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Postural changes in women with chronic pelvic pain: a case control study
Mary LLS Montenegro, Elaine CL Mateus-Vasconcelos, Júlio C Rosa e Silva, Francisco dos Reis, Antonio A Nogueira, Omero B Poli-Neto
BMC Musculoskeletal Disorders , 2009, DOI: 10.1186/1471-2474-10-82
Abstract: A case-control study included 108 women with CPP of more than 6 months' duration (CPP group) who consecutively attended at the Hospital of the University of S?o Paulo and 48 healthy female volunteers (control group). Postural assessment was noninvasive and performed in the standing position, with the reference points of Kendall used as normal parameters. Factors associated with CPP were assessed by logistic regression analysis.Logistic regression showed that the independent factors associated with CPP were postural changes in the cervical spine (OR 4.1; 95% CI 1.6–10.7; p < 0.01) and scapulae (OR 2.9; 95% CI 1.1–7.6; p < 0.05).Musculoskeletal changes were associated with CPP in 34% of women. These findings suggest that a more detailed assessment of women with CPP is necessary for better diagnosis and for more effective treatment.Among women, chronic pelvic pain (CPP) is a highly prevalent (2% to 25%) clinical problem [1,2], with substantial costs [3] as well as social and marital repercussions [4,5]. CPP is defined as continuous or recurrent pain in the lower abdomen or pelvis lasting at least six months, not related to pregnancy, and sufficiently severe to interfere with the habitual activities of the patient. CPP excludes pain occurring exclusively in association with menstruation (dysmenorrhea) or during sexual intercourse (dyspareunia).Although the etiology is often unknown, it may result from complex interactions among the gastrointestinal, urinary, gynecologic, musculoskeletal, neurologic and endocrine systems, as well as being influenced by psychological and sociocultural factors [6]. To date, few therapeutic modalities have been effective in relieving the symptoms of CPP, particularly over the long term [7]. An interdisciplinary approach has therefore been recommended [8-10], both to diagnose the presumed primary etiology, and to diagnose and control all the secondary factors associated with CPP.In clinical practice, postural changes are frequently observed
Laparoscopic findings in chronic pelvic pain  [PDF]
J Bajracharya,NS Shrestha,C Karki,R Saha
Journal of Kathmandu Medical College , 2012, DOI: 10.3126/jkmc.v1i2.8146
Abstract: Background: Chronic pelvic pain is a common problem in reproductive age group women. Diagnosis of chronic pelvic pain needs multidisciplinary approach. Diagnostic laparoscopy is one of the investigations which can help in reaching the diagnosis. Objective: To know the etiology in chronic pelvic pain. Methods: This was a descriptive study done in the Department of Obstetrics and Gynaecology of Kathmandu medical college teaching hospital from January 2010 to June 2012 (30 months). All the cases of laparoscopic surgery done for chronic pelvic pain were noted and details of these cases were analyzed regarding age, parity and laparoscopic findings. Results: Total 48 cases of Chronic Pelvic Pain underwent diagnostic laparoscopy during the study period. Mean age of cases were 33 years, ranging from 20-46yrs. Almost half of the cases 43.75% were of parity two. Laparoscopic finding was negative in 29.17% and pelvic pathology was present in 70.83% of the cases. Out of the pelvic pathology endometriosis was present in 55.88% followed by pelvic adhesions, pelvic congestion and pelvic inflammatory disease, chronic ectopic in 20.58%, 14.70%, 5.88%, 2.94% respectively. Conclusion: Diagnostic laparoscopy is a useful modality in the diagnosis of etiology and management of Chronic pelvic pain. In our study, Pelvic endometriosis was the most common pelvic pathology in cases of Chronic pelvic pain. DOI: http://dx.doi.org/10.3126/jkmc.v1i2.8146 Journal of Kathmandu Medical College, Vol. 1, No. 2, Oct.-Dec., 2012: 100-102
The Impact of Chronic Pelvic Pain in Women  [PDF]
Adriana P. M. S. Rom?o, Ricardo Gorayeb, Gustavo Salata Rom?o, Omero Benedicto Poli-Neto, Antonio Alberto Nogueira
International Journal of Clinical Medicine (IJCM) , 2013, DOI: 10.4236/ijcm.2013.410076
Abstract:

Chronic pelvic pain (CPP) is a prevalent condition with a significant impact on the personal, social, professional and marital life of women. It is a complex condition that may have no specific causal diagnosis or may be associated with multiple diagnoses, frequently involving treatment failure. The definition of health care strategies fundamentally depends on the way women live with this condition. Thus, the objective of the present study is to learn how women with CPP experience their diagnosis and the meaning they attribute to it. A qualitative study was conducted by interviewing a focus group of 11 women. The content of the interviews was recorded and fully transcribed, and the speeches were interpreted by Bardin’s content analysis. The topics most frequently dealt with in the interview were diagnosis, beginning of pain, worsening and improving factors, marital and interpersonal relationships, interference with daily activities, association with emotional aspects, and perspectives for the future. It could be perceived how much these women need to be better heard and how much the association between psychic and physical questions must be visualized by the professionals who provide care for them. The approach used by professionals from different areas, when properly structured, can minimize the problem of the division of a sick person into separate parts. Psychological care is very important, especially in relation to the discovery of more effective strategies for living with pain.

