scholarly journals Complementary Approaches for Military Women with Chronic Pelvic Pain: A Randomized Trial

2021 ◽  
Author(s):  
Carol D Crisp ◽  
Robert Baldi ◽  
Matthew Fuller ◽  
Eduardo Abreu ◽  
Andrea G Nackley
Keyword(s):  
Pelvic Pain ◽  
Stress Reduction ◽  
Chronic Pelvic Pain ◽  
Behavioral Treatment ◽  
Pain Perception ◽  
Healthy Lifestyle ◽  
Military Women ◽  
Gm Csf ◽  
Non Invasive ◽  
Cytokine Levels

Abstract Introduction: Active-duty (AD) women suffer with chronic pelvic pain (CPP) while providers tackle diagnoses and treatments to keep them functional without contributing to the opioid epidemic. The purpose of this study was to determine the effectiveness of non-invasive, self-explanatory mindfulness-based stress reduction (MBSR) or self-paced healthy lifestyle (HL) interventions on CPP in AD women.Methods: We conducted a six-week interventional prospective study with AD women aged 21–55 at Mountain Home (MTHM), Idaho. Women were randomly assigned to MBSR (N = 21) or HL (N = 20) interventions. The primary outcome was pain perception. Secondary outcomes were depression and circulating cytokine levels.Results: Women in the MBSR group exhibited reduced pain interference (P < .01) and depression (P < .05) alongside decreased IL-4 (P < .05), IL-6 (P < .05), eotaxin (P < .05), MCP-1 (P = .06), and IL-1ra (P < .01) and increased VEGF (P < .05). Those in the HL group did not have changes in pain, however, did exhibit reduced depression (P < .05) alongside decreased GM-CSF (P < .05) and increased TNFα (P < .05), SDF-1 (P < .01), and IL-1ra (P < .01).Conclusion: AD women receiving MBSR or HL had reduced depression scores and altered circulating cytokine levels, however only those receiving MBSR had reduced pain perception. Findings support MBSR as an effective and viable behavioral treatment for AD women suffering from CPP.

scholarly journals Relationship Between Blood Cytokine Levels, Psychological Comorbidity, and Widespreadness of Pain in Chronic Pelvic Pain

2021 ◽  
Vol 12 ◽  
Author(s):  
Bianka Karshikoff ◽  
Katherine T. Martucci ◽  
Sean Mackey
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Negative Relationship ◽  
The Body ◽  
Research Network ◽  
Low Grade ◽  
Healthy Controls ◽  
Gm Csf ◽  
Cytokine Levels ◽  
The Relationship

Background: Low-grade inflammation has been implicated in the etiology of depression, long-term fatigue and chronic pain. TNFα and IL-6 are perhaps the most studied pro-inflammatory cytokines in the field of psychoneuroimmunology. The purpose of our study was to further investigate these relationships in patients with chronic pelvic pain specifically. Using plasma samples from a large, well-described cohort of patients with pelvic pain and healthy controls via the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network, we examined the relationship between TNFα and IL-6 and comorbid psychological symptoms. We also investigated the relationship between IL-8 and GM-CSF, and widespreadness of pain.Methods: We included baseline blood samples in the analyses, 261 patients (148 women) and 110 healthy controls (74 women). Fourteen pro- and anti-inflammatory or regulatory cytokines were analyzed in a Luminex® xMAP® high-sensitivity assay. We used regression models that accounted for known factors associated with the outcome variables to determine the relationship between cytokine levels and clinical measures.Results: There were no statistical differences in cytokine levels between patients and healthy controls when controlling for age. In patients, TNFα was significantly associated with levels of fatigue (p = 0.026), but not with pain intensity or depression. IL-6 was not significantly related to any of the outcome variables. Women with pelvic pain showed a negative relationship between IL-8 and widespreadness of pain, while men did not (p = 0.003). For both sexes, GM-CSF was positively related to widespreadness of pain (p = 0.039).Conclusion: Our results do not suggest low-grade systemic inflammation in chronic pelvic pain. Higher TNFα blood levels were related to higher fatigue ratings, while higher systemic GM-CSF levels predicted more widespread pain. Our study further suggests a potentially protective role of IL-8 with regard to with regard to the widepreadness of pain in the body, at least for women.

scholarly journals The role of the multi-disciplinary team and multi-disciplinary therapeutic protocol in the management of the chronic pelvic pain: There is strenght in numbers!

