changes may be a cause of chronic pelvic pain in women. 10.1016/j.ejogrb.2007.11.006
    Relationship between chronic pelvic pain and functional constipation in women of reproductive age. Modesto Waleska Oliveira,Bahamondes Luis The Journal of reproductive medicine OBJECTIVE:To evaluate the effect of functional constipation on women with and without chronic pelvic pain (CPP). STUDY DESIGN:One hundred women ages 18-50 were separated into three groups: (A) women without CPP, (B) women with CPP but without functional constipation, and (C) women with CPP with functional constipation according to Rome III criteria. All participants were followed over 3 months, completing a questionnaire on pain and constipation daily. CPP was evaluated using a visual analog scale (VAS). RESULTS:In Group A, 16 of 31 women complained of lumpy or hard stools; 13 had symptoms of functional constipation. In Group B, 4 of 19 women had lumpy or hard stools. In Group C, 46 of 50 reported straining or incomplete bowel movements and 49 reported lumpy or hard stools. Regarding CPP, no significant differences were found in VAS pain score between Groups B and C; no changes were found in VAS pain score throughout the 12-week evaluation period. The most common diagnoses associated with CPP were idiopathic pain, endometriosis, and pelvic adhesions. CONCLUSION:Functional constipation was significantly more prevalent in women with CPP than women without CPP; however, it does not appear to have a role in worsening the pain.
    Effect of ultramicronized-palmitoylethanolamide and co-micronized palmitoylethanolamide/polydatin on chronic pelvic pain and quality of life in endometriosis patients: An open-label pilot study. Stochino Loi Emanuela,Pontis Alessandro,Cofelice Vito,Pirarba Silvia,Fais Maria Francesca,Daniilidis Angelos,Melis Irene,Paoletti Anna Maria,Angioni Stefano International journal of women's health Purpose:The aim of the present study was to evaluate the effectiveness of the ultramicronized-palmitoylethanolamide (um-PEA) and co-micronised palmitoylethanolamide/polydatin m(PEA/PLD) in the management of chronic pelvic pain related to endometriosis in patients desiring pregnancy. Patients and methods:Thirty symptomatic women with laparoscopic diagnosis of endometriosis and pregnancy desire were enrolled. Patients were treated with um-PEA twice daily for 10 days followed by m(PEA/PLD) twice daily for 80 days. Intensity of chronic pelvic pain, dyspareunia, dysmenorrhea, dyschezia, and dysuria were evaluated at baseline, after 10, 30, 60, 90 days and after 30 days from the end of treatment, by VAS. Quality of life and women's psychological well-being were evaluated at baseline and at the end of the treatment after 90 days with 36-Item Short Form Health Survey questionnaire and Symptom Check list-90 questionnaire, respectively. All collected data were analyzed with the non-parametric Wilcoxon test. Results:At the end of the treatment, all patients showed a significant improvement in chronic pelvic pain, deep dyspareunia, dysmenorrhea, dyschezia, as well as in quality of life and psychological well-being. Conclusion:In spite of the study's limited sample size and the open-label design, this research suggests the efficacy of um-PEA and m(PEA/PLD) in reducing painful symptomatology and improving quality of life as well as psychological well-being in patients suffering from endometriosis. Additionally, this treatment did not show any serious side effect, proving particularly suitable for women with pregnancy desire and without other infertility factors. 10.2147/IJWH.S204275
    Chronic pelvic pain improvement: impact on quality of life and mood. Cagnacci Angelo,Della Vecchia Elena,Xholli Anjeza Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology Women with chronic pelvic pain (CPP) frequently suffer from mood disturbances and reduced quality of life. Whether pain improvement ameliorates mood and quality of life is still unclear, and it was investigated in an observational prospective study performed in a cohort of 117 of the outpatient services for endometriosis and chronic pelvic pain at a University Hospital. Depending on disease, women were treated either by surgery or by the administration of an estrogen-progestin or a progestin alone. Pain during menses, between menses and at intercourse was evaluated by a 100 mm visual analog (VAS) scale. Quality of life was evaluated by the SF-36 questionnaire, state of anxiety by the Y-1 form of the State-Trait Anxiety Inventory (STAI-Y1) and depression the Self Evaluating Depression Scale (SDS). Women were 34.2 ± 8.1 years old. After a mean follow-up period of 10.0 ± 9.1 months, and independently on treatment (43.6% surgery), pain during menses (-28.2 ± 36.8; p<.0001), between menses (-11.3 ± 37.1; p<.002) and at intercourse (-8.3 ± 35.4; p<.02) decreased. SF-36 increased (3.3 ± 16.2; p<.03), STAI slightly decreased (-1.9 ± 8.6; p<.02), while depression did not change (-0.7 ± 7.8; p=.36). Pain changes were not related to changes of SF-36 or mood scores. In women with CPP, prolonged pain amelioration, has little impact on mood, particularly on depression. The data support the need for a multidisciplinary approach to women with CPP. 10.1080/09513590.2018.1540571
