Biopsychosocial correlates of persistent postsurgical pain in women with endometriosis

ObjectiveTo examine pain and biopsychosocial correlates over time for women with persistent postsurgical pain after surgery for endometriosis.MethodsCrossâ sectional study of women who underwent any endometriosis surgery between 2003 and 2006. Following surgery, patients completed validated questionnaires (Shortâ Form McGill Pain Questionnaire, 12â item Shortâ Form Health Survey, Beck Depression Inventory, Coping Strategies Questionnaire catastrophizing subscale). The primary outcome was pelvic pain intensity, measured by the McGill total pain score. Bivariate comparisons between each potential predictor and pain intensity were performed using the Ï 2 and t tests, 1â way analysis of variance, and simple linear regression.ResultsIn total, 79 completed the questionnaires and were included in the present analysis. The McGill affective pain score was negatively correlated with age (βâ coefficient â 0.12, P = 0.002) and positively correlated with catastrophization (βâ coefficient 0.66, P = 0.01). Women with a history of dyspareunia scored significantly higher on the McGill total pain score (P < 0.001); there was no association between pain intensity and endometriosis severity.ConclusionYounger age and catastrophization are correlated with persistent pain following surgery for endometriosis. The severity of endometriosis does not predict persistent pain. Further evaluation of psychosocial factors may identify patients who are least likely to benefit from surgeries for endometriosisâ associated pelvic pain.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135478/1/ijgo169.pd

Mucosal versus muscle pain sensitivity in provoked vestibulodynia

An estimated 8.3%—16% of women experience vulvovaginal discomfort during their lifetime. Frequently these patients report provoked pain on contact or with attempted intercourse, commonly referred to as provoked vestibulodynia (PVD). Despite the burden of this condition, little is known about its potential etiologies including pelvic floor muscular dysfunction and mucosal components. This knowledge would be beneficial in developing targeted therapies including physical therapy

Intrinsic brain connectivity in fibromyalgia is associated with chronic pain intensity

OBJECTIVE Fibromyalgia (FM) is considered to be the prototypical central chronic pain syndrome and is associated with widespread pain that fluctuates spontaneously. Multiple studies have demonstrated altered brain activity in these patients. Our objective was to investigate the degree of connectivity between multiple brain networks in FM, as well as how activity in these networks correlates with spontaneous pain. METHODS Resting functional magnetic resonance imaging (fMRI) data in FM patients (n=18) and age-matched healthy controls (HC, n=18) were analyzed using dual regression independent component analysis (ICA) - a data driven approach used to identify independent brain networks. We evaluated intrinsic, or resting, connectivity in multiple brain networks: the default mode network (DMN), the executive attention network (EAN), and the medial visual network (MVN), with the MVN serving as a negative control. Spontaneous pain levels were also covaried with intrinsic connectivity. RESULTS We found that FM patients had greater connectivity within the DMN and right EAN (rEAN; p<0.05, corrected), and greater connectivity between the DMN and the insular cortex – a brain region known to process evoked pain. Furthermore, greater spontaneous pain at the time of the scan correlated with greater intrinsic connectivity between the insula and both the DMN and rEAN (p<0.05, corrected). CONCLUSION Our findings indicate that resting brain activity within multiple networks is associated with spontaneous clinical pain in FM. These findings may also have broader implications for how subjective experiences such as pain arise from a complex interplay amongst multiple brain networks

Pregnancy prevention in adolescents

No Abstract. South African Family Practice Vol. 47(3) 2005: 24-2

Life in the laparoscopic fast lane: evidence- based perioperative management and enhanced recovery in benign gynaecological laparoscopy

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167468/1/tog12723-sup-0001-Supinfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167468/2/tog12723_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167468/3/tog12723.pd

Mucosal versus muscle pain sensitivity in provoked vestibulodynia

BACKGROUND: An estimated 8.3%—16% of women experience vulvovaginal discomfort during their lifetime. Frequently these patients report provoked pain on contact or with attempted intercourse, commonly referred to as provoked vestibulodynia (PVD). Despite the burden of this condition, little is known about its potential etiologies including pelvic floor muscular dysfunction and mucosal components. This knowledge would be beneficial in developing targeted therapies including physical therapy. OBJECTIVE: To explore the relative contribution of mucosal versus muscle pain sensitivity on pain report from intercourse among women with PVD. DESIGN: In this proof of concept study, 54 women with PVD underwent a structured examination assessing mucosal and pelvic muscle sensitivity. METHODS: We examined three mucosal sites in the upper and lower vestibule. Patients were asked to rate their pain on cotton swab palpation of the mucosa using a 10-point visual analog scale. Muscle pain was assessed using transvaginal application of pressure on right and left puborectalis, and the perineal muscle complex. The Gracely pain scale (0–100) was used to assess the severity of pain with intercourse, with women rating the lowest, average, and highest pain levels; a 100 rating the highest level of pain. RESULTS: The lower vestibule’s mucosa 5.81 (standard deviation =2.83) was significantly more sensitive than the upper vestibule 2.52 (standard deviation =2.6) (P<0.01) on exam. However, mucosal sensitivity was not associated with intercourse pain, while muscle sensitivity was moderately associated with both average and highest intensity of intercourse pain (r=−0.46, P=0.01 and r=−0.42, P=0.02), respectively. CONCLUSION: This preliminary study suggests that mucosal measures alone may not sufficiently capture the spectrum of clinical pain report in women with PVD, which is consistent with the empirical success of physical therapy in this population

Comparison of 2 minimally invasive routes for hysterectomy of large uteri

ObjectiveTo compare the perioperative outcomes associated with 2 minimally invasive surgical routes for the hysterectomy of large fibroid uteri.MethodsRetrospective review of 84 women undergoing hysterectomy via minilaparotomy (n = 54) or robotâ assisted laparoscopy (n = 30) for uteri weighing at least 500 g. Outcome measures included hemorrhage (blood loss of 500 mL or more) and postoperative length of stay.ResultsUnadjusted mean blood loss (560.2 ± 507.4 mL versus 165.0 ± 257.5 mL, P < 0.001), rate of hemorrhage (40.7% versus 6.7%, P = 0.001, odds ratio 6.1 [95% confidence interval 1.5â 24.2]), and rate of blood transfusion (14.8% versus 0%, P = 0.03 ) were all higher with minilaparotomy than with robotâ assisted surgery, while the median postoperative stay was significantly shorter with robotic surgery (2 [range 1â 4] days versus 1 [range 0â 7] days, P < 0.01). After adjusting for differences in uterine weight using a multivariate linear regression analysis, the mean blood loss and the rate of hemorrhage were no longer significantly different between the 2 groups.ConclusionThe minilaparotomy approach may be used to remove very large uteri and does not require specialized and expensive equipment, or advanced endoscopic training. The robotic approach, when feasible, allows for early postoperative discharge.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135283/1/ijgo128.pd