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

Background. Hysteroscopic tubal sterilization (Essure) is a minimally invasive option for permanent contraception with high reported rates of patient satisfaction. A small percentage of these women subsequently choose to have the tubal inserts removed due to regret or perceived side effects such as late-onset pelvic pain secondary to placement of the Essure device.Case. A twenty-nine-year-old woman G4P4014 presented with a two-year complaint of chronic pelvic pain and dyspareunia after the hysteroscopic placement of an Essure device for sterilization. On reviewing the images of the HSG, it was noted that although tubal occlusion was confirmed, the left Essure coil appeared curved on itself in an elliptical fashion and did not seem to follow the expected anatomic trajectory of the fallopian tube. The patient reported resolution of chronic pelvic pain following laparoscopic removal of Essure device.Conclusion. A misplaced Essure device should be considered in the differential diagnosis of chronic pelvic pain in women who had difficult placement of the device. In addition to demonstrating tubal occlusion, careful examination of the configuration of the Essure microinserts on HSG examination provides valuable information in patients with pelvic pain after Essure placement.

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Chronic Pelvic Pain and Infertility Resulting from Unrecognized Retained Laminaria

Case Reports in Obstetrics and Gynecology ◽

10.1155/2017/6345712 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3

Author(s):

Wesley Nilsson ◽

Sasha Mikhael ◽

Jennifer Kaplan

Keyword(s):

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Transvaginal Ultrasound ◽

Laminaria Japonica ◽

The United States ◽

Pathology Report ◽

Operative Hysteroscopy ◽

Menstrual Cycles ◽

Patient Reported ◽

Delayed Complications

Background. In 2013, the abortion rate in the United States was found to be 200 abortions per 1,000 live births. Of these, the CDC estimates that nearly 49% were performed using unsafe measures. Even when these procedures are safely performed, patients are at risk for immediate or delayed complications. In second-trimester terminations, mechanical dilation with an osmotic dilator is common to allow for delivery of the fetus. The Japanese seaweed Laminaria japonica is used to achieve this purpose. Case. A 28-year-old primigravida presented with chronic pelvic pain and infertility. She had irregular menstrual cycles and reported scant yellow discharge. A transvaginal ultrasound revealed an abnormally appearing endometrium with an elongated structure suspicious for a foreign body. The patient reported a voluntary termination of pregnancy twelve years earlier, for which laminaria were placed prior to the dilation and extraction. She underwent an operative hysteroscopy confirming our suspicion for retained laminaria. The pathology report demonstrated chronic severe endometritis and plant based material. Conclusion. Retained laminaria are associated with chronic pelvic pain and chronic infertility. Since they can be difficult to detect on conventional imaging, proper counting prior to insertion and after removal is an essential physician responsibility.

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Application of Patient-Reported Outcomes Measurement Information System to Chronic Pelvic Pain

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2010.12.001 ◽

2011 ◽

Vol 18 (2) ◽

pp. 189-193 ◽

Cited By ~ 8

Author(s):

Bradford W. Fenton ◽

Patrick Palmieri ◽

Gina Diantonio ◽

Vivian Vongruenigen

Keyword(s):

Information System ◽

Pelvic Pain ◽

Patient Reported Outcomes ◽

Chronic Pelvic Pain ◽

Measurement Information ◽

Outcomes Measurement ◽

Patient Reported ◽

Measurement Information System

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Classifying Patients with Chronic Pelvic Pain into Levels of Biopsychosocial Dysfunction Using Latent Class Modeling of Patient Reported Outcome Measures

Pain Research and Treatment ◽

10.1155/2015/940675 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Bradford W. Fenton ◽

Scott F. Grey ◽

Krystel Tossone ◽

Michele McCarroll ◽

Vivian E. Von Gruenigen

Keyword(s):

Outcome Measures ◽

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Latent Profile Analysis ◽

Latent Class ◽

Disease Process ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Essentially Normal ◽

Patient Reported

Chronic pelvic pain affects multiple aspects of a patient’s physical, social, and emotional functioning. Latent class analysis (LCA) of Patient Reported Outcome Measures Information System (PROMIS) domains has the potential to improve clinical insight into these patients’ pain. Based on the 11 PROMIS domains applied to n=613 patients referred for evaluation in a chronic pelvic pain specialty center, exploratory factor analysis (EFA) was used to identify unidimensional superdomains. Latent profile analysis (LPA) was performed to identify the number of homogeneous classes present and to further define the pain classification system. The EFA combined the 11 PROMIS domains into four unidimensional superdomains of biopsychosocial dysfunction: Pain, Negative Affect, Fatigue, and Social Function. Based on multiple fit criteria, a latent class model revealed four distinct classes of CPP: No dysfunction (3.2%); Low Dysfunction (17.8%); Moderate Dysfunction (53.2%); and High Dysfunction (25.8%). This study is the first description of a novel approach to the complex disease process such as chronic pelvic pain and was validated by demographic, medical, and psychosocial variables. In addition to an essentially normal class, three classes of increasing biopsychosocial dysfunction were identified. The LCA approach has the potential for application to other complex multifactorial disease processes.

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