    Effects of long-term treatment with Dienogest on the quality of life and sexual function of women affected by endometriosis-associated pelvic pain. Caruso Salvatore,Iraci Marco,Cianci Stefano,Vitale Salvatore Giovanni,Fava Valentina,Cianci Antonio Journal of pain research Purpose:The aim of this prospective study was to evaluate quality of life (QoL) and sexual function of women affected by endometriosis pain treated with Dienogest (DNG) for 24 months. Patients and methods:Fifty-four women constituted the study group and were given DNG 2 mg/daily; 38 women were given non-steroidal anti-inflammatory drugs (NSAIDs) and constituted the control group. To define endometriosis-associated pelvic pain, dysmenorrhea and dyspareunia the Visual Analogic Scale (VAS) was used. The Short Form-36 (SF-36), the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS) were used to assess the QoL, sexual function and the sexual distress, respectively. The study included five follow-ups at 3, 6, 12, 18 and 24 months. Results:Slight improvements in chronic pelvic pain, dysmenorrhea and dyspareunia were observed in the study group at 3 months (<0.05) and improved more from 6 to 24 months of DNG treatment (<0.001). QoL improved with a similar trend: at 3 months the improvement was significant in several categories (<0.05), and from 6 to 24 months in all categories (<0.001). The FSFI score did not change at the 3 month follow-up (=not significant [NS]) but it improved from 6 to 24 months (<0.001). A similar trend was observed for the FSDS score (<0.001). No change was observed in the control group (=NS). Conclusion:Long-term treatment with DNG 2 mg once-daily in women with endometriosis-associated pelvic pain may have positive effects on the QoL and sexual life, confirming the observations of the previous study on the first 6 months of treatment. 10.2147/JPR.S207599
    History of childhood maltreatment and symptoms of anxiety and depression in women with chronic pelvic pain. Poli-Neto Omero Benedicto,Tawasha Kalil Antonio Salotti,Romão Adriana Peterson Mariano Salata,Hisano Marcel Kawashima,Moriyama Aska,Candido-Dos-Reis Francisco Jose,Rosa-E-Silva Júlio Cesar,Nogueira Antônio Alberto Journal of psychosomatic obstetrics and gynaecology OBJECTIVE:To determine the prevalence of physical, sexual and emotional abuse and physical and emotional neglect suffered by women with chronic pelvic pain (CPP) during childhood and whether these occurrences are associated with symptoms of pain, anxiety and depression. METHODS:A case-control study was conducted on 154 women older than 18 years, 77 of them healthy and 77 with CPP. A history of sexual, physical, and emotional abuse and physical and emotional neglect was determined using the Childhood Trauma Questionnaire (CTQ). Anxiety and depression symptoms were determined using the Hospital Anxiety and Depression (HAD) scale. Pain intensity was determined using a visual analog scale (VAS). The quantitative variables were compared by the Wilcoxon test, and the qualitative variables were compared by the Chi-square test or exact Fisher test when appropriate. Correlation between the CTQ, HAD and VAS scores was estimated by the Spearman's p coefficient. Independent association of the variables with the presence of CPP was determined by logistic multiple regression analysis. RESULTS:The prevalence of childhood maltreatment was 77.9% and 64.9%, respectively, for women with CPP and healthy women (p = 0.07). Emotional neglect was more frequent among women with CPP than among healthy women (58.4% versus 41.5%, p = 0.04). There was a moderate correlation between anxiety and depression symptoms and CTQ scores for women with CPP. Unemployment (OR = 4.15, 95% CI 1.73-9.94; OR =  3.30, 95% CI 1.26-8.55) was independently associated with the presence of CPP. CONCLUSIONS:Women with CPP reported emotional neglect abuse more frequently than healthy women. There was a direct correlation between maltreatment scores and anxiety and depression scores. On the other hand, CPP was independently associated only with unemployment. 10.1080/0167482X.2017.1306515