2021 ◽  
Vol 93 (2) ◽  
pp. 211-214
Author(s):  
Antonella Centemero ◽  
Lorenzo Rigatti ◽  
Donatella Giraudo ◽  
Guglielmo Mantica ◽  
Davide De Marchi ◽  
...  
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Trigger Points ◽  
Non Invasive ◽  
Patient Global Impression ◽  
Strict Diet ◽  
Voiding Diary ◽  
Group A ◽  
Group B ◽  
Multi Disciplinary Team

Introduction: The aim of the study is to evaluate the effectiveness of a Multi-disciplinary team (MDT) and multi-disciplinary approach in the treatment of Chronic Pelvic Pain (CPP). Methods: The data of all consecutive patients referred for a CPP from 11/2016 to 2/2019 has been prospectively collected. The sample was divided in two groups: Group A, made by patients managed after the institution of our MDT, and Group B, made of patients managed before this date. The MDT is composed by three urogynecologists, a psychologist and a physiotherapist. All Group A patients underwent a weekly bladder instillation with dimethyl sulfoxide (DMSO), kinesiotherapy for trigger points and Percutaneous Tibial Nerve Stimulation for 10 consecutive weeks. Patients were asked to perform a self-treatment following the Stanford Protocol and to adhere to a specific diet. All Group B patients were managed only with DMSO instillations and a strict diet. Results: The Group A was made of 41 females and 6 males while the Group B was made of 38 females and 5 males. The Group A patients showed a statistically significant improvement in the Pelvic Pain Urgency Frequency, in the frequency times reported at the 6 months voiding diary, and a better Patient Global Impression of Improvement. Conclusions: Our data support the efficacy of the MDT in the management of CPP. The multimodal approach might represent an effective and reproducible non-invasive option to manage successfully CPP.

Pelvic congestion syndrome: chronic pelvic pain caused by ovarian and internal iliac varices

2007 ◽  
Vol 22 (3) ◽  
pp. 100-104 ◽  
Author(s):  
A D Liddle ◽  
A H Davies
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Significant Proportion ◽  
Duplex Ultrasound ◽  
Childbearing Age ◽  
Pelvic Congestion Syndrome ◽  
Non Invasive ◽  
Internal Iliac ◽  
Mechanical Factors ◽  
Pelvic Congestion

Chronic pelvic pain is a common and disabling condition affecting women of childbearing age. A specific diagnosis for the condition is often difficult, and referred pain from the abdominal viscera, neurogenic and psychogenic factors have all been implicated, as have pelvic conditions such as endometriosis, pelvic inflammatory disease and ovarian cysts; no diagnosis is made in 60% of patients. Pelvic congestion syndrome (PCS), the presence of varices of the pelvic veins, has been shown to be the underlying aetiology in a significant proportion of patients with chronic pelvic pain; the development of these varices is caused by a combination of endocrine and mechanical factors. Given the positional nature of these varices, they are rarely diagnosed with conventional methods such as B-mode ultrasound and diagnostic laparoscopy. Diagnosis is best made with selective ovarian venography, although newer, non-invasive methods such as magnetic resonance imaging and duplex ultrasound are increasingly gaining favour. Pelvic varices are eminently treatable, either using ovarian suppression or by the ligation or embolization of the pelvic veins.

Endometriosis-related chronic pelvic pain: A mini review on pathophysiology and impact on mental health

2020 ◽  
Vol 12 (1) ◽  
pp. 35-40
Author(s):  
Thomas Vrekoussis ◽  
Vassiliki Siafaka ◽  
Alexandra Tsitou ◽  
Orestis Tsonis ◽  
Iordanis Navrozoglou ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Central Nervous System ◽  
Nervous System ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Pain Perception ◽  
Reproductive Age ◽  
Current Evidence

Endometriosis-related chronic pelvic pain is a major component of the disease that affects quality of life in women of reproductive age suffering from endometriosis. The present review summarizes current evidence upon pathophysiology and its impact on mental health. It seems that endometriosis-related chronic pelvic pain is the result of chronic stress on the central nervous system as a consequence of chronic pelvic inflammation. Mental health issues may rise as a result of central nervous system derangement and further aggravate pain perception and therefore quality of life. Further properly designed studies are needed in order to elucidate the connection between mental disorders and endometriosis-related chronic pelvic pain.

