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Query: UMLS:C0030794 (pelvic pain)
 4,056 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The efficacy and safety of buserelin acetate in the treatment of endometriosis was studied in 4 open non-comparative trials and 2 open randomized comparative trials with danazol. 444 women were enrolled in the buserelin group and 89 in the danazol group. Treatment was for 6-10 months using 900-1200/micrograms intranasal buserelin/day and 400-800/micrograms oral danazol/day; patients were followed up for 6-8 months. Endometriotic lesions improved or disappeared in most women; pain (dysmenorrhoea, dyspareunia and pelvic pain) subsided rapidly. Most women had no, or alleviated, symptoms throughout follow-up, although ovarian function resumed promptly. Nearly a quarter of infertile women with a desire for children became pregnant. No significant differences between treatments emerged. Buserelin treatment was characterized by menopausal-like symptoms in most women, as well as by headache and nausea. Danazol treatment, which also gave rise to these effects, was accompanied by weight gain, myalgia and acne in a considerable proportion of women, as well as other anabolic and androgenic side effects. Buserelin would thus appear to be a safe and effective alternative to the standard therapy, danazol, in the treatment of endometriosis.
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PMID:Efficacy and safety of intranasal buserelin acetate in the treatment of endometriosis: a review of six clinical trials and comparison with danazol. 210 46

The study, which was part of a cardiovascular screening programme of 40-42 year old women organised by the National Health Screening Service, wanted to assess the prevalence of locomotor complaints in Middle-Norway. Forty-nine percent of the respondents reported the occurrence of musculoskeletal disorders. Low back pain and myalgia was the most and chronic inflammatory joint diseases the least frequent. Between healthy women and some groups of women reporting musculoskeletal disorders, significant differences in sociodemographic background, workload, working ability, and health care utilisation emerged. Among lifestyle factors, smoking was significantly more frequent for women reporting fibromyalgia. Analysing the occurrence of symptoms and diseases in the genital tract revealed that a significantly higher proportion of women reporting musculoskeletal disease answered positively. Differences between healthy women and women reporting pelvic joint syndrome, fibromyalgia, whiplash, or arthritis were significant in bleeding disorders chronic pelvic pain and inflammatory pelvic disease. Patients with rheumatoid arthritis reported oophorectomy significantly more often than healthy women. In conclusion, a high rate of musculoskeletal symptoms and disorders was reported by middle-aged women. A strong association between musculoskeletal disorders and gynecological disease was found.
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PMID:Sociodemographic characteristics and gynecological disease in 40-42 year old women reporting musculoskeletal disease. 943 2

A 51-year-old woman consulted for pelvic pain, metrorrhagia and leukorrhea. Physical examination revealed a renitent and mobile mass in the pelvis. A right lateral uterine mass with hydroxalpinx was found at ultrasonography. Pathology examination of the right annexectomy specimen provided the definitive diagnosis: fallopian tube cancer with polymyositis. No residual tumor was found at total hysterectomy with total bilateral annexectomy. The patient was lost to follow-up for three years without complementary treatment then consulted later for functional disability of the upper then lower limbs with myalgia, swallowing disorders and left supraclavian node enlargement resulting from pelvic relapse of the right fallopian tube adenocarcinoma and left supraclavian metastasis with paraneoplastic polymositis. The patient was given 6 courses of chemotherapy with radiotherapy (45 Gy) centered on the left clavian region. The patient exhibited a spectacular response, and remains in complete remission 50 months after diagnosis. The association of a fallopian tube tumor with polymyositis is exceptional, requiring rapid anticancer treatment effective against the cancer and the paraneoplastic polymyositis.
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PMID:[Association of fallopian tube cancer and polymyositis. Apropos of 1 case]. 1188 28

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a debilitating condition, traditionally treated with antimicrobials, nonsteroidal anti-inflammatory drugs, and alpha-blockers. Pelvic floor tension myalgia is hypothesized to be a contributing factor in CPPS. Biofeedback training for CPPS is based on the principle that maximum muscle contraction prompts maximum muscle relaxation. Similar chronic pain conditions have been treated successfully with biofeedback-assisted techniques of neuromuscular reeducation. Preliminary study by our group has shown biofeedback, pelvic floor reeducation, and bladder training to be helpful in the treatment of CP/CPPS. Overall, 8 of 11 patients had improvement in either pain scores or their chronic prostatitis pain index scores. With no cure for CP/CPPS available, biofeedback and pelvic floor reeducation merit further evaluation in the treatment of this condition.
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PMID:Bladder training biofeedback and pelvic floor myalgia. 1252 95