    Measurement of pain and anthropometric parameters in women with chronic pelvic pain. Gurian Maria Beatriz Ferreira,Mitidieri Andréia Moreira de Souza,da Silva Joyce Beatriz,da Silva Ana Paula Moreira,Pazin Carolina,Poli-Neto Omero Benedicto,Nogueira Antônio Alberto,dos Reis Francisco José Candido,Rosa-e-Silva Júlio César Journal of evaluation in clinical practice RATIONALE, AIMS AND OBJECTIVES:To analyse anthropometric parameters, clinical pain and experimental pain in women with chronic pelvic pain (CPP). METHODS:Ninety-one women with a clinical diagnosis of CPP, mean age of 40.03 ± 9.97 years, submitted to anthropometric evaluation based on body mass index (BMI) and percent body fat (%BF) using bioimpedance body composition monitor; pain intensity was determined by visual analogue scale (VAS), numerical categorical scale (NCS) and McGill Pain Questionnaire; experimental pain was determined by transcutaneous electrical nerve stimulation (TENS), and anxiety and depression symptoms were determined by the Hospital Anxiety and Depression scale. RESULTS:A total of 54.8% of the women showed %BF >32 risk of disease associated with obesity. Regarding the anthropometric data, a statistically significant difference was observed between groups for both BMI and %BF (P<0.0001). In the analysis of pain intensity by the VAS, NCS and total McGill, there was no significant difference between the groups, and experimental pain by TENS revealed significant difference only between the normal weight and overweight groups (P=0.0154). The results of anxiety symptoms were above the cut-off point in all groups, with no significant difference between them (P=0.3710). The depression symptoms were below the cut-off point in the normal weight group and above the cut-off point in the overweight and obese groups, 9.469(4.501) and 9.741(4.848), respectively, with no significant difference between them (P=0.6476). CONCLUSION:Evaluation of anthropometric parameters and pain measurements can be applied in clinical practice, making a contribution to the diagnosis and influencing the choice of a more effective treatment for women with CPP. 10.1111/jep.12221
    [Clinical profile of patients with chronic pelvic pain: a descriptive analysis]. Itza Fernando,Teba Fernando,Zarza Daniel,Salinas Jesús,Gomes Mario Archivos espanoles de urologia OBJECTIVES:The aim of this paper is to analyze the clinical profile of patients with chronic pelvic pain (CPP) to obtain a more accurate and fast clinical diagnosis. METHODS:In this retrospective and descriptive cross-sectional study, we recruited 64 patients with CPP (32 men and 32 women. Patients had confirmed diagnosis of CPP. History was done including past medical history, prior abdominal and pelvic surgery, practice of risk sports, start and evolution of the pain, and number of physicians visited. We evaluated pain intensity with a VAS scale, neuropathic characteristics of the pain with the DN4 questionnaire, anxiety and depression with the HAD Scale (HADS) and disability with the Oswestry Disability Index (ODI ). Pelvic floor evaluation integrated intrapelvic and extrapelvic muscles assessment. RESULTS:Average number of doctors visited was 6.4 for men and 10 for women. The VAS for men was 5.43 (± 2.29), for women 6.89 (± 1.89). The DN4 for men was 4.53 (± 2.2), for women 4.44 (± 2.2). The mean anxiety in men was 10.18 (±4.27) and for women 9 (± 4.6) and mean depression in men was 7.31 (± 4.88) and for women 7.16 (± 4). ODI for men was 26.7% (±2.2), for women 33.75% (± 2.2). CONCLUSION:We have defined a clinical profile of patients with CPP that can enable a better approach to the reality of these patients with diminished quality of life.
    A Novel, Non-opioid Treatment for Chronic Pelvic Pain in Women with Previously Treated Endometriosis Utilizing Pelvic-Floor Musculature Trigger-Point Injections and Peripheral Nerve Hydrodissection. Plavnik Kathy,Tenaglia Amy,Hill Charity,Ahmed Tayyaba,Shrikhande Allyson PM & R : the journal of injury, function, and rehabilitation BACKGROUND:Endometriosis is the abnormal growth of uterine tissue outside the uterine cavity that can cause chronic pain, dysmenorrhea, and dyspareunia. Although the disease is common and nonmalignant in nature, the symptoms can severely impact function and quality of life. Treatment options for endometriosis are limited and not well understood despite a growing need. OBJECTIVE:To determine the effectiveness of pelvic-floor musculature trigger-point injections and peripheral nerve hydrodissection in treating endometriosis symptoms, associated pain, and pelvic functionality. DESIGN:Retrospective longitudinal study case series. SETTING:Private practice. PATIENTS:Sixteen female patients with biopsy-confirmed endometriosis. INTERVENTIONS:Ultrasound-guided pelvic-floor trigger-point injections and peripheral nerve hydrodissection performed once a week for 6 weeks. MAIN OUTCOME MEASUREMENTS:Pelvic pain intensity as measured pretreatment and posttreatment by the 0 to 10 Visual Analogue Scale (VAS) and the Functional Pelvic Pain Scale (FPPS). RESULTS:Pretreatment, the mean VAS score was 6.0 (standard deviation [SD] 2.7), and posttreatment the mean VAS score was 2.9 (SD 2.6); P < .05, 95% confidence interval (CI) 1.16 to 4.97. The mean total FPPS score before treatment was 14.4 (SD 5.2) and posttreatment it was 9.1 (SD 5.8); P < .05, 95% CI 1.34 to 9.28. Analysis of the subcategories within the FPPS indicated that the improvement was statistically significant in the categories of intercourse, sleeping, and working. In the category of intercourse, the mean change in score after treatment was 1.3 (P < .05, 95% CI 0.26-2.31). In the category of sleeping, the mean change in score after treatment was 1.2 (P < .05, 95% CI 0.32-1.99). In the category of working, the mean change in score after treatment was 0.9 (P < .05, 95% CI 0.18-1.53). CONCLUSIONS:Analysis suggests that the treatment was effective at relieving pain related to endometriosis; it also reflected promise in improving overall pelvic function, particularly in relation to intercourse, working, and sleeping. 10.1002/pmrj.12258
    A randomized, placebo-controlled, double-blind study of hysteroscopic-guided pertubal diluted bupivacaine infusion for endometriosis-associated chronic pelvic pain. Shokeir Tarek,Mousa Sherif International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics OBJECTIVE:To assess the effectiveness of hysteroscopic-guided pertubal diluted bupivacaine infusion for endometriosis-associated chronic pelvic pain (CPP). METHODS:Between June 2010 and July 2013, a randomized, placebo-controlled, double-blind study was undertaken at Mansoura University Hospital, Mansoura, Egypt. Patients meeting inclusion criteria (laparoscopically confirmed endometriosis, patent fallopian tubes, ≥6 months CPP, pain score on visual analogue scale [VAS] >5) were randomly assigned using a computer-generated randomization sequence to receive either office hysteroscopic-guided pertubal diluted bupivacaine infusion (0.25%) or placebo. Response to treatment was assessed using subjective data for scores on VAS and a monthly verbal rating scale (VRSmonthly) at baseline and at 1, 2, and 3 months of follow-up. Additionally, women completed a questionnaire to evaluate the overall satisfaction at 3 months. RESULTS:Thirty patients were assigned to each group. In the bupivacaine group, VAS and VRSmonthly scores were significantly lower at 1, 2, and 3 months than at baseline (P<0.05 for all). Additionally, scores were significantly lower in the bupivacaine group than in the placebo group at 1, 2, and 3 months (P<0.05 for all). At 3 months, 22 (73%) women in the bupivacaine group expressed satisfaction, compared with 2 (7%) in the placebo group (P=0.18). CONCLUSION:Office pertubal hysteroscopic-guided diluted bupivacaine infusion could be used to manage endometriosis-associated CPP for at least 3 months. AEARCTR-0000573. 10.1016/j.ijgo.2015.03.043
    Quality of life and sexual function of women affected by endometriosis-associated pelvic pain when treated with dienogest. Caruso S,Iraci M,Cianci S,Casella E,Fava V,Cianci A Journal of endocrinological investigation PURPOSE:The aim of the study was to evaluate the effects of dienogest (DNG) on quality of life (QoL) and sexual function of women affected by endometriosis pain. METHODS:Fifty-four women constituted the study group and were given 2 mg/daily DNG; 48 women were given non-steroidal anti-inflammatory drugs and constitut ed the control group. To define the endometriosis-associated pelvic pain, the Visual Analogic Scale (VAS) was used. The Short Form-36 (SF-36), the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS) were used to assess the QoL, the sexual function and the sexual distress, respectively. The study included two follow-ups at 3 and 6 months. RESULTS:Pain improvement was observed in the study group at 3 (p < 0.05) and 6 months (p < 0.001) of treatment. At the 1st follow-up, women reported QoL improvements in some functions (p < 0.05); at the 2nd follow-up, they reported improvement in all categories (p < 0.001). The FSFI score did not change at the 1st follow-up (p = NS). On the contrary, at the 2nd follow-up, it improved with respect to the baseline (p < 0.05). At the 2nd follow-up, the FSFI score had risen to 27.8 (p < 0.001) and the FSDS score had dropped to 11.3 (p < 0.001). No change was observed in the control group (p = NS). CONCLUSIONS:The progressive reduction of the pain syndrome reported by women over the treatment period could contribute to improve the QoL and sexual life of women on DNG. 10.1007/s40618-015-0383-7
