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Background:
Chronic pelvic pain syndrome (CPPS) is one of the common diseases in urology and gynecology. CPPS is a multifactorial disorder where pain may originate in any of the urogynecological, gastrointestinal, pelvic musculoskeletal, or nervous systems. The symptoms of CPPS appear to result from an interplay between psychological factors and d...
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Context 1
... may be that changes in the effectiveness of pain processing, control, and regulation processes, which characterize women with CPPS, affect the severity of the symptoms and are involved in the response to interventions [1,52]. These variables and their relationship with the severity of CPPS and the effect of the treatment should be examined in future research.Similar to other syndromes in which the pathogenesis process is unknown [53], the treatment of CPPS is varied (Figure 2) and includes: ...
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Background
Etiological factors involved in chronic prostatitis (CP) type IIIb and chronic pelvic pain are not sufficiently understood; however, the nervous system has a significant role in the generation and maintenance of chronic pelvic pain. This study was designed to evaluate the sympathetic skin response (SSR) in men with CP type IIIb compared...
Citations
... As comorbidades avaliadas no grupo com DPC não se associaram com o escore de intensidade da dor, com história de aborto, de violência física nem de violência sexual (p>0,05). No grupo de mulheres com DPC e endometriose, a mediana do escore de ansiedade e de depressão foi significativamente menor do que no grupo sem endometriose (14,5;IC 95%: 11,(0)(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)9) versus (17,0; IC 95%: 14,6-16,7), p=0,012 e (13,0; IC 95%: 11,[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]9) versus (16,5; IC 95%: 14,5-17,6), p=0,045, respectivamente. Em pacientes com enxaqueca, a mediana do escore de depressão foi maior no grupo de mulheres com DPC em relação ao grupo sem DPC (15, ...
... As comorbidades avaliadas no grupo com DPC não se associaram com o escore de intensidade da dor, com história de aborto, de violência física nem de violência sexual (p>0,05). No grupo de mulheres com DPC e endometriose, a mediana do escore de ansiedade e de depressão foi significativamente menor do que no grupo sem endometriose (14,5;IC 95%: 11,(0)(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)9) versus (17,0; IC 95%: 14,6-16,7), p=0,012 e (13,0; IC 95%: 11,[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]9) versus (16,5; IC 95%: 14,5-17,6), p=0,045, respectivamente. Em pacientes com enxaqueca, a mediana do escore de depressão foi maior no grupo de mulheres com DPC em relação ao grupo sem DPC (15, ...
... As comorbidades avaliadas no grupo com DPC não se associaram com o escore de intensidade da dor, com história de aborto, de violência física nem de violência sexual (p>0,05). No grupo de mulheres com DPC e endometriose, a mediana do escore de ansiedade e de depressão foi significativamente menor do que no grupo sem endometriose (14,5;IC 95%: 11,(0)(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)9) versus (17,0; IC 95%: 14,6-16,7), p=0,012 e (13,0; IC 95%: 11,[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]9) versus (16,5; IC 95%: 14,5-17,6), p=0,045, respectivamente. Em pacientes com enxaqueca, a mediana do escore de depressão foi maior no grupo de mulheres com DPC em relação ao grupo sem DPC (15, ...
BACKGROUND AND OBJECTIVES
Chronic pelvic pain (CPP) is a common condition in women and there are often associated comorbidities. The objective of this study was to evaluate the prevalence of comorbidities in patients with CPP and to seek associations between comorbidities and the manifestations of chronic pain.
METHODS
Observational case-control study with sociodemographic, behavioral and clinical information, including comorbidities, in 246 women, 123 with CPP and 123 without CPP (control group).
RESULTS
Anxiety, depression, migraine and endometriosis were the most frequent comorbidities in women with CPP. The comorbidities assessed in the CPP group were not associated with pain intensity score, history of abortion, physical violence or sexual violence (p>0.05). In the group of women with CPP and endometriosis, the median anxiety and depression score was significantly lower than in the group without endometriosis (14.5; 95% CI: 11.0-14.9) versus (17.0; 95% CI: 14.6-16.7), p=0.012 and (13.0; 95%CI: 11.1-15.9) versus (16.5; 95% CI: 14.5-17.6), p= 0.045, respectively. In patients with migraine, the median depression score was higher in the group of women with CPP compared to the group without CPP (15.0; 95% CI: 14.1-17.8) versus (10.0; 95% CI: 8.5-12.4), p=0.048.
