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

Abstract

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.

Understanding the Female Physical Examination in Patients with Chronic Pelvic and Perineal Pain

“…The examination of patients with central sensitization seems to confirm the patient's phenotype (tier 2), reveals the affected compartments, and allows for the proposal of multidisciplinary procedures for pain management [20]. Pain central sensitization guides treatments towards combined therapies for myofascial pain syndrome, as well as neuro-pathic and visceral pain treatments.…”

“…Data from the examination were collected according to the pain mapping method reported in previously published works [19,20], including the following.…”

Endometriosis Care in the Indonesian Healthcare Referral System: Evaluating Diagnostic Delays and Therapeutic Approaches

“…However, it is estimated that around 30% to 60% of patients do not respond to conventional therapies, including surgery. Hence, there is a current recommendation to shift the approach of endometriosis treatment towards an immune and inflammatory environment surrounding endometrial implant modifications that are currently being developed (11). It is predicted to have a significant impact on symptom management along with disease burden for endometriosis patients worldwide (12).…”

Manejo laparoscópico y farmacológico del dolor de miembro pélvico en pacientes con endometriosis profunda: resultados de una serie de casos

“…13 En pequeños estudios aleatorizados no se ha demostrado que la sertralina tenga efecto analgésico sobre el placebo para el tratamiento del dolor pélvico crónico 14 la mayoría de las pacientes presentan dolores mixtos y requieren de terapias combinadas. 15 La mayoría de las pacientes presentan retraso de años para recibir un tratamiento adecuado para la endometriosis profunda, mermando significativamente su calidad de vida. El objetivo de este estudio es evaluar la mejoría clínica de las pacientes posterior a la cirugía laparoscópica de remoción de endometriosis profunda y tratamiento médico con neuromoduladores.…”