A physiatrist's understanding and application of the current literature on chronic pelvic pain: a narrative review

Ullger, Cory; Seko, Kyle; Shrikhande, Allyson; Natarajan, Janaki; Tailor, Yogita; Thompson-Chudy, Carolyn

doi:10.1097/pr9.0000000000000949

Cited by 5 publications

(7 citation statements)

References 114 publications

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“…The pudendal nerve and the posterior femoral cutaneous nerves were treated as they are the two major sensory nerves that innervate the lower two-thirds of the pelvis. 15 Given the cross innervation between these two nerves, it is important to downregulate and reverse the aberrant firing and neurogenic inflammation that occurs in both nerves. 16 BPS/IC is thought to have a major component of neurogenic inflammation and pelvic floor hypertonia that through the pelvic cross-sensitisation process and inter-neuronal connections, this causes injury/trauma to the bladder and results in symptoms commonly associated with BPS/IC.…”

Section: Resultsmentioning

confidence: 99%

“…This supports the validity of an outpatient treatment protocol aimed at treating the underlying hypertonic pelvic floor myofascial pain and concomitant peripheral neurogenic inflammation often seen in the major pelvic nerves of BPS/IC patients. The pudendal nerve and the posterior femoral cutaneous nerves were treated as they are the two major sensory nerves that innervate the lower two‐thirds of the pelvis 15 . Given the cross innervation between these two nerves, it is important to downregulate and reverse the aberrant firing and neurogenic inflammation that occurs in both nerves 16 …”

Section: Discussionmentioning

confidence: 99%

“…The pudendal nerve and the posterior femoral cutaneous nerves were treated as they are the two major sensory nerves that innervate the lower two‐thirds of the pelvis. 15 Given the cross innervation between these two nerves, it is important to downregulate and reverse the aberrant firing and neurogenic inflammation that occurs in both nerves. 16 …”

Section: Discussionmentioning

confidence: 99%

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Bladder pain syndrome/interstitial cystitis response to nerve blocks and trigger point injections

et al. 2022

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Objectives: Bladder pain syndrome (BPS)/interstitial cystitis (IC) is a debilitating condition characterised by bladder/pelvic pain and pressure as well as persistent or recurrent urinary symptoms in the absence of an identifiable cause. It is hypothesised that in addition to organ specific visceral hypersensitivity, contributions of the hypertonic pelvic floor, peripheral sensitisation, and central sensitisation exacerbate this condition. The aim of this paper is to investigate outcomes of treating underlying neuromuscular dysfunction and neuro-plastic mechanisms in BPS/IC patients.Methods: A retrospective chart review of 84 patients referred to an outpatient pelvic rehabilitation centre with a diagnosis of BPS/IC given to them by a urologist. All 84 patients failed to progress after completing 6 weeks of pelvic floor physical therapy and underwent an institutional review board approved protocol (IRB# 17-0761) consisting of external ultrasound-guided trigger point injections to the pelvic floor musculature, peripheral nerve blocks of the pudendal and posterior femoral cutaneous nerves and continued pelvic floor physical therapy once weekly for 6 weeks. Pelvic pain intensity and functionality were measured pretreatment and 3 months posttreatment using Visual Analogue Scale (VAS) and Functional Pelvic Pain Scale (FPPS).Results: Pretreatment, mean VAS was 6.23 AE 2.68 (95% CI 5.65 to 6.80). Posttreatment mean VAS was 3.90 AE 2.63 (95% CI 3.07-4.74). Mean FPPS before treatment was 11.98 AE 6.28 (95% CI 10.63 to 13.32). Posttreatment mean FPPS was 7. . Analysis of subcategories within FPPS indicated highest statistically significant improvement in the categories of bladder, intercourse and working.Conclusions: Analysis suggests the treatment was effective at ameliorating bladder pain and function including urinary urgency, frequency, and burning in BPS/IC patients.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Bladder pain syndrome/interstitial cystitis response to nerve blocks and trigger point injections

et al. 2022

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“…Las mujeres con SDMF del suelo pélvico presentan de manera frecuente cuadros de ansiedad o depresión, en ocasiones con un antecedente de trauma pélvico o abuso sexual (15). Estos factores de estrés mental y emocional favorecen la formación de puntos gatillo musculares y el desarrollo de dispareunia y constipación, que generan una sobrecarga nociceptiva y mecánica a nivel del suelo pélvico (33).…”

Section: Psicoterapiaunclassified

Síndrome de dolor miofascial en la musculatura del suelo pélvico femenino. Revisión narrativa de la literatura.

