Background: Chronic pelvic pain (CPP) in women causes significant disability and distress. Like other chronic pain conditions, psychosocial variables likely play as key a role in the development and maintenance of CPP as physiological ones. The purposes of this study were to use the Biopsychosocial model to determine the predictors of pain and quality of life (QOL) and to specifically examine to effect of baseline catastrophizing on 12-month pain and QOL. Methods: Secondary analysis of baseline and 12-month data collected from women presenting for CPP treatment (n = 673) at a tertiary referral center was performed. Questionnaires assessed medical symptoms, physical and mental health, abuse, trauma, catastrophizing and the main outcome measures of pain reports (McGill Pain Questionnaire) and QOL scores (adapted version of the Irritable Bowel Syndrome QOL Questionnaire). Results: Of the 673 enrolled, 401 completed baseline questionnaires. These women were predominantly middle aged (M = 35.68, SD = 9.87), married (66%), Caucasian (78%), and educated (M = 14.83, SD = 2.55). Two hundred seventy-two women completed questionnaires at baseline and 12 months and were similar in most characteristics but reported fewer incidents of trauma and abuse, improved physical health and fewer medical symptoms. Women experienced a significant reduction in pain (t (261) = 11.23, p < .001) and improved QOL (t (257) = 6.78, p< .001). Baseline catastrophizing was a predictor of baseline pain (R2 = .42, pβ = .46, p < .001) and baseline QOL (R2 = .79, p< .001; β = .71 p < .001) with similar results at 12-month follow-up. While baseline catastrophizing contributed only 3% of the variance it remained a significant predictor of 12-month pain (R2 = .39, p < .001; β = .18, p = .003). Unexpectedly, abuse and trauma histories were not significant predictors of pain or QOL. Conclusions: These findings contribute to the existing body of literature by confirming the complex nature of CPP and suggest that psychological processes such as catastrophizing play a vital role in CPP. Future research in CPP will benefit from the exploration of the contribution of psychological processes to CPP and the application of research from other pain conditions to gynecologic pain disorders.

The aim of this thesis is to investigate the prevalence and management of bladder pain syndrome (BPS) amongst women with chronic pelvic pain (CPP) through a series of systematic reviews, a structured survey and primary study. It has been acknowledged that the diagnosis and management of BPS is a contentious subject. The mean prevalence of BPS in women with CPP is 61%. I initially carried out a patient and clinician survey to understand how BPS was being managed in the UK. I found wide variation in diagnostic methods and treatments of BPS used by clinicians and experienced by patients with no obvious consensus. Since we know the predominant complaint in these patients is pain (bladder or pelvic) I used patients with pelvic pain as my cohort. Cystoscopy is no longer used as a diagnostic test for BPS. It is possible to diagnose BPS through a consensus expert panel using symptom-based criteria. This method of deriving a reference standard is demonstrated in the primary study, since no gold standard diagnostic test exists for BPS. A case-control feasibility study was undertaken to investigate the accuracy of a group of urinary symptoms to diagnose BPS. While, neither index test of bladder filling pain or bladder wall tenderness can sensitively diagnose BPS alone, the symptoms of bladder filling pain, urinary frequency, pain on urination and pain on full bladder are a good predictor of the condition. A systematic review assessing the reporting outcomes identified five measures that should be included in studies; pain, urinary symptoms, general 8 wellbeing, quality of life and bladder capacity. Of the 19 treatments used for BPS, the level and strength of evidence ratings overestimated quality compared to the GRADE ratings. BPS can be diagnosed symptomatically but there is variable reporting of outcome measures and poor evidence for treatment effectiveness.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2008. / Härtill 4 uppsatser.

Thesis (Ph. D.)--University of Texas at Austin, 2004. / Supervisor: Guy J. Manaster. Vita. Includes bibliographical references.

