The effect of biofeedback interventions on pain, overall symptoms, quality of life and physiological parameters in patients with pelvic pain

Summary Background Biofeedback is recognized as an effective additive method for treating certain phenotypes of chronic pelvic pain syndrome and is a therapeutic option in other pelvic pain conditions. This review aims to evaluate evidence from the literature with a focus on the effect of biofeedback on pain reduction, overall symptom relief, physiological parameters and quality of life. Methods A systematic literature search was conducted using the databases PubMed, MEDLINE, Embase, Cochrane Library and PEDro from inception to July 2020. Data were tabulated and a narrative synthesis was carried out, since data heterogeneity did not allow a meta-analysis. The PEDro scale and the McMaster Critical Review Form—Quantitative Studies were applied to assess risk of bias. Results Out of 651 studies, 37 quantitative studies of primary research evaluating pelvic pain conditions in male and female adults and children were included. They covered biofeedback interventions on anorectal disorders, chronic prostatitis, female chronic pelvic pain conditions, urologic phenotypes in children and adults and a single study on low back pain. For anorectal disorders, several landmark studies demonstrate the efficacy of biofeedback. For other subtypes of chronic pelvic pain conditions there is tentative evidence that biofeedback-assisted training has a positive effect on pain reduction, overall symptoms relief and quality of life. Certain factors have been identified that might be relevant in improving treatment success. Conclusions For certain indications, biofeedback has been confirmed to be an effective treatment. For other phenotypes, promising findings should be further investigated in robust and well-designed randomized controlled trials.

Miscellaneous

This chapter includes a range of miscellaneous curriculum topics including endoscopy, anorectal disorders and gastrointestinal (GI) investigations. Questions discussing the role and indications for antibiotic prophylaxis in endoscopy, sedation, performance measures and consent will provide education on best practice in endoscopy. Coverage is also given to the management of anticoagulation pre- and post-endoscopy together with commonly encountered procedural complications: post-polypectomy syndrome, post-endoscopic retrograde cholangiopancreatography pancreatitis and caustic injury. The presentation and management of key anorectal disorders (haemorrhoids, anal fissures, anal intraepithelial neoplasia, infectious proctitis) are also presented here. Finally, principles of salient GI investigations including anorectal manometry and breath tests are well described. Additional curriculum material regarding miscellaneous gastrointestinal conditions and investigations will be covered in the mock examination chapter.

PREVENTION AND MANAGEMENT OF GUDAGATA VIKARA (ANORECTAL DISORDERS)- AYURVEDIC PERSPECTIVE

Gudagata Vikara (Anorectal disorders) refers to ailments of the anus and/ or rectum. Gudagata Vikara includes; Arsha (Haemorrhoids), Bhagandara (Fistula in Ano), Parikartika (Fissure in Ano), Guda Kandu (Pruritus Ani), etc. These are some common disorders in human being. A study by Sharma et al. showed that Hemorrhoids (49%) and fistula-in-ano (27%) were commonest anorectal conditions, mostly affecting the age group 18-45 years. Apathya Ahara and Vihara leads to vitiation of Doshas causing Mandagni and vitiation of Apanavayu resulting in stagnation of Mala in Gudavali which leads to anorectal disorders. In present study a thorough and scientific review of Ahara (diet) and Vihara (lifestyle) has been carried out for the prevention and management of anorectal diseases. Materials and methods: Ayurvedic treaties, text books, Dissertation, Articles from PUBMED, SCOPUS, Google scholar, Mesh, Google search has been searched thoroughly related to the subject. Discussion: Gudagata Vikara, Anorectal Disorders, Ahara (Diet), Vihara (Lifestyle), Dinacharya, Ritucharya, Sadvritta has been discussed. Conclusions: Food articles mentioned in Ayurvedic text are effective in the management of Anorectal diseases. Lifestyle changes according to Dinacharya, Ritucharya and Sadavritta and following do’s and don’ts are effective in the management of Anorectal diseases