Pelvic Congestion Syndrome: A Review of Current Diagnostic and Minimally Invasive Treatment Modalities

2012 ◽  
Vol 27 (1_suppl) ◽  
pp. 52-57 ◽  
Author(s):  
D D Kies ◽  
H S Kim
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Medical Condition ◽  
Treatment Modalities ◽  
Invasive Treatment ◽  
Cross Sectional ◽  
Pelvic Congestion Syndrome ◽  
Non Invasive ◽  
Cross Sectional Imaging ◽  
Pelvic Congestion

Chronic pelvic pain is a debilitating medical condition with a host of potential causes. Although often overlooked, pelvic congestion syndrome (PCS) is a well-established cause of chronic pelvic pain due to abnormal ovarian and pelvic varices. The diagnosis is established with modern non-invasive cross-sectional imaging, preferably contrast enhanced magnetic resonance imaging. Although medical and open surgical therapies exist, transcatheter percutaneous embolotherapy has been shown to be a safe, effective and durable therapy for the treatment of PCS. Further prospective randomized studies are needed to refine optimal technique and assess long-term patient outcomes.

scholarly journals Comparative analysis of molecular signatures suggests the use of gabapentin for the management of endometriosis-associated pain

2018 ◽  
Author(s):  
Brice Bellessort ◽  
Anne Bachelot ◽  
Virginie Grouthier ◽  
Camille de Lombares ◽  
Nicolas Narboux-Neme ◽  
...  
Keyword(s):  
Gene Expression ◽  
Comparative Analysis ◽  
Calcium Channel ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Pain Perception ◽  
University Hospital ◽  
Small Scale ◽  
Early Event ◽  
Null Mouse

CapsuleComparative analysis of gene expression signatures from endometriosis and mouse models shows that CACNAα2δs calcium-channel components involved in nociception are targets for the treatment of endometriosis-associated pain.ContextDifferential gene expression analyses comparing endometriotic lesions to eutopic endometrium have shown that the transcription factors DLX5 and DLX6 are drastically down-regulated in the ectopic implants. These finding suggests that regulatory cascades involving DLX5/6 might be involved in the origin of endometriosis symptoms such as chronic pelvic pain. We have shown that mice in which Dlx5 and Dlx6 are selectively inactivated in the uterus present an endometrial phenotype reminiscent of endometriosis implants.ObjectiveIdentify new targets for the treatment of endometriosis.DesignTo better focus the search for endometriosis targets we have compared the profile of genes deregulated in normal and ectopic women endometrium to those deregulated in the uterus of normal and Dlx5/Dlx6-null mice.SettingsAcademic research unit and University Hospital research laboratoryAnimalsMice carrying a uterus-specific deletion of Dlx5/Dlx6.InterventionsAnalysis of archive sections from normal endometrium and endometriosis implants.Main OutcomeA novel endometriosis signature suggests that α2δs subunits of voltage-gated calcium channel are targets for the management of endometriosis-associated pain.ResultsWe identify a signature of 30 genes similarly deregulated in human endometriosis implants and in Dlx5/6-null mouse uteri reinforcing the notion that the down-regulation of Dlx5/6 is an early event in the progress of endometriosis. CACNA2D3, a component of the voltage-dependent calcium channel complex is strongly overexpressed both in endometriosis implants and in mutant mouse uteri; other members of the alfa2delta family, CACNA2D1 and CACNA2D2, are also overexpressed in endometriosis.ConclusionCACNA2D1, CACNA2D2 and CACNA2D3 are directly involved in pain perception. In particular, CACNA2D3 has been associated to pain sensitization and heat nociception in animal models while, in patients, variants of this gene are associated to reduced sensitivity to acute noxious stimuli. As CACNA2Ds are targets of gabapentinoids analgesics, our results suggest to consider the use of these drugs for the treatment of endometriosis-associated pain. Indeed, recent small-scale clinical studies have shown that gabapentin can be effective in the treatment of women chronic pelvic pain. Our findings reinforce the need for a large definitive trial.

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