    Randomized trial of long-term effects of percutaneous tibial nerve stimulation on chronic pelvic pain. Istek Ayse,Gungor Ugurlucan Funda,Yasa Cenk,Gokyildiz Sule,Yalcin Onay Archives of gynecology and obstetrics OBJECTIVE:To evaluate the long-term effects of percutaneous tibial nerve stimulation (PTNS) on quality of life in women with chronic pelvic pain. MATERIALS AND METHODS:Thirty-three women with chronic pelvic pain were randomized into PTNS (n = 16) or control (n = 17) groups. In PTNS group, weekly PTNS in 30-min sessions for 12 weeks was performed whereas the control group received no stimulation. Present pain intensity-visual analog scale (PPI-VAS), short-form McGill pain questionnaire (SF-MPQ), and SF-36 were used at baseline, 12-week, and 6-month follow-up for the evaluation of pain intensity and quality of life. RESULTS:Two women (12.5 %) were cured, 7 (43.8 %) were much improved, 6 (37.5 %) were the same and 1 (6.3 %) was worse after PTNS. Two women (11.8 %) were improved, 10 (58.8 %) were the same, and 5 (29.4 %) were worse in the control group. Mean PPI-VAS of PTNS group at baseline, 12 weeks, and 6 months was 8.4 ± 1.1, 3.8 ± 3.5 and 4.5 ± 3.7, respectively. There was a significant improvement in PPI-VAS scores of PTNS group whereas no change was observed in the control group. There was a slight increase in the PPI-VAS scores of the PTNS group at 6-month, but the difference was not statistically significant. There was significant improvement in all domains of SF-MPQ and SF-36 in PTNS group with continuing effects at 6 months whereas no significant change was observed in the control group. CONCLUSION:PTNS is a minimally invasive treatment method that leads to decrease in pain severity and improvement in quality of life in women with chronic pelvic pain with effects continuing at 6 months. 10.1007/s00404-014-3190-z
    Chronic pelvic pain, quality of life and sexual health of women treated with palmitoylethanolamide and α-lipoic acid. Caruso S,Iraci Sareri M,Casella E,Ventura B,Fava V,Cianci A Minerva ginecologica AIM:The aim of this paper was to evaluate the effects of the association between palmitoylethanolamide (PEA) and α-lipoic acid (LA) on quality of life (QoL) and sexual function in women affected by endometriosis-associated pelvic pain. METHODS:Fifty-six women constituted the study group and were given PEA 300 mg and LA 300mg twice daily To define the endometriosis-associated pelvic pain, the visual analogic scale (VAS) was used. The Short Form-36 (SF-36), the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS) were used to assess the QoL, the sexual function and the sexual distress, respectively. The study included three follow-ups at 3, 6 and 9 months. RESULTS:No changes were observed in pain, QoL and sexual function at the 3rd month follow-up (P=NS). By the 6th and 9th month, pain symptoms (P<0.001) and all categories of the QoL (P<0.001) improved. The FSFI and the FSDS scores did not change at the 3rd month follow-up (P=ns). On the contrary, at the 3rd and 9th months follow-ups they improved with respect to the baseline (P<0.001). CONCLUSION:The progressive reduction of the pain syndrome reported by women over the treatment period could contribute to improve the QoL and sexual life of women on PEA and LA.
    Pelvic pain and quality of life of women with endometriosis during quadriphasic estradiol valerate/dienogest oral contraceptive: a patient-preference prospective 24-week pilot study. Grandi Giovanni,Xholli Anjeza,Napolitano Antonella,Palma Federica,Cagnacci Angelo Reproductive sciences (Thousand Oaks, Calif.) OBJECTIVE:The progestin dienogest (DNG) given alone effectively reduces pelvic pain of women with endometriosis. It is not clear whether the same occurs when DNG is associated with estradiol (E2). DESIGN:Patient preference prospective observational study. SETTING:Outpatient centre of university hospital. PATIENTS:40 patients with endometriosis and menstrual pain. INTERVENTIONS:24-week treatment with a quadriphasic association of E2 valerate (E2V) and DNG or a nonsteroidal anti-inflammatory drug (NSAID) to be used only in case of pain (ketoprofene 200-mg tablets). MAIN OUTCOME MEASURES:Menstrual pain and, when present, intermenstrual pain, and dyspareunia were investigated by means of a 10-cm visual analogue scale (VAS). Quality of life was investigated by the short form 36 (SF-36) of the health-related quality of life questionnaire. RESULTS:Final study group consists of 34 patients, 19 in the E2V/DNG group and 15 in the NSAID group. After 24 weeks, no significant modification of menstrual pain, intermenstrual pain, dyspareunia, or SF-36 score was observed in the NSAID group. Treatment with E2V/DNG reduced the VAS score of menstrual pain by 61% (P < .0001). In the subgroups of women with intermenstrual pain or dyspareunia, E2V/DNG reduced these complaints by 65% (P = .013) and 52% (P = .016), respectively. The reduction in menstrual (P = .0001) and intermenstrual pain (p = 0.03) was significantly greater during E2V/DNG than NSAID. Quality of life improved during E2V/DNG (P = .0002), both in physical (P = .0003) and mental domains (P = .0065). Only a few minor adverse effects were described during E2V/DNG, and none caused withdrawal from treatment. CONCLUSION:In patients with endometriosis and pelvic pain, the 24-week administration of the quadriphasic association of E2V/DNG decreases pelvic pain and improves quality of life. 10.1177/1933719114556488