Endometriosis is a pain syndrome representing a major cause of pelvic pain in women of reproductive age. The aim of this study was to test the hypothesis that persistent nociceptive input from endometriotic tissues leads to central sensitization manifested by somatic hyperalgesia and increased referred pain areas to experimental saline-induced muscle pain in patients with endometriosis, compared to healthy control subjects. Ten women with laparoscopically confirmed endometriosis and 10 healthy, age-matched women participated in the study. Hypertonic saline (0.5 mL, 5.8%) was injected intramuscularly, in random succession, into 1 site of menstrual pain referral (the multifidus muscle at the low back) and into 1 non-pain control site (first dorsal interosseous muscle [FDI] of the hand). The post-saline pain intensity and pain areas at the FDI were significantly greater in patients with endometriosis than in control subjects (P <.05) but were not different between the groups for the back. An absence of enhancement of post-saline pain responses at the back in the endometriosis group suggests that saline-induced pain at the back appears to activate segmental inhibitory systems in patients with endometriosis. Manifestation of central sensitization in women with endometriosis is demonstrated by increased muscle nociceptor input in the form of increased post-saline pain intensity, pain areas at the FDI, and hypersensitivity to pressure stimulation. These findings provide new insights into the complex pain mechanisms associated with endometriosis.
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PMID:Endometriosis is associated with central sensitization: a psychophysical controlled study. 1462 79

Limbic associated pelvic pain is a proposed pathophysiology designed to explain features commonly encountered in patients with chronic pelvic pain, including the presence of multiple pain diagnoses, the frequency of previous abuse, the minimal or discordant pathologic changes of the involved organs, the paradoxical effectiveness of many treatments, and the recurrent nature of the condition. These conditions include endometriosis, interstitial cystitis, irritable bowel syndrome, levator ani syndrome, pelvic floor tension myalgia, vulvar vestibulitis, and vulvodynia. The hypothesis is based on recent improvements in the understanding of pain processing pathways in the central nervous system, and in particular the role of limbic structures, especially the anterior cingulate cortex, hippocampus and amygdala, in chronic and affective pain perception. Limbic associated pelvic pain is hypothesized to occur in patients with chronic pelvic pain out of proportion to any demonstrable pathology (hyperalgesia), and with more than one demonstrable pain generator (allodynia), and who are susceptible to development of the syndrome. This most likely occurs as a result of childhood sexual abuse but may include other painful pelvic events or stressors, which lead to limbic dysfunction. This limbic dysfunction is manifest both as an increased sensitivity to pain afferents from pelvic organs, and as an abnormal efferent innervation of pelvic musculature, both visceral and somatic. The pelvic musculature undergoes tonic contraction as a result of limbic efferent stimulation, which produces the minimal changes found on pathological examination, and generates a further sensation of pain. The pain afferents from these pelvic organs then follow the medial pain pathway back to the sensitized, hypervigilant limbic system. Chronic stimulation of the limbic system by pelvic pain afferents again produces an efferent contraction of the pelvic muscles, thus perpetuating the cycle. This cycle is susceptible to disruption through blocking afferent signals from pelvic organs, either through anesthesia or muscle manipulation. Disruption of limbic perception with psychiatric medication similarly produces relief. Without a full disruption of both the central hypervigilance and pelvic organ dysfunction, pain recurs. To prevent recurrence, clinicians will need to include some form of therapy, either medical or cognitive, targeted at the underlying limbic hypervigilance. Further research into novel, limbic targeted therapies can hopefully be stimulated by explicitly stating the role of the limbic system in chronic pain. This hypothesis provides a framework for clinicians to rationally approach some of the most challenging patients in medicine, and can potentially improve outcomes by including management of limbic dysfunction in their treatment.
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PMID:Limbic associated pelvic pain: a hypothesis to explain the diagnostic relationships and features of patients with chronic pelvic pain. 1729 60