OBJECTIVES: This study aims to explore the relationship between central pain amplification and persistent pelvic pain. No previous studies have utilized bimanual pelvic examination findings, in addition to pressure-pain analysis, in an effort to investigate the mechanisms contributing to Chronic Pelvic Pain (CPP) in women with endometriosis. METHODS: Participants included 144 women aged 18-50 years old, diagnosed with CPP and/or surgically-confirmed endometriosis compared to healthy controls. Participants were categorized into four groups, including pain-free endometriosis (Endo Ø Pain), painful endometriosis (Endo + Pain), Chronic Pelvic Pain without endometriosis (CPP Ø Endo), and healthy controls. Pressure-pain Quantitative Sensory Testing (QST) was conducted on all participants to determine levels of pain thresholds. External systemic tenderpoints were assessed utilizing standardized fibromyalgia tenderpoint criteria. A pelvic examination was performed on participants in the gynecological sample in order to assess internal tenderness. One-way ANOVA, chi-square analyses were conducted to assess descriptive variables. Correlation calculations were performed to assess the relationship between pressure-pain thresholds and tenderpoints. Generalized Linear Models (GLM) were conducted to analyze the differences on pressure-pain thresholds and pelvic exam tenderpoints between groups, while controlling for age and number of comorbid chronic pain syndromes (CPS). RESULTS: Endo Ø Pain had a significantly higher stage of endometriosis and were significantly older than the Endo + Pain group. Healthy controls had less external systemic tenderpoints than all patient subgroups. CPP Ø Endo and Endo + Pain had more CPS than healthy controls and Endo Ø Pain. Pelvic exam tenderpoints (r= -0.31, p < 0.01) and systemic external tenderpoints (r = -0.35, p <0.01) were negatively correlated with low pressure-pain threshold. Systemic external tenderpoints were negatively correlated with the high pressure staircase (r= -0.41, p < 0.01), but pelvic exam tenderpoints were not. The GLMs conducted revealed that Endo Ø Pain had significantly higher low pressure-pain threshold compared to both Endo + Pain (difference = 0.57, p < 0.01, CI= 0.12, 1.02) and healthy controls (difference = 0.55, p < 0.05, CI= 0.08, 1.02). The CPP Ø Endo group had significantly lower high pressure-pain threshold scores compared to healthy controls (difference = 0.38, p < 0.05, CI= 0.05, 0.71). The Endo + Pain group also had significantly lower high-pain thresholds as compared to healthy controls (difference= 0.31, p < 0.05, CI= 0.04, 0.58). CPP Ø Endo group had significantly more pelvic tenderpoints compared to Endo Ø Pain (difference = 2.81, p < 0.001, CI = 1.36, 4.27); Endo + Pain group also had significantly more pelvic exam tenderpoints than the Endo Ø Pain (difference= 2.10, p < 0.001, CI = 0.96, 3.24). CONCLUSIONS: The findings of this study suggest that pain thresholds, as measured by QST pressure-pain testing, are associated with persistent pelvic pain. CPP Ø Endo and Endo + Pain experienced more systemic tenderness, and more CPS than the Endo Ø Pain group and healthy controls. This indicates that chronic pain, not endometrial lesions, are likely responsible for the development of centralized pain amplification. Although the etiology of endometriosis and CPP is poorly understood, the findings of this study contribute to the idea that central sensitization is associated with the shared underlying pain mechanism in chronic pain syndromes. / 2020-07-03T00:00:00Z