    Treatment strategies for pelvic pain associated with adenomyosis. Radzinsky V E,Khamoshina M B,Nosenko E N,Dukhin A O,Sojunov M A,Orazmuradov A A,Lebedeva M G,Orazov M R Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology OBJECTIVE:To observe the effects of levonorgestrel-releasing intrauterine system (LNG-IUS) in treatment of chronic pelvic pain associated with adenomyosis (AM) and in prevention of its recurrence. METHODS:A prospective continuing study including 180 patients with chronic pelvic pain associated with AM who received insertion of LNG-IUS who were divided into three groups depending on the pain severity. The visual analog scale (VAS) was used for pain assessment before and during the treatment and transvaginal ultrasonic measurement of the uterine size, while various side effects, were observed and recorded. RESULTS:After placement of LNG-IUS, scores of pain and ratio of severe pelvic pain decreased significantly compared with baselines (p < 0.01), the scores of VAS were 9.0 ± 0.8, 6.5 ± 2.8, 4.3 ± 1.8, 3.3 ± 2.2, 2.2 ± 2.1, 2.2 ± 1.8, 1.4 ± 1.6 and 1.3 ± 1.3 at 0, 3, 6 and 12 months, respectively. During 12 months after placement of LNG-IUS, scores of pain had improved significantly compared with preceding period (p < 0.01). We found no universal dependent factors predicting improvement of pain, which was neither relevant with simultaneous changes of menstruation patterns nor with adverse effects (p > 0.005). CONCLUSION:The obtained results allowed to confirm the possibility of using LNG-IUS in the treatment of pelvic pain syndrome associated with AM, particularly with mild and moderately severe pelvic pain syndrome. This is a cost effective, reversible and long-term treatment for women with pelvic pain associated with AM, which reduces the need for surgical interventions. 10.1080/09513590.2016.1232673
    Potentized estrogen in homeopathic treatment of endometriosis-associated pelvic pain: A 24-week, randomized, double-blind, placebo-controlled study. Teixeira Marcus Zulian,Podgaec Sérgio,Baracat Edmund Chada European journal of obstetrics, gynecology, and reproductive biology OBJECTIVE:To evaluate the efficacy and safety of potentized estrogen compared to placebo in homeopathic treatment of endometriosis-associated pelvic pain (EAPP). STUDY DESIGN:The present was a 24-week, randomized, double-blind, placebo-controlled trial that included 50 women aged 18-45 years old with diagnosis of deeply infiltrating endometriosis based on magnetic resonance imaging or transvaginal ultrasound after bowel preparation, and score≥5 on a visual analogue scale (VAS: range 0 to 10) for endometriosis-associated pelvic pain. Potentized estrogen (12cH, 18cH and 24cH) or placebo was administered twice daily per oral route. The primary outcome measure was change in the severity of EAPP global and partial scores (VAS) from baseline to week 24, determined as the difference in the mean score of five modalities of chronic pelvic pain (dysmenorrhea, deep dyspareunia, non-cyclic pelvic pain, cyclic bowel pain and/or cyclic urinary pain). The secondary outcome measures were mean score difference for quality of life assessed with SF-36 Health Survey Questionnaire, depression symptoms on Beck Depression Inventory (BDI), and anxiety symptoms on Beck Anxiety Inventory (BAI). RESULTS:The EAPP global score (VAS: range 0 to 50) decreased by 12.82 (P<0.001) in the group treated with potentized estrogen from baseline to week 24. Group that used potentized estrogen also exhibited partial score (VAS: range 0 to 10) reduction in three EAPP modalities: dysmenorrhea (3.28; P<0.001), non-cyclic pelvic pain (2.71; P=0.009), and cyclic bowel pain (3.40; P<0.001). Placebo group did not show any significant changes in EAPP global or partial scores. In addition, the potentized estrogen group showed significant improvement in three of eight SF-36 domains (bodily pain, vitality and mental health) and depression symptoms (BDI). Placebo group showed no significant improvement in this regard. These results demonstrate superiority of potentized estrogen over placebo. Few adverse events were associated with potentized estrogen. CONCLUSIONS:Potentized estrogen (12cH, 18cH and 24cH) at a dose of 3 drops twice daily for 24 weeks was significantly more effective than placebo for reducing endometriosis-associated pelvic pain. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT02427386. 10.1016/j.ejogrb.2017.01.052