Vega¹,

Gálvez²,

Sánchez³

2022

Rev. Soc. Esp. Dolor.

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Introducción: El síndrome de dolor miofascial del suelo pélvico en la mujer es una causa frecuente de dolor agudo y crónico, en ocasiones superpuesto a otras entidades patológicas. Es secundario a la sobrecarga mecánica muscular que favorece la aparición de puntos gatillo.Objetivo: Describir una entidad dolorosa frecuente, su fisiopatología y posibilidades de tratamiento.Metodología: Se realizó una revisión de la literatura con términos Mesh en inglés y español en las bases de datos Embase, Pubmed, Lilacs, Sage, Google Acedemics y Scielo desde el año 1983 hasta el año 2021. Se encontraron 240 artículos y fueron seleccionados 50, basados en su impacto clínico.Resultados: El dolor pélvico afecta a más del 50 % de las mujeres mayores de 35 años.Existen diferentes condiciones clínicas que favorecen la sobrecarga mecánica muscular y la formación de puntos miofasciales dolorosos. El diagnóstico es clínico, pero se pueden solicitar estudios imagenológicos. El tratamiento incluye varias modalidades: terapia física, psicoterapia, farmacoterapia e intervencionismo con aguja seca, estimulación eléctrica y toxina botulínica.Conclusión: El síndrome miofascial en la musculatura pélvica femenina es una condición prevalente que debe ser considerada dentro del diagnóstico de dolor pélvico y abordada de manera multidisciplinaria.

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“…CPP patients often obtain insufficient relief of their symptoms, consult many doctors without obtaining a precise diagnosis/ appropriate management for many years, and can have the impression of being abandoned by the medical profession [ 28 ]. Currently, the treatment of CPP and its related comorbidities is a multimodal interdisciplinary comprehensive outpatient protocol involving pharmacological agents, physical therapy, behavioral health, lifestyle modifications of diet, exercise, and sleep as well as ultrasound guided peripheral nerve blocks, trigger point injections and/or surgical interventions if conservative management fails to resolve symptoms [ 29 , 30 ]…”

Section: Introductionmentioning

confidence: 99%

The burden of Chronic Pelvic Pain (CPP): Costs and quality of life of women and men with CPP treated in outpatient referral centers

et al. 2023

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Introduction Chronic Pelvic Pain (CPP) is a complex, multifaceted condition that affects both women and men. There is limited literature on the cost utilization the healthcare system and CPP patients incur. The purpose of this analysis is to characterize the overall healthcare utilization, cost burden, and quality-of-life restrictions experienced by CPP patients using data from an outpatient pelvic rehabilitation practice. Methods Healthcare utilization data was gathered by systematically reviewing and analyzing data from new patient visit progress notes stored in the clinic’s electronic health records (EHR). We obtained in-network costs by using the FAIR Health Consumer online database. Overall costs were then calculated as the utilization times the per-unit costs from the FAIR database. Additionally, data on patients’ visual analogue scale (VAS), absenteeism, presenteeism emergency room visits, usage of common pain medications, use of diagnostics, and participation in common treatment modalities was gathered. Results Data from 607 patients was used. The overall cost burden per patient for all surgeries combined was $15,750 for in-network services. The cost burden for diagnostics was $5,264.22 and treatments was $8,937 per patient for in-network treatments. Conclusion Chronic Pelvic Pain was found to have a large cost burden of $29,951 for in-network services which includes treatments, diagnostics, and surgeries. This analysis sets the stage for future investigations involving data on costs of medications that patients have tried prior to presenting to us and costs associated with work hours lost.

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A physiatrist's understanding and application of the current literature on chronic pelvic pain: a narrative review

Abstract: Understanding the complex, multifactorial nature of chronic pelvic pain can help physicians determine the pain's etiology and thus refer specialists to include in the multidisciplinary treatment required.

Cited by 5 publications

References 114 publications

Bladder pain syndrome/interstitial cystitis response to nerve blocks and trigger point injections

Bladder pain syndrome/interstitial cystitis response to nerve blocks and trigger point injections

Síndrome de dolor miofascial en la musculatura del suelo pélvico femenino. Revisión narrativa de la literatura.

The burden of Chronic Pelvic Pain (CPP): Costs and quality of life of women and men with CPP treated in outpatient referral centers

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