CONCLUSION
The most prevalent comorbidities in women with CPP were mental disorders, migraine and endometriosis. Comorbidities were not related to pain intensity, physical violence or sexual violence. Having a diagnosis of endometriosis is associated with lower anxiety and depression scores in patients with CPP. Overlapping migraine and CPP were associated with a worse depression score.
Keywords:
Chronic pain; Comorbidity; Endometriosis; Pelvic pain
... CPP is a multifactorial disorder with pain originating in any of the urogynecological, gastrointestinal, pelvic musculoskeletal, or nervous systems (4). Endometriosis is an estrogen-dependent chronic in ammatory disease de ned by the presence of functional endometrial tissue outside the uterine cavity. ...
Background
Sacral neuromodulation (SNM) is an established therapy in urology and gastroenterological surgery for treatment of overactive bladder symptoms, urge urinary incontinence or fecal incontinence. SNM has also been used with good results in patients with chronic pelvic pain (CPP). Our aim was to analyze long-term results of SNM in Finnish patients with endometriosis related CPP.
Methods
This is a register-based retrospective study including all the endometriosis patients treated with SNM for CPP in Finland between 2004 and 2017. There were four centers where these procedures were performed, two University Hospitals and two Central Hospitals. Long-term results were assessed by phone interview in spring 2021.
Results
A total of 16 women with endometriosis, with a median age of 39 (25–50) years, underwent SNM treatment for chronic pelvic pain (CPP), with the median follow-up time of 73 (48–85) months. The Implantable Pulse Generator (IPG) was implanted to 14 patients (88%). By the end of the follow-up period, 10 patients (62,5% of all patients and 71% of those who received IPG) had a functional SNM. Pain was assessed by numeral rating scale (NRS) and decreased from a median of 7.4 (3.6–10) to 2.25 (0-6.5).
Conclusions
SNM could be a good option in the treatment of endometriosis related chronic pelvic pain when standard therapy is not enough.
... However, the etiology of CPP is complex, requiring multidirectional diagnostic analyzes since the experience of pain and its processing involves many variables. (15) The results of this study indicate that the relationship with parents has a great influence on interviewees' lives. Patients who still live with CPP highlight that before the onset of pain they experienced parental emotional abandonment or constant disagreements with their parents. ...
... However, the etiology of CPP is complex, requiring multidirectional diagnostic analyzes since the experience of pain and its processing involves many variables. (15) The results of this study indicate that the relationship with parents has a great influence on interviewees' lives. Patients who still live with CPP highlight that before the onset of pain they experienced parental emotional abandonment or constant disagreements with their parents. ...
Objective: To understand the meaning of chronic pelvic pain from the perspective of diagnosed women and analyze the determining factors for outpatient discharge. Methods: This is qualitative research, using strategic social research as its theoretical methodological framework. 14 women participated in the study, seven of whom were undergoing outpatient follow-up and seven who were discharged from the gynecology outpatient clinic of a university hospital in the city of Goiânia, Goiás, Brazil. Semi-structured interviews were carried out with guiding questions. The analysis of results was based on the thematic modality of content analysis, according to Bardin. Results: Data analysis culminated in three thematic categories: “Before the pain”, “Living with the pain” and “Treating the pain”. Parental emotional abandonment, grief, disagreement with parents and childhood difficulties were prominent before the onset of pain. The onset of pain was related to the birth of children, menarche, surgeries and family conflicts. Living with pain promoted great suffering, fear, harm to relationships and work activity. The improvement in emotional state and financial conditions, the resolution of marital conflicts, the opportunity to express oneself and talk to other patients, the use of medication and some surgical procedures were decisive for pain control and outpatient discharge. Conclusion: Chronic pelvic pain was related to socioeconomic, emotional and physical suffering. The resolution of these aspects contributed to outpatient discharge.
... CPP is a multifactorial disorder, and pain may originate from gynecological, gastrointestinal, pelvic, musculoskeletal, or nervous systems [3]. Chronic pelvic pain syndrome (CPPS) is a diagnosis of exclusion based on the presence of CPP in the absence of a confirmed infection or a local pathology accounting for the pain [4]. ...