Interstitial Cystitis: Chronic Pelvic Pain Syndrome  [PDF]
Fatih Atu?,Naime Canoru?
Dicle Medical Journal , 2005,
Abstract: Interstitial cystitis, is a chronic inflammatory disease of the bladder of unknown etiology characterized by urinary frequency, urgency, nocturia and suprapubic pain. The syndrome presents differently in many patients, with the unifying factor being chronic pelvic pain and disruption of daily life activities.Although there are abundance of theories, the etiology of the condition remains unclear. This review focuses on recently published literature on the epidemiology, etiology, diagnosis and treatment of interstitial cystitis.
Bedside Testing for Chronic Pelvic Pain: Discriminating Visceral from Somatic Pain  [PDF]
John Jarrell,Maria Adele Giamberardino,Magali Robert,Maryam Nasr-Esfahani
Pain Research and Treatment , 2011, DOI: 10.1155/2011/692102
Abstract: Objectives. This study was done to evaluate three bedside tests in discriminating visceral pain from somatic pain among women with chronic pelvic pain. Study Design. The study was an exploratory cross-sectional evaluation of 81 women with chronic pelvic pain of 6 or more months' duration. Tests included abdominal cutaneous allodynia (aCA), perineal cutaneous allodynia (pCA), abdominal and perineal myofascial trigger points (aMFTP) and (pMFTP), and reduced pain thresholds (RPTs). Results. Eighty-one women were recruited, and all women provided informed consent. There were 62 women with apparent visceral pain and 19 with apparent somatic sources of pain. The positive predictive values for pelvic visceral disease were aCA-93%, pCA-91%, aMFTP-93%, pMFTP-81%, and RPT-79%. The likelihood ratio (+) and 95% C.I. for the detection of visceral sources of pain were aCA-4.19 (1.46, 12.0), pCA-2.91 (1.19, 7.11), aMTRP-4.19 (1.46, 12.0), pMFTP-1.35 (0.86, 2.13), and RPT-1.14 (0.85, 1.52), respectively. Conclusions. Tests of cutaneous allodynia, myofascial trigger points, and reduced pain thresholds are easily applied and well tolerated. The tests for cutaneous allodynia appear to have the greatest likelihood of identifying a visceral source of pain compared to somatic sources of pain. 1. Introduction Chronic pelvic pain is a complex disorder that is poorly understood. Chronic pelvic pain is defined as pain of six or more months’ duration that is situated in the abdomen, groin or lower back [1]. The use of diagnostic imaging techniques such as ultrasound, CT scanning, and magnetic resonance techniques has been helpful for many gynecological conditions, but commonly the tests are normal despite the presence of severe chronic pain [2, 3]. Women suffering from chronic pelvic pain are often personally challenged because of the absence of evidence to support their complaints of severe pain [4, 5]. Recognized causes of chronic pelvic pain include visceral conditions such as endometriosis, pelvic inflammatory disease, and pelvic adhesions and somatic conditions such as lower genital tract surgery or vehicular trauma to the pelvis [6, 7]. In many cases the differentiation between visceral and somatic reasons is obvious, but in some, the distinction is not evident. This can lead to situations where investigations and surgery are repeated and in some cases extensively. Pain arising from the pelvic organs of the uterus, fallopian tubes, ovaries, ureter, kidney pelvis, bladder, and rectum is defined as visceral in nature. Such pain is due to the presence of visceral nociceptors
Role of laparoscopy in evaluation of chronic pelvic pain  [cached]
Hebbar Shripad,Chawla Chander
Journal of Minimal Access Surgery , 2005,