Chronic pelvic pain occurs in about 15% of women and has a variety of causes requiring accurate diagnosis and appropriate treatment if pain reduction is to be effected. Superficial conditions such as provoked vestibulodynia and deeper pelvic issues such as pelvic floor myalgia were traditionally difficult to diagnose and adequately treat. For provoked vestibulodynia, there are limited data, in the form of case reports and small series, to indicate that botulinum toxin (BoNT) injections may provide short-term (3-6 months) benefit. Retreatment is reported to be successful and side effects are few. Class-I studies are essential to adequately assess this form of treatment. For pelvic floor myalgia, 1 class-I study and 3 class-II to -III studies indicate efficacy of BoNT. In the only double-blind, randomized, controlled study, significant reduction in pelvic floor pressures with significant pain reduction for some types of pelvic pain are reported compared with baseline. No differences in pain occurred compared with the control group who had physical therapy as an intervention. Physical therapy should be used as a noninvasive first-line treatment, with BoNT injections reserved for those who are refractory to treatment. Pelvic floor disorders should be considered as a cause for chronic pelvic pain in women and an attempt made to diagnose and treat such problems as a routine practice. The use of BoNT as a therapeutic option for pelvic floor muscle spasm and pain is still in its infancy. Initial reports suggest that there may be a significant role for women with chronic pain that is refractory to currently available medical and surgical treatments, however, there are very few high-quality studies and research is essential before this novel treatment can be accepted into widespread use for pelvic pain attributable to the pelvic floor.
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PMID:The use of botulinum toxin in the pelvic floor for women with chronic pelvic pain-a new answer to old problems? 1916 73

Myalgias most commonly occur in polymyalgia rheumatica (PMR). About 45% of patients with giant cell arteritis present with symptoms of PMR. Other vasculitides may also lead to arthralgia and myalgia. While shoulder and pelvic pain is characteristic for PMR pain often also occurs in the back of the neck and in the region of the thoracic spine. In addition, patients often present with malaise, morning stiffness and weight loss. CRP and ESR are elevated. Ultrasound and MRI delineate minor synovitis, tenosynovitis and bursitis in the shoulder. Hip joint synovitis and trochanteric bursitis are also commonly seen. PMR should be distinguished from rheumatoid arthritis. The initial treatment comprises a prednisolone dose of 15-25 mg/day, followed by a weekly decrease of 1-2.5 mg. Once 10 mg/day has been reached the dose should be reduced more slowly.
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PMID:[Myalgia in polymyalgia rheumatica, temporal arteritis and other vasculitides]. 1958 33

This article reviews the literature on management of chronic cyclical pelvic pain (CCPP). Electronic resources including Medline, PubMed, CINAHL, The Cochrane Library, Current Contents, and EMBASE were searched using MeSH terms including all subheadings and keywords: "cyclical pelvic pain", "chronic pain", "dysmenorrheal", "nonmenstrual pelvic pain", and "endometriosis". There is a dearth of high-quality evidence for this common problem. Chronic pelvic pain affects 4%-25% of women of reproductive age. Dysmenorrhea of varying degree affects 60% of women. Endometriosis is the commonest pathologic cause of CCPP. Other gynecological causes are adenomyosis, uterine fibroids, and pelvic floor myalgia, although other systems disease such as irritable bowel syndrome or interstitial cystitis may be responsible. Management options range from simple to invasive, where simple medical treatment such as the combined oral contraceptive pill may be used as a first-line treatment prior to invasive management. This review outlines an approach to patients with CCPP through history, physical examination, and investigation to identify the cause(s) of the pain and its optimal management.
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PMID:Optimal management of chronic cyclical pelvic pain: an evidence-based and pragmatic approach. 2115 32

Chronic pelvic pain (CPP) is defined as pain in the pelvic organs and related structures of at least 6 months' duration. The pathophysiology of CPP is uncertain, and its treatment presents challenges. Botulinum toxin A (BoNT-A), known for its antinociceptive, anti-inflammatory, and muscle relaxant activity, has been used recently to treat refractory CPP with promising results. In patients with interstitial cystitis/bladder pain syndrome, most studies suggest intravesical BoNT-A injection reduces bladder pain and increases bladder capacity. Repeated BoNT-A injection is also effective and reduces inflammation in the bladder. Intraprostatic BoNT-A injection could significantly improve prostate pain and urinary frequency in the patients with chronic prostatitis/chronic pelvic pain syndrome. Animal studies also suggest BoNT-A injection in the prostate decreases inflammation in the prostate. Patients with CPP due to pelvic muscle pain and spasm also benefit from localized BoNT-A injections. BoNT-A injection in the pelvic floor muscle improves dyspareunia and decreases pelvic floor pressure. Preliminary studies show intravesical BoNT-A injection is useful in inflammatory bladder diseases such as chemical cystitis, radiation cystitis, and ketamine related cystitis. Dysuria is the most common adverse effect after BoNT-A injection. Very few patients develop acute urinary retention after treatment.
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PMID:Novel Treatment of Chronic Bladder Pain Syndrome and Other Pelvic Pain Disorders by OnabotulinumtoxinA Injection. 2609 97


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