Background and Objectives: Chronic pelvic pain (CPP) represents a major public health problem for women with a significant impact on their quality of life. In many cases of CPP, due to gynecological causes—such as endometriosis and vulvodynia—improper pelvic floor muscle relaxation can be identified. Treatment of CPP with pelvic floor hypertonicity (PFH) usually involves a multimodal approach. Traditional magnetic stimulation has been proposed as medical technology to manage muscle hypertonicity and pelvic pain conditions through nerve stimulation, neuromodulation, and muscle relaxation. New Flat Magnetic Stimulation (FMS)—which involves homogeneous rather than curved electromagnetic fields—has the potential to induce sacral S2–S4 roots neuromodulation, muscle decontraction, and blood circulation improvement. However, the benefits of this new technology on chronic pelvic pain symptoms and biometrical muscular parameters are poorly known. In this study, we want to evaluate the modification of the sonographic aspect of the levator ani muscle before and after treatment with Flat Magnetic Stimulation in women with chronic pelvic pain and levator ani hypertonicity, along with symptoms evolution. Materials and Methods: A prospective observational study was carried out in a tertiary-level Urogynaecology department and included women with CPP and PFH. Approval from the local Ethics Committee was obtained before the start of the study (protocol code: MAGCHAIR). At the baseline, the intensity of pelvic pain was measured using a 10 cm visual analog scale (VAS), and patients were asked to evaluate their pelvic floor symptoms severity by answering the question, “How much do your pelvic floor symptoms bother you?” on a 5-answer Likert scale. Transperineal ultrasound (TPU) was performed to assess anorectal angle (ARA) and levator ani muscle minimal plane distance (LAMD). Treatment involved Flat Magnetic Stimulation alone or with concomitant local or systemic pharmacological therapy, depending on the patient’s preferences. FMS was delivered with the DR ARNOLD system (DEKA M.E.L.A. Calenzano, Italy). After the treatment, patients were asked again to score the intensity of pelvic pain using the 10 cm visual analog scale (VAS) and to evaluate the severity of their pelvic floor symptoms on the 5-answer Likert scale. Patients underwent TPU to assess anorectal angle (ARA) and levator ani muscle minimal plane distance (LAMD). Results: In total, 11 patients completed baseline evaluation, treatment, and postoperative evaluation in the period of interest. All patients underwent eight sessions of Flat Magnetic Stimulation according to the protocol. Adjuvant pharmacological treatment was used in five (45.5%) patients. Specifically, we observed a significant increase in both ARA and LAMD comparing baseline and post-treatment measurements (p < 0.001). Quality of life scale scores at baseline and after treatment demonstrated a significant improvement in both tools (p < 0.0001). Conclusions: Flat Magnetic Stimulation, with or without adjuvant pharmacological treatment, demonstrated safety and efficacy in reducing pelvic floor hypertonicity, resulting in improvement in symptoms’ severity and sonographic parameters of muscular spasm.
... The GRA consists of a 7-point centered scale, from −3 to +3, indicating markedly worse to markedly improved symptoms. The IC/BPS symptoms were also evaluated using the OSS, including the interstitial cystitis symptom index (ICSI) and interstitial cystitis problem index (ICPI) [45]. Pain severity was assessed using an NRS from 0 to 10 points, with 0 indicating no bladder or pelvic pain and 10 indicating the worst imaginable bladder or pelvic pain [46]. ...
Intravesical botulinum toxin A (BoNT-A) injections are included in the interstitial cystitis/bladder pain syndrome (IC/BPS) treatment guidelines. However, the IC phenotype suitable for treatment with BoNT-A has not been clarified. Therefore, we identified the factors influencing treatment outcomes for intravesical BoNT-A injections in patients with non-Hunner IC/BPS (NHIC). This retrospective study included patients with NHIC who underwent 100 U BoNT-A intravesical injections over the past two decades. Six months after treatment, treatment outcomes were assessed using the Global Response Assessment (GRA). Outcome endpoints included GRA, clinical symptoms, urodynamic parameters, urine biomarkers, and the identification of factors contributing to satisfactory treatment outcomes. The study included 220 patients with NHIC (42 men, 178 women). The satisfactory group (n = 96, 44%) had significantly higher pain severity scores and IC symptoms index, larger maximum bladder capacity (MBC), and lower 8-isoprostane levels at baseline. Logistic regression revealed that larger MBC (≥760 mL) and bladder pain predominance were associated with satisfactory outcomes after BoNT-A injection. Subjective parameters and pain severity scores improved significantly in patients with bladder pain-predominant IC/BPS after BoNT-A injection. Thus, NHIC patients with bladder or pelvic pain are more likely to experience satisfactory outcomes following intravesical BoNT-A injections.