Abstract: Introduction: Chronic pelvic pain (CPP) is a common medical problem affecting women. Too often the physical signs are not specific. This study aims at determining the accuracy of diagnostic laparoscopy over clinical pelvic examination. Settings and Design: A retrospective study of patients who underwent diagnostic laparoscopy for CPP. Materials and Methods: The medical records of 86 women who underwent laparoscopic evaluation for CPP of at least 6-month duration were reviewed for presentation of symptoms, pelvic examination findings at the admission, operative findings and follow up when available. Statistical analysis used: McNemar Chi-square test for frequencies in a 2 x 2 table. Results: The most common presentation was acyclic lower abdominal pain (79.1%), followed by congestive dysmenorrhoea (26.7%). 61.6% of women did not reveal any significant signs on pelvic examination. Pelvic tenderness was elicited in 27.9%. Diagnostic laparoscopy revealed significant pelvic pathology in 58% of those who essentially had normal pervaginal findings. The most common pelvic pathology by laparoscopy was pelvic adhesions (20.9%), followed by pelvic congestion (18.6%). Laparoscopic adhesiolyis achieved pain relief only in one-third of the women. Conclusion: The study revealed very low incidence of endometriosis (4.7%). Overall clinical examination could detect abnormality in only 38% of women, where as laparoscopy could detect significant pathology in 66% of women with CPP. This shows superiority of diagnostic laparoscopy over clinical examination in detection of aetiology in women with CPP (P < 0.001). Adhesiolysis helps only small proportion of women in achieving pain control.
Psycophisical predictors of outcome in pelvic chronic pain therapy
P. Poli,M. Paroli,A. Ciaramella
Pathos : Trimestrale di Algologia , 2012,
Abstract: 32 patients with chronic pelvic pain (CPP) were compared with 24 patients with low back pain (LB) for the entire course of treatment which lasted 1 year, with follow up at 1,6 and 12 months.At baseline, the group of subjects with CPP presented more hypochondriacal traits, major depression and affective inhibition if compared with LB group, but such psychological variables havenot been able to predict the outcome to treatment. No significant difference has been found between LB and CPP subjects regarding the pain threshold of and/or the pain tolerance, when pain was induced by cold stimulation to the hand.High pain tolerance together with the high expectation of analgesia and the conviction of disease appear to be the most important predictors of treatment outcome.
Baropodometry on women suffering from chronic pelvic pain - a cross-sectional study
Carolina W Kaercher, Vanessa K Genro, Carlos A Souza, Mariane Alfonsin, Greice Berton, Jo?o S Cunha Filho
BMC Women's Health , 2011, DOI: 10.1186/1472-6874-11-51
Abstract: We performed a prospective study in a university hospital. We selected 32 patients suffering from chronic pelvic pain (study group) and 30 women without this pathology (regular gynecological work out - control group). Pain scores and baropodometric analysis were performed.As expected, study group presented higher pain scores than control group. Study and control groups presented similar averages for the maximum pressures to the left and right soles as well as soles supports in the forefeet and hind feet. Women suffering from chronic pelvic pain did not present differences in baropodometric analysis when compared to healthy controls.This data demonstrates that postural abnormalities resulting from CPP could not be demonstrated by baropodometric evaluation. Other postural measures should be addressed to evaluate pelvic pain patients.Chronic Pelvic Pain (CPP) is a major health problem [1], and it can be defined as a nonmalignant pain perceived in structures related to the pelvis; constant or recurring over a period of 6 months. In some cases it might be associated with negative cognitive, behavioral and social consequences [2]. Prevalence of CPP in the female population has been suggested to be 3.8% [3], however it can reach 40% in infertility patients [4]. CPP is a significant symptom in reproductive age women [5], with a direct impact on their marital, social and professional life [1,6]. Several papers with different methodological characteristics have shown an association of CPP with a negative impact on personal activities [7,8]. CPP accounts for approximately 40% of laparoscopies and 10 to 15% of hysterectomies [9]. It has been estimated that women who suffer from CPP take approximately three times more medication when compared to women without pain [5]. Additionally, pelvic pain is a cause of absenteeism from work in 15% of cases, being associated to reduced productivity and limitation of home activities [6,10]. An association was demonstrated between CPP and alt