    Efficacy of acupuncture on pelvic pain in patients with endometriosis: study protocol for a randomized, single-blind, multi-center, placebo-controlled trial. Liang Ruining,Li Peishuang,Peng Xuemei,Xu Ling,Fan Pei,Peng Jiahua,Zhou Xu,Xiao Chunlin,Jiang Miao Trials BACKGROUND:Endometriosis is a chronic gynecological disease that is characterized by the presence of endometrial tissue outside the uterine cavity. The main symptoms include dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility. These symptoms impair the lives of most of the women suffering from the disease. Surgical resection of endometriotic lesions is an effective means of treating dysmenorrhea, but the risk of recurrence is high. Western medicine has limited use for treating it due to side effects and ineffectiveness. The purpose of this study is to verify the effectiveness and safety of acupuncture. METHODS/DESIGN:This trial will be carried out in four parts. A total of 106 eligible patients with pelvic pain related to endometriosis will be randomly assigned into two groups, in a 1:1 ratio, as the treatment group or the control group. The participants assigned to the treatment group will be treated with acupuncture treatment at Guanyuan (CV4), Sanyinjiao (SP6), Taichong (LR3), Zhaohai (KI6) and Qichong (ST30) while the control group will receive acupuncture at non-acupoints. The trial will include three menstrual cycles of treatment and three menstrual cycles of follow-up. The primary outcome is pelvic pain that will be assessed by means of a 10-cm visual analog scale (VAS). At each stage, we will evaluate the safety of the acupuncture treatment. DISCUSSION:The study will compare the effectiveness and safety of acupuncture with comfort needles on pelvic pain related to endometriosis in the hope of providing significant evidence for using acupuncture on pelvic pain related to endometriosis. TRIAL REGISTRATION:ClinicalTrials.gov, ID: NCT03125304 . Registered on 30 April 2017. 10.1186/s13063-018-2684-6
    Should women with chronic pelvic pain have adhesiolysis? Cheong Ying C,Reading Isobel,Bailey Sarah,Sadek Khaled,Ledger William,Li Tin C BMC women's health BACKGROUND:Pelvic adhesions are found in up to 50% of women with CPP during investigative surgeries and adhesiolysis is often performed as part of their management although the causal or casual association of adhesions, and the clinical benefit of adhesiolysis in the context of CPP is still unclear. Our aim was to test the hypothesis of whether laparoscopic adhesiolysis leads to significant pain relief and improvement in quality of life (QoL) in patients with chronic pelvic pain (CPP) and adhesions. METHODS:This was a double-blinded RCT. This study was conducted in 2 tertiary referral hospitals in United Kingdom over 4 years. Women with chronic pelvic pain (CPP) were randomized into having laparoscopic adhesiolysis or diagnostic laparoscopy. Women were assessed at 0, 3 and 6 months for Visual analogue scale scores (VAS) and Quality of Life (QoL) measures (SF-12 and EHP-30). RESULTS:A total of 92 participants were recruited; 50 qualified to be randomized, with 26 in the adhesiolysis and 24 in the control group. The results are expressed in median (interquartile ranges). In women who underwent adhesiolysis, there was a significant improvement at 6 months in VAS scores (-17.5 (-36.0 - -5.0) compared to controls (-1.5 (-15.0 - 4.5; p = 0.048); SF-12 scores physical component score (25.0 (18.8 - 43.8)) compared to controls (6.3 (-6.3 - 18.8); p = 0.021), SF-12 emotional component score 32.5 (4.4 - 48.8) compared to controls -5 (-21.3 - 15.0); p < 0.0074) and EHP-30 emotional well being domain 32.5 (4.4 - 48.8) compared to the controls -5 (-21.3 - 15.0; p < 0.0074). CONCLUSIONS:This study stopped before recruitment reached the statistically powered sample size due to difficulty with enrollment and lack of continued funding. In selected population of women presenting to the gynecological clinic with chronic pelvic pain, adhesiolysis in those who have adhesions may be of benefit in terms of improvement of pain and their quality of life. TRIAL REGISTRATION NUMBER:ISRCTN 43852269. 10.1186/1472-6874-14-36
    The pelvic floor muscle hyperalgesia (PFMH) scoring system: a new classification tool to assess women with chronic pelvic pain: multicentre pilot study of validity and reliability. Bhide Alka A,Puccini Federica,Bray Rhiannon,Khullar Vik,Digesu G Alessandro European journal of obstetrics, gynecology, and reproductive biology OBJECTIVE:The contribution of pelvic floor muscle tenderness to chronic pelvic pain (CPP) is well established in the literature. However pelvic floor muscle hyperalgesia (PFMH) is often missed during vaginal examination of women with CPP. To our knowledge criteria for diagnosing PFMH has not been established or validated so far. The aim of this study is to assess the validity and reliability of the PFMH scoring system. STUDY DESIGN:Women with and without PFMH were recruited prospectively. Digital pelvic examination was performed to detect any pain. All women were asked to report of any discomfort or pain evoked by digital palpation of the PFMs and