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Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy
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...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8779548/ https://www.ncbi.nlm.nih.gov/pubmed/35055416 http://dx.doi.org/10.3390/jpm12010101 |
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author | Pereira, Augusto Herrero-Trujillano, Manuel Vaquero, Gema Fuentes, Lucia Gonzalez, Sofia Mendiola, Agustin Perez-Medina, Tirso |
author_facet | Pereira, Augusto Herrero-Trujillano, Manuel Vaquero, Gema Fuentes, Lucia Gonzalez, Sofia Mendiola, Agustin Perez-Medina, Tirso |
author_sort | Pereira, Augusto |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-8779548 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-87795482022-01-22 Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy Pereira, Augusto Herrero-Trujillano, Manuel Vaquero, Gema Fuentes, Lucia Gonzalez, Sofia Mendiola, Agustin Perez-Medina, Tirso J Pers Med Article 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. MDPI 2022-01-13 /pmc/articles/PMC8779548/ /pubmed/35055416 http://dx.doi.org/10.3390/jpm12010101 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Pereira, Augusto Herrero-Trujillano, Manuel Vaquero, Gema Fuentes, Lucia Gonzalez, Sofia Mendiola, Agustin Perez-Medina, Tirso Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy |
title | Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy |
title_full | Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy |
title_fullStr | Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy |
title_full_unstemmed | Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy |
title_short | Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy |
title_sort | clinical management of chronic pelvic pain in endometriosis unresponsive to conventional therapy |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8779548/ https://www.ncbi.nlm.nih.gov/pubmed/35055416 http://dx.doi.org/10.3390/jpm12010101 |
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