Chronic Pelvic Pain frequency among a group of Iranian employed women
Dehghan FM,Ghanbari Z,Frootan M,Kuhpayeh Zadeh J
Tehran University Medical Journal , 2009,
Abstract: "nBackground: Chronic Pelvic Pain (CPP), a common health problem in women, characterized by lower abdominal pain that has lasted at least for six months. Although, it's annual prevalence estimated 3.8 to 49%, there is no data in Iranian society. This study was aimed at gathering comprehensive and reliable data regarding the prevalence of CPP in female employees at two university hospitals in Tehran in 2006-2007. "nMethods: A cross-Sectional study was conducted to determine the CPP prevalence on 303 volunteer females aged 19-63(34.7±9.2) years, working in two university hospitals, Tehran. A designed questionnaire with four parts containing questions regarding demographic information, gynecological, urinary and gastrointestinal symptoms was used. The ethical committee of the Shaheed Beheshti Medical University approved the study. "nResults: The prevalence of present pelvic pain unrelated to menstrual cycle was 22.3% and totally 10.2% subjects suffered from CPP during the last 6-12 months. Our data showed a significant difference in prevalence of CPP between women with and without vaginal delivery (37% VS. 24 P=0.036%). There was a significant relationship between incomplete and hard defecation and occurrence of CPP (p<0.001). The prevalence of LBP & PPD in women with CPP was higher than women with no CPP (p<0.001). "nConclusions: Regarding to the prevalence of CPP and its relationship with gynecological, urinary, musculoskeletal and gastrointestinal factors, we emphasize on a multidisciplinary approach for management of CPP, also recommend performing further community-based epidemiological studies.
A randomised controlled trial to assess the efficacy of Laparoscopic Uterosacral Nerve Ablation (LUNA) in the treatment of chronic pelvic pain: The trial protocol [ISRCTN41196151]
The LUNA Trial Collaboration
BMC Women's Health , 2003, DOI: 10.1186/1472-6874-3-6
Abstract: The principal objective is to test the hypothesis that in women with chronic pelvic pain in whom diagnostic laparoscopy reveals either no pathology or mild endometriosis (AFS score ≤ 5) LUNA alleviates pain and improves life quality at 12 months. A multi-centre, prospective, randomised-controlled-trial will be carried out with blind assessment of outcomes in eligible consenting patients randomised at diagnostic laparoscopy to LUNA (experimental group) or to no pelvic denervation (control group). Postal questionnaires including visual analogue scale for pain (primary outcome), an index of sexual satisfaction and the EuroQoL 5D-EQ instrument (secondary outcomes) will be administered at 3, 6 and 12 months. The primary assessment of the effectiveness of LUNA will be from comparison of outcomes at the one-year follow-up, although the medium-term and longer-term risks and benefits of LUNA will also be evaluated.The sample size for this trial has been estimated as 420 patients in total using the hypothesis that LUNA will alleviate pain symptoms (i.e. reduce pain scores on a VAS) more than no intervention at one-year following diagnostic laparoscopy and taking into consideration 20% loss to follow-up. The intention to treat analysis to address the principal research questions will be conducted using the one-year follow-up data.Pelvic pain remains the single most common indication for referral to a Gynaecology clinic accounting for 20% of all outpatient appointments [1,2]. Five percent of all new appointments are for chronic pelvic pain[3]. It continues to be one of the most difficult and perplexing problems encountered in Gynaecology. Pelvic pain has a major impact on health-related quality of life, work productivity and health care utilisation. It is also a major cause of workplace absenteeism [4]. An estimated 158 million pounds are spent annually on the management of this condition in the health service [5]. In primary care, the annual prevalence is 38/1000 in women aged
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