scholarly journals Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy

2022 ◽  
Vol 12 (1) ◽  
pp. 101
Author(s):  
Augusto Pereira ◽  
Manuel Herrero-Trujillano ◽  
Gema Vaquero ◽  
Lucia Fuentes ◽  
Sofia Gonzalez ◽  
...  
Keyword(s):  
Pelvic Pain ◽  
Conventional Therapy ◽  
Chronic Pelvic Pain ◽  
Myofascial Pain ◽  
Visceral Pain ◽  
University Hospital ◽  
Common Symptom ◽  
Rectal Pain ◽  
Inferior Hypogastric Plexus ◽  
Hypogastric Plexus

Background: Although several treatments are currently available for chronic pelvic pain, 30–60% of patients do not respond to them. Therefore, these therapeutic options require a better understanding of the mechanisms underlying endometriosis-induced pain. This study focuses on pain management after failure of conventional therapy. Methods: We reviewed clinical data from 46 patients with endometriosis and chronic pelvic pain unresponsive to conventional therapies at Puerta de Hierro University Hospital Madrid, Spain from 2018 to 2021. Demographic data, clinical and exploratory findings, treatment received, and outcomes were collected. Results: Median age was 41.5 years, and median pain intensity was VAS: 7.8/10. Nociceptive pain and neuropathic pain were identified in 98% and 70% of patients, respectively. The most common symptom was abdominal pain (78.2%) followed by pain with sexual intercourse (65.2%), rectal pain (52.1%), and urologic pain (36.9%). A total of 43% of patients responded to treatment with neuromodulators. Combined therapies for myofascial pain syndrome, as well as treatment of visceral pain with inferior or superior hypogastric plexus blocks, proved to be very beneficial. S3 pulsed radiofrequency (PRF) plus inferior hypogastric plexus block or botulinum toxin enabled us to prolong response time by more than 3.5 months. Conclusion: Treatment of the unresponsive patient should be interdisciplinary. Depending on the history and exploratory findings, therapy should preferably be combined with neuromodulators, myofascial pain therapies, and S3 PRF plus inferior hypogastric plexus blockade.

scholarly journals Inferior hypogastric plexus blockade versus acupuncture for the management of idiopathic chronic pelvic pain: A randomized clinical trial

2015 ◽  
Vol 38 (4) ◽  
pp. 317 ◽  
Author(s):  
MohamedAkhatim Alsammani ◽  
SalahRoshdy Ahmed ◽  
MagdyM Amin ◽  
AbdouS Ait-Allah ◽  
Ahmed El-SaidA Ali ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Inferior Hypogastric Plexus ◽  
Hypogastric Plexus

scholarly journals How Prevalent Are Symptoms and Risk Factors of Pelvic Inflammatory Disease in a Sexually Conservative Population.

2020 ◽  
Author(s):  
Oqba Al-Kuran ◽  
Al-Mehaisen Lama ◽  
Alduraidi Hamza ◽  
Naser Alhusban ◽  
Balqees Attarakih ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pelvic Inflammatory Disease ◽  
Symptom Score ◽  
Pelvic Pain ◽  
Inflammatory Disease ◽  
Chronic Pelvic Pain ◽  
University Hospital ◽  
Medical Procedure ◽  
Adult Women ◽  
Jordanian Population

Abstract Background: Pelvic Inflammatory Disease (PID) is the inflammation of the adnexa of the uterus, that mainly manifests in a subclinical/chronic context and goes largely underreported. However, it poses a major threat to women’s health, as it is responsible for infertility and ectopic pregnancies, as well as chronic pelvic pain. Previous studies in Jordan have not reported PID, attributed mainly to the social structure of the country which largely represent a sexually conservative population. Our study aims to report the clinical symptoms that point towards PID and investigate the major risk determinants in a Jordanian population, in a cross-sectional study. Methods: One hundred sixty-eight consecutive adult women that came in the Outpatient Clinics of Gynaecological Department of the Jordan University Hospital were interviewed and their medical history and symptoms were registered and analysed. A Score for PID symptoms, we developed, was given to each woman. Results and correlations were then statistically tested.Results: Our study population consisted of relatively young women (37.7±11) that had their first child at an average age of 24.1 (±4.8) and a mean parity of 3.1 (±2.2). Fifty-eight women (34.5%) reported having undergone at least one CS, while the mean PID Symptom Score was 3.3 (±2.3). The women in our study exhibited 8 symptoms of PID, namely dysmenorrhea and vaginal discharge; being the commonest (45.2% and 44.6% respectively), in addition to chronic pelvic pain, pelvic heaviness, , menorrhagia, dyspareunia, , urinary symptoms, and smelly urine, and reported history of 3 conditions that can be attributed to PID, that is infertility, preterm labour, and miscarriages.Conclusions: Our PID Scoring System seems to identify the risk factors of PID and predict well the PID likelihood. This score predicts that women with higher parity, who used contraceptives and underwent any invasive medical procedure are expected to score higher in the PID Symptom Score. Our data also suggest that PID should not be ruled out in the Jordanian population when symptoms are compatible to this diagnosis.

scholarly journals Association of Chronic Pelvic Pain and Endometriosis With Signs of Sensitization and Myofascial Pain