... It's crucial to obtain a comprehensive overview of the patient's pain complaints and assess systems relevant to the pelvis, encompassing musculoskeletal, neurologic, urologic, gastrointestinal, gynecologic, and psychiatric aspects. Exploring the psychosocial context is integral during this history-taking process [12]. ...
... Another effective intervention for managing musculofascial pain is Myofascial Physical Therapy (MPT). It focuses on strengthening pelvic floor muscles, decreasing excessive muscle tension, improving tissue flexibility, postural balance and pelvic perfusion [12]. FitzGerald et al. proved that Pelvic Myofascial Therapy (MMT) was much more efficient in pain reduction among women with CPPS compared to women treated only with general massage [25]. ...
Introduction and purpose: Chronic Pelvic Pain Syndrome (CPPS) is characterized as intermittent or constant pain located in the lower abdomen or pelvis, persisting continuously for at least 6 months [1]. Reports on the prevalence of chronic pelvic pain indicate the occurrence of this condition at a level of 5.7–26.6% in women of reproductive age. However, only a third of women suffering from chronic pelvic pain, seek medical care [2]. Clinical picture of CPPS consists of various patterns and symptoms, often as the intersection of the multiple systems, which additionally complicates and delays the diagnostic process. The aim of this review is to summarize existing literature about the diagnostics and management of Chronic Pelvic Pain Syndrome among women and create an awareness about the challenges which this condition poses for healthcare professionals. A brief description of the state of knowledge: Chronic Pelvic Pain Syndrome is a multifaceted condition and the pathophysiology of it has not yet been comprehensively studied. Clinical picture often involves dysfunctions in pelvic floor, urinary tract, or gastrointestinal system. Treatment involves a multidisciplinary approach including non-pharmacological and pharmacological interventions. Summary (conclusions): Chronic Pelvic Pain is a complex condition involving symptoms affecting the psychological, gastrointestinal, musculoskeletal systems. The most successful treatment approach emphasizes the role of collaboration among a diverse team of specialists such as gynecologists, gastroenterologists, psychiatrists, psychologists, and physiotherapists. More research focused on multimodal strategies in management of the CPP is needed to match patients most effectively with the most suitable combination of treatment and reduce the systemic consequences of chronic pain.
... The symptoms of IC/BPS or chronic pelvic pain syndrome have long been considered to result from an interplay between psychological factors and dysfunction in the immune, neurological, and endocrine systems [48]. Corticotropin-releasing hormone (CRH) has been demonstrated to be involved in stress-induced intestinal disturbances, possibly through the release of mast cell proteases and TNF-α [49]. ...
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic pain syndrome of unknown etiology, the pathophysiology of which has not been fully explored. This article reports recently published research in diagnosis and treatment of IC/BPS.
Current research shows that the syndrome is likely heterogeneous, with different pathogeneses, clinical characteristics, cystoscopic findings, and characteristics of urine biomarkers. Chronic bladder inflammation results in deficits in the bladder urothelial barrier in addition to increased apoptosis and impaired regeneration of urothelial cells, causing bladder pain symptoms and urinary frequency and urgency. The initial therapeutic approach is conservative treatment with lifestyle modification, anti-inflammatory drugs, and intravesical glycosaminoglycan replenishment and dimethyl sulfoxide instillation. In patients with non-Hunner’s lesion IC/BPS refractory to conventional therapy, intravesical botulinum toxin A injection and sacral neuromodulation may be tried. Experimental therapies are intravesical platelet-rich plasma, low-energy shock wave bladder treatment and bladder instillation of liposomes with or without mixed botulinum toxin A. For IC/BPS patients with Hunner’s lesion, electrocauterization or laser ablation is the first-line treatment. Patients with Epstein-Barr virus infection may also benefit from antiviral therapy. For patients with Hunner’s IC/BPS and a contracted bladder, partial cystectomy with augmentation enterocystoplasty or total cystectomy with urinary diversion should be the last resort for treatment to address early elimination and bladder pain and to resume normal lower urinary tract function.