to rate the severity of pain/discomfort as none (grade 0), mild (grade I) moderate (grade II) or severe (grade III). All women were also asked to describe the severity of the pain/discomfort using a visual analogue scale (VAS). Following examination a PFMH score was given according to each patient's reactions. Intra-observer and inter-observer reliability was assessed. Construct and content validity was also determined. RESULTS:111 (44 symptomatic and 67 controls) were recruited. Intraobserver reliability had ICCs between 0.426 and 0.804. Interobserver reliability had ICCs between 0.724 and 0.917. There was a good correlation between PFMH scores and VAS scores (rho 0.994, p<0.01). Total scores between symptomatic and controls were significantly different (p<0.01 Mann-Whitney U test). CONCLUSION:The PFMH scoring system is a simple, reliable, valid and easy screening tool for in the assessment of women with CPP. 10.1016/j.ejogrb.2015.07.008
    [Histamine metabolism disorder in pathogenesis of chronic pelvic pain in patients with external genital endometriosis]. Orazov M R,Radzinskiy V Y,Khamoshina M B,Nosenko E N,Tokaeva E S,Barsegyan L K,Zakirova Y R Patologicheskaia fiziologiia i eksperimental'naia terapiia Objective. To study features of histamine metabolism in patients with chronic pelvic pain associated with external genital endometriosis. Methods. For quantitative assessment of histamine level in peripheral blood was taken from 100 patients which than was centrifuged. In blood serum histamine concentration was determined by enzyme-linked immunosorbent assay method with reagents «Histamine ЕLISA» on the machine BAE-1000 Histamine (Labor Diagnostika Nord - LDN, Hermany). A pain syndrome was assessed by Visual Analog Scale (VAS), quality of life assessment - by Endometriosis Health Profile Questionnaire (EHR-30), level of anxiety was determined by Spielberger-Khanin questionnaire. The results. Showed statistically higher histamine level in patients with severe pain according to VAS. After assessment of results obtained from Spielberger-Khanin questionnaire 100% experimental group's women with external genital endometriosis (n = 60) were noted to be have high level of state and trait anxiety, then 40% women of control group (n = 16) have moderate level of anxiety. The incidence of depression in women with chronic pelvic pain was 58.3% (n = 35) and the main part (n = 20) were women with severe stage of pelvic pain according to VAS. Conclusions. Psycho emotional condition of women with external genital endometriosis associated pelvic pain characterized by higher depression and anxiety levels, with significant decrease quality of life. Direct relationship also was found between pain syndrome intensity and histamine level in peripheral blood in patients with external genital endometriosis.
    Botulinum toxin for chronic pelvic pain in women with endometriosis: a cohort study of a pain-focused treatment. Tandon Hannah K,Stratton Pamela,Sinaii Ninet,Shah Jay,Karp Barbara I Regional anesthesia and pain medicine BACKGROUND AND OBJECTIVES:Many women with endometriosis continue to have pelvic pain despite optimal surgical and hormonal treatment; some also have palpable pelvic floor muscle spasm. We describe changes in pain, spasm, and disability after pelvic muscle onabotulinumtoxinA injection in women with endometriosis-associated pelvic pain, a specific population not addressed in prior pelvic pain studies on botulinum toxin. METHODS:We present an open-label proof-of-concept case series of women with surgically diagnosed endometriosis. Under conscious sedation and with topical anesthetic, 100 units of onabotulinumtoxinA was injected transvaginally into pelvic floor muscle spasm areas under electromyography guidance. Changes in pain intensity, muscle spasm, disability, and pain medication use were assessed at periodic visits for up to 1 year after injection. RESULTS:Thirteen women underwent botulinum toxin injection and were followed for at least 4 months. Before injection, 11 of the 13 women had spasm in >4/6 assessed pelvic muscles and reported moderate pain (median visual analog scale (VAS): 5/10; range: 2-7). By 4-8 weeks after injection, spasm was absent/less widespread (≤3 muscles) in all (p=0.0005). Eleven rated their postinjection pain as absent/mild (median VAS: 2; range: 0-5; p<0.0001); 7/13 reduced pain medication. Disability decreased in 6/8 women with at least moderate preinjection disability (p=0.0033). Relief lasted 5-11 months in 7 of the 11 patients followed for up to 1 year. Adverse events were mild and transient. CONCLUSIONS:These findings suggest pelvic floor spasm may be a major contributor to endometriosis-associated pelvic pain. Botulinum toxin injection may provide meaningful relief of pain and associated disability. TRIAL REGISTRATION NUMBER:NCT01553201. 10.1136/rapm-2019-100529