2015 ◽  
Vol 125 (3) ◽  
pp. 719-728 ◽  
Author(s):  
Pamela Stratton ◽  
Izabella Khachikyan ◽  
Ninet Sinaii ◽  
Robin Ortiz ◽  
Jay Shah
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Myofascial Pain

Patient with Chronic Pelvic Pain from Endometriosis

2016 ◽  
Author(s):  
Jianguo Cheng ◽  
Yoon-Jeong Cho
Keyword(s):  
Pelvic Pain ◽  
Hormonal Therapy ◽  
Chronic Pelvic Pain ◽  
Reproductive Tract ◽  
Visceral Pain ◽  
Surgical Removal ◽  
Antiinflammatory Drugs ◽  
Persistent Symptoms ◽  
Incomplete Removal ◽  
Management Procedures

Endometriosis, a chronic and progressive condition characterized by the presence of endometrial tissue outside the uterus, accounts for about one third of the cases of chronic pelvic pain in women. Pain in endometriosis may be due to nociceptive, inflammatory, and/or neu­ropathic mechanisms. The clinical presentation is often variable between patients, and diagnostic laparoscopy for visualization and biopsy of lesions is the gold standard for diagnosis. The treatment may consist of two elements: chronic pelvic pain itself as a diagnosis and endometriosis as a disease. Hormonal therapy is used to reduce the amount of estrogen and hence reduce symptoms such as pelvic pain and dysmenorrhea. In patients with severe endometriosis, surgical removal of lesions, adhesions, and cysts and restoration of pelvic anatomy may be preferred. Both hormonal and surgical treatments have been shown to be effective in decreasing pain symptoms associated with endometriosis. A variety of analgesics, including nonsteroidal antiinflammatory drugs, opioids, tricyclic antidepressants, dual reuptake inhibitors of serotonin and norepinephrine, and antiepileptic drugs, have been used to ameliorate pain in endometriosis, with varying degrees of success. In patients with persistent symptoms, interventional pain management procedures may be performed to target the visceral and somatic organs and their innervations. Infertility is the most common complication of endometriosis. Between 10 and 20% of women with endometriosis have recurrence of the disease regardless of the treatment they receive. The recurrence of pain may be due to remodeling of the central nervous system, the role of the reproductive tract in reactivating pain, and incomplete removal or recurrence of lesions. This review contains 2 tables and 52 references  Key words: chronic abdominal pain, chronic pelvic pain, dyschezia, dysmenorrhea, dyspareunia, endometrioma, endometriosis, hormonal therapy, infertility, retrograde menstruation, visceral pain 

Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer

Pain ◽  
1993 ◽  
Vol 54 (2) ◽  
pp. 145-151 ◽  
Author(s):  
Oscar A. de Leon-Casasola ◽  
Edward Kent ◽  
Mark J. Lema
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Hypogastric Plexus ◽  
Superior Hypogastric Plexus ◽  
Plexus Block

scholarly journals RETROGRADE EJACULATION FOLLOWING LUMBOPELVIC SYMPATHETIC NEUROLYSIS – A CASE SERIES

2017 ◽  
pp. 133-142
Author(s):  
Ajax Yang
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Case Series ◽  
Retrograde Ejaculation ◽  
Potential Consequence ◽  
Careful Evaluation ◽  
Hypogastric Plexus ◽  
Superior Hypogastric Plexus ◽  
Male Patients ◽  
Ganglion Impar

Background: Sympathetic neurolysis, or sympathectomy, is an established modality for the treatment of chronic pain. In cases of chronic pelvic pain (CPP), the ganglion of impar (GI) and the superior hypogastric plexus (SHP) are widely accepted targets for such therapy. Objective: While diagnostic injections typically predate any neurolysis for the purpose of ascertaining any potential effi cacy for interrupting a particular pathway, careful attention is equally paid to evaluate for possible adverse events - in the case of lumbopelvic neurolysis, retrograde ejaculation (RE) is one such possibility. Study Design: A case series. Setting: An outpatient pain management clinic. Methods: We present 3 male patients with CPP treated who underwent neurolytic procedures targeting the GI and SHP. Results: The fi rst patient developed RE after undergoing a simultaneous neurolysis of both the SHP and GI, in the same sitting. The second and third patients both experienced temporary RE immediately after diagnostic blockades of the SHP, following GI neurolysis that was performed several weeks prior. Limitations: Cause-effect conclusions cannot be drawn from the results of a case series. Conclusions: RE is a potential consequence of combined or serial SHP and GI neurolysis. While neurolysis of either the GI or SHP individually have not been known to cause RE in men, this case series demonstrates the potential risk in causing it when both structures are simultaneously incapacitated in some form; as such, the authors recommend against both structures being ablated or disabled concurrently without careful evaluation with temporary blockades fi rst. In an effort to avoid such a complication or evaluate for the possibility in a particular individual, we recommend that an individual with CPP, who has already been treated with a neurolysis, undergoes diagnostic blocks fi rst on whichever of the 2 structures has not yet been ablated to carefully evaluate if RE will occur. Key words: Retrograde ejaculation, superior hypogastric plexus, ganglion impar; neurolysis, chronic pelvic pain, male infertility, diagnostic block

Sign in / Sign up

Export Citation Format

Share Document