Pelvic & Urogenital Pain

 

  •  GENERAL

National and International Guidelines

The Initial Management of Chronic Pelvic Pain.

RCOG May 2012

Guidelines on Chronic Pelvic Pain. 

European Association of Urology 2012

Consensus Guidelines for the Management of Chronic Pelvic Pain.

SOGC 2005.

European guidelines for the diagnosis and treatment of pelvic girdle pain.

2008

Cochrane Reviews

Interventions for treating chronic pelvic pain in women.

Stones W, Cheong YC, Howard FM, Singh S. Cochrane Database of Systematic Reviews 2005, Issue 2

Summary: 

Chronic pelvic pain in women is a common problem. Symptoms include lower abdominal pain, and pain before and during sexual intercourse. Specific causes are difficult to identify and treatment is often limited to relief of symptoms. An ultrasound or internal examination using a laparoscope is done to rule out serious conditions and to provide reassurance. The review of trials found that a multidisciplinary approach helps alleviate symptoms. A high dose of progestogen therapy using medroxyprogesterone acetate also helps but goserelin has a longer duration of benefit. There is an indication of benefit from writing therapy for some patients.

Transcutaneous electrical nerve stimulation for primary dysmenorrhoea.

Proctor M, Farquhar C, Stones W, He L, Zhu X, Brown J. Cochrane Database of Systematic Reviews 2002, Issue 1

Summary: 

High-frequency nerve stimulation may help relieve painful menstrual cramps. Dysmenorrhoea is a very common complaint that refers to painful menstrual cramps in the uterus. Transcutaneous electrical nerve stimulation (TENS) involves the sending of an electric current by placing electrodes on the skin to stimulate the nerves and reduce pain. It is thought to alter the body's ability to receive and understand pain signals rather than by having a direct effect on the uterine contractions. The review of trials found that high-frequency TENS may help but there is not enough evidence to assess the effect of low-frequency TENS. More research is needed.

 

  •  PHARMACOLOGICAL

Cochrane Reviews

Anti-TNF-α treatment for pelvic pain associated with endometriosis.

Lu D, Song H, Shi G. Cochrane Database of Systematic Reviews 2013, Issue 3.

Summary: 

Endometriosis is a painful condition in which endometrial tissue grows outside the uterus. It potentially affects a woman's ability to conceive. Recent studies support the contributing role of inflammation in endometriosis-related pain. Since anti-TNF-α drugs can inhibit the inflammation process, they may relieve the symptoms of the disease without inhibiting ovulation. However, this systematic review included one randomised controlled trial and found that there was not enough evidence from which to draw conclusions about the effectiveness and safety of anti-TNF-α drugs in relieving pain in women with endometriosis. There was no evidence of an increase in adverse events in the anti-TNF-α drugs group compared with the placebo group.

Danazol for pelvic pain associated with endometriosis.

Farquhar C, Prentice A, Singla AA, Selak V. Cochrane Database of Systematic Reviews 2007, Issue 4.

Summary: 

Danazol reduces the painful symptoms of endometriosis but has androgenic effects. Endometriosis is a painful condition where endometrial tissue grows outside the uterus. It can cause cysts and infertility. Danazol is a hormone that produces male characteristics as well as weight gain and acne. It does, however, relieve the painful symptoms of endometriosis, although the side effects can be unacceptable. The improvement was still present six months after treatment was stopped. There was some evidence that women who took danazol were satisfied with the treatment compared with women who had inactive treatment.

Pregabalin for chronic prostatitis.

Aboumarzouk OM, Nelson RL. Cochrane Database of Systematic Reviews 2012, Issue 8.

Summary: 

It has been suggested that chronic prostatitis/chronic pelvic pain syndrome is due to pain caused by the nerves in or around the prostate. Pregabalin is a pain killer that is specific for nerve pain. Therefore we conducted a search of the literature to evaluate the use of pregabalin for this ailment and whether or not it was better than placebo. We concluded that pregabalin was no more effective than placebo and is associated with adverse effects. Though there was no conclusive evidence for the use of pregabalin, further research is recommended.

Herbal and dietary therapies for primary and secondary dysmenorrhoea.

Proctor M, Murphy PA. Cochrane Database of Systematic Reviews 2001, Issue 2

Summary: 

Dysmenorrhoea is a very common complaint that refers to painful menstrual cramps in the uterus. When the pain is associated with a recognised condition such as endometriosis, it is called secondary dysmenorrhoea. Primary dysmenorrhoea refers to pain of an unknown cause. Nonsteroidal anti-inflammatory drugs or the contraceptive pill have been used but more women are looking for non-drug therapies, including herbal and dietary treatments. The review of trials found some evidence that Vitamin B1 and magnesium help reduce pain but more research is needed.

 

  •  INVASIVE THERAPIES

Cochrane Reviews

Laparoscopic surgery for pelvic pain associated with endometriosis.

Jacobson TZ, Duffy JMN, Barlow D, Koninckx PR, Garry R. Cochrane Database of Systematic Reviews 2009, Issue 4

Summary: 

Endometriosis is the presence of tissue that normally lines the uterus in inappropriate sites (usually within the pelvic cavity). It can cause fertility problems, painful menstruation and painful sexual intercourse. Hormonal drugs such as the oral contraceptive pill are used but may have adverse effects and are not suitable for women wishing to become pregnant. Laparoscopic surgery (where small incisions are made in the abdomen) is performed to remove visible areas of endometriosis. The review of trials found that laparoscopic surgery is effective in treating pelvic pain associated with endometriosis. More research is needed.

Acupuncture for pain in endometriosis.

Zhu X, Hamilton KD, McNicol ED Cochrane Database of Systematic Reviews 2011, Issue 9.

Summary: 

Endometriosis is a gynaecological disease that causes chronic pelvic pain, most notably painful menstruation, as the most common complaint. Acupuncture is frequently used to treat both pain and various gynaecological conditions. This review examined the effectiveness of acupuncture for reducing pain in endometriosis; however only one study met our inclusion criteria. The data from the included study, involving 67 women, indicated that ear acupuncture is more effective compared to Chinese herbal medicine for reducing menstrual pain. The study did not report whether participants suffered any side effects from their treatments. Larger, well-designed studies comparing acupuncture with conventional therapies are necessary to confirm these results.

 

  •  PSYCHOLOGICAL THERAPIES

Cochrane Reviews

Behavioural interventions for dysmenorrhoea.

Proctor M, Murphy PA, Pattison HM, Suckling JA, Farquhar C. Cochrane Database of Systematic Reviews 2007, Issue 3.

Summary: 

Dysmenorrhoea is a very common complaint that refers to painful menstrual cramps in the uterus (womb). When the pain is due to a recognised medical condition such as endometriosis it is called secondary dysmenorrhoea. When the pain is of unknown cause it is called primary dysmenorrhoea. Nonsteroidal anti-inflammatory drugs or the contraceptive pill have been used as treatment for period pain but more women are looking for non-drug therapies. Behavioural therapies assume that psychological (the mind) and environmental factors interact with, and influence, physical processes, for example stress might influence period pain. Behavioural therapies focus on both physical and psychological coping strategies for symptoms such as pain rather than focusing on medical solutions for any underlying causes of the symptoms. An example of a behavioural therapy is using relaxation to help a woman cope with painful period cramps. This review found that progressive muscle relaxation with or without imagery and relaxation may help with spasmodic (acute, cramping pain) symptoms of period pain. Also that pain management training and relaxation plus biofeedback may help with period pain in general. The results are not conclusive due to the small number of women in the trials and the poor methods used in some of the trials.

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