IC/BPS remains a mysterious bladder disease with chronic inflammation and urothelial dysfunction and involves functional somatic disorders. Treatment should be multidisciplinary and target at potential pathogenesis of the disease.
... Хроническая тазовая боль (ХТБ) -боль, возникающая в нижних отделах живота (в проекции малого таза) в течение не менее шести месяцев, лишенная какой-либо цикличности, не связанная с органической патологией и менструальным циклом [1,2]. В исследовании, в котором оценивали психическое состояние пациенток с ХТБ, использовали формализованные критерии Международной классификации болезней 10-го пересмотра. ...
... Смулевич и соавт. считают, что недооценка психической патологии напрямую влияет на прогноз ХТБ и ухудшение со стороны соматической патологии [1,6]. На важность понимания психогенных механизмов боли указывает A. Graziottin, отмечая, что «лишь немногие врачи считают психогенные факторы серьезными биологическими причинами боли». ...
... Ye.V. Sibirskaya, PhD, Prof. 1 ...
Chronic pelvic pain (CPP) in women is a multifactorial problem that requires an interdisciplinary approach involving the teamwork of an obstetrician-gynecologist and related specialists. In 80% of patients the causes of CPP are inorganic, while 40% of diagnostic laparoscopic operations and 12% of hysterectomies are performed annually. Pathogenetic reactions triggering CPP syndrome include increased anxiety, neurosis and concomitant high levels of stress. A cascade of such reactions leads to the formation of a vicious circle. CPP directly affects the social life of women. About 15% of women with CPP cannot work, and 45% have a noticeable decrease in productivity. Treatment of the psychoemotional component of CPP is a priority task of an obstetrician-gynecologist.
... We hypothesized that in patients with an ongoing chronic inflammatory process in the prostate, a condition whose clinical image may rise suspicion of csPC and lead to an unnecessary biopsy (32), the periprocedural pain would be increased, as prostatitis or chronic pelvic pain syndrome (CPPS) is commonly linked to altered nociception in the pelvis (33). As DRE status and PSA level, as well as PSAD, might have been different in those patients, as compared to patients truly harboring PC, we investigated those factors for a possible link with SP, although, no association was found. ...
Background:
Biopsy by transperineal (TP) approach is recommended standard for prostate cancer (PC) diagnosis. To avoid pain, patients undergoing TP biopsy may be offered sedation or general anesthesia. Our aim was to investigate the degree of patient-reported pain for magnetic resonance imaging (MRI)/ultrasound (US) fusion biopsy of the prostate being performed under local anesthesia (LA) and to study for possible factors associated with increased risk of significant pain (SP) in this setting.
Methods:
In this retrospective observational study, we reviewed data of consecutive patients without a prior diagnosis of PC who underwent MRI/US software fusion biopsy of the prostate under LA with lidocaine at two centers between May 2020 and April 2022, and who reported their periprocedural pain on a Wong-Baker FACES Pain Rating Scale (0-10). We defined SP as reported pain score of 6-10. Patient and procedure characteristics together with SP were studied for interdependencies.
Results:
A total of 299 patients were included. Median pain score was 2 (interquartile range: 2-4), with SP having been reported by 55 (18.4%) patients. Among patient characteristics, only age demonstrated association with SP [odds ratio (OR), per 10 years =0.53, 95% confidence interval (CI): 0.35-0.80, P=0.003] and patients aged 62 or above were significantly less likely to report SP (OR =0.33, 95% CI: 0.18-0.60, P<0.001).
Conclusions:
Performing TP MRI/US fusion prostate biopsy under LA is associated with low rates of SP, with the risk being significantly lower in older men. The results of this study can serve as evidence resource for preprocedural counselling in patients especially concerned about the risk of pain.