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Extreme controversy surrounds the uncertainty of pelvic mesh and sling devices to essentially cure patients of stress urinary incontinence (SUI). A relatively new product that has taken the market by storm is the tension free Vaginal Tape‐ Obturator (TVT‐O) mesh by Ethicon, Gynecare. It has obtained Center for Disease Control approval and labeled a “clinically proven, safe product with a 90% cure rate for urinary incontinence,” according to the manufactures website (Ethicon, Gynecare)4, 8. One side effect that is known about this particular device is its ability to leave patients post surgery with unbearable, chronic pelvic pain2. Although the mesh is needed to prevent urinary incontinence, it is pivotal that the quality of life of our patients does not suffer appreciably with elective, non‐life threatening procedures. Another common mesh product is the pelvic sling by Monarc. One‐study reports more than 95 percent of patients who underwent elective surgery with the insertion of Monarc sling achieved complete dryness and did not require the use of pads following the procedure22. These are successful outcomes, but what occurs with the minority of patients that have unfavorable outcomes such as chronic pain12, 15, 16? A retrospective study was completed to deduce the onset of pain and severity of pain caused by the TVT‐O mesh and Monarc mesh‐utilizing data from Dr. Hibner’s patients. There were 19 chronic pelvic pain patients with an average age of 50, standard deviation of 11 years, seen by Dr. Hibner and his colleagues. These patients completed the International Pelvic Pain assessment form upon their first visit to the office and SF‐36 scores of physical and mental scores were obtained. Results found physical scores of 29.5 and mental scores of 36 in pelvic pain patients, which were higher than certain other chronic, medical diseases1. We were able to conclude that patients with pelvic pain from mesh have lower physical and mental SF‐36 scores than patients with other chronic diseases representing a decreased quality of life overall.

No description available.

Thesis (M. A.)--University of Canterbury, 2010. / Typescript (photocopy). Includes bibliographical references (leaves 122-161). Also available via the World Wide Web.

Orientador: Luis Guillermo Bahamondes / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-16T20:36:59Z (GMT). No. of bitstreams: 1 Modesto_WaleskaOliveira_M.pdf: 793320 bytes, checksum: ec8512a5c3785d9f14ee566b2d844e1f (MD5) Previous issue date: 2010 / Resumo : O objetivo do estudo foi avaliar a influência da constipação funcional em mulheres com dor pélvica crônica (DPC). No período de julho de 2009 a junho de 2010 foram avaliadas 100 mulheres com idade de 18 a 50 anos no Ambulatório de Ginecologia do Centro de Atenção Integral à Saúde da Mulher (CAISM) da Universidade Estadual de Campinas (UNICAMP). Em uma análise prospectiva, as mulheres foram divididas em três grupos: grupo A - mulheres sem o diagnóstico de DPC -, Grupo B - mulheres com o diagnóstico de DPC e sem constipação funcional - e grupo C - mulheres com diagnóstico de DPC e com constipação funcional, de acordo com os critérios de ROMA III. Todas as mulheres participantes tiverem um seguimento de três meses, preenchendo o diário da dor e constipação. A DPC foi avaliada diariamente segundo a escala análoga visual (EAV). Os resultados mostraram que no grupo A, 13 (41,9%) apresentaram os sintomas de constipação funcional, incluindo 16 (51,6%) mulheres que relataram fezes endurecidas ou fragmentadas. No grupo B, 4 mulheres (21,1%) apresentaram fezes endurecidas ou fragmentadas. No grupo C, 46 mulheres (92%) relataram esforço ao evacuar e a sensação de evacuação incompleta, 49 mulheres referiram fezes endurecidas ou fragmentadas. O estudo mostrou que os grupos B e C não apresentaram diferença significante na dor, não existiu relação na EAV durante as 12 semanas de acompanhamento. Os diagnósticos mais comuns associados à DPC foram: idiopática (44,9%), endometriose (23,2%) e aderência pélvica (17,4%). Os resultados mostraram que a constipação funcional não exerce influência sobre o aumento da dor das pacientes com DPC / Abstract : This study evaluated the effect of functional constipation on women with and without chronic pelvic pain (CPP). During the period of July 2009 through June 2010 a total of 100 women aged 18-50 years at the CAISM/UNICAMP were divided into 3 groups: A) women without CPP; B) women diagnosed with CPP but without functional constipation; and C) women diagnosed with CPP with functional constipation diagnosed according to the Rome III criteria. All participants were followed over 3 months, completing a daily questionnaire on pain and constipation. CPP was evaluated using a visual analogue scale (VAS). The result showed that in the Group A, 16/31 women (51.6%) complained of lumpy or hard stools, while 13 (41.9%) had symptoms of functional constipation. In Group B, 4/19 women (21.1%) had lumpy or hard stools. In Group C, 46/50 women (92%) reported straining or incomplete bowel movements, while 49 reported lumpy or hard stools. Regarding CPP, no significant differences were found in VAS pain score between Groups B and C and no changes were found in VAS pain score throughout the 12-week evaluation period. The most common diagnoses associated with CPP were idiopathic pain (44.9%), endometriosis (23.2%) and pelvic adhesions (17.4%). These results showed that functional constipation does not affect pain score in women with CPP / Mestrado / Fisiopatologia Ginecológica / Mestre em Ciências da Saúde

L’endométriose est définie comme la présence de tissu endométrial et de stroma en dehors de la cavité utérine. Ses localisations les plus fréquentes sont le péritoine pelvien et les ovaires. L’endométriose infiltrante est classiquement décrite comme la présence de tissu endométriotique plus de cinq millimètres sous le péritoine pelvien ou la séreuse d’un organe. Histologiquement il s’agit d’une lésion endométriotique mais qui contrairement aux lésions ovariennes ou péritonéales contient significativement plus de muscle lisse et de fibrose et est davantage associée à la douleur. Les lésions infiltrantes peuvent être responsables de dysménorrhée, dyspareunie profonde et douleurs pelviennes chroniques sévères ayant un charactère hyperalgique tel qu’on peut le retrouver dans les douleurs neuropathiques. Ces douleurs nécessitent souvent la prise de quantités importantes d’antalgiques et ont des répercussions importantes sur la vie professionnelle, quotidienne et sexuelle des femmes atteintes. L’endométriose infiltrante présente un rapport histologique étroit avec les structures nerveuses du rétropéritoine ou les nerfs des organes atteints. Dans sa localisation rectovaginale il existe une relation histologique étroite entre les lésions d’endométriose et les nerfs ainsi qu’une correlation entre l’intensité de la douleur et le nombre de structures nerveuses envahies par l’endometriose ou engaînées dans la fibrose. Ces lésions infiltrantes expriment le «nerve growth factor» (NGF), une neurotrophine qui joue un rôle clé dans la genèse de l’hyperalgie et de la douleur. Les structures nerveuses du rétropéritoine pelvien expriment quant à elles le récepteur spécifique pour la neurotrophine NGF. Le système «NGF-récepteur spécifique» peut être responsable d’un chimiotactisme tissulaire entre les tissus sécrétant du NGF et les nerfs qui expriment le récepteur pour le NGF. Le système «NGF- récepteur spécifique» au sein de la relation endométriose-nerfs pourrait rendre compte du caractère hyperalgique des lésions endométriotiques infiltrantes ainsi, qu’expliquer pourquoi les lésions nodulaires n’apparaissent que dans les sites anatomiques richement innervés (ligaments utérosacrés, lame rectovaginale, paroi du rectum ou du côlon…) et pas ailleurs. Le traitement de première intention est chirurgical. Il convient d’être suffisamment agressif sur les lésions tout en engendrant le moins de séquelles postopératoires possibles sachant que nombre de ces femmes sont stériles. En cas d’atteinte digestive basse, les modalités de l’intervention sont dictées par l’extension et le degré d’infiltration de la paroi digestive. Dans le but de réaliser dans la majorité des cas une chirurgie minimalement invasive (laparoscopique) avec des cicatrices de petites tailles, nous avons développé une stratégie de traitement basée sur le degré d’infiltration de la paroi digestive. Dans ce cadre nous avons développé une technique laparo-assistée de résection colique segmentaire et de résection antérieure du rectum.