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How Does Visceral Pelvic Pain Differ from Nonvisceral Pelvic Pain?
Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S1eS51 Measurements and Main Results: Compared with controls, in the nonbleeding model ProGEL AB reduced percent length of uterine horn with adhesions from 47 þ 12% (n 5 5) to 2.1 þ 1% (n 5 4) (p ! 0.05) and increased the adhesion-free outcome percent of horns with no adhesions from 0% to 70% (p 5 0.004). In the presence of superimposed bleeding, ProGEL AB reduced the extent of adhesions from 44 þ 8% (n 5 6) to 5 þ 2% (n 5 6) (p ! 0.01) and increased the adhesion-free outcome from 8% to 50% (p ! 0.05). ProGEL was easy to apply with minimal tissue reaction and no adverse effects noted. Conclusion: The results of this study showed NeoMend ProGEL AB spray significantly reduced adhesion formation relative to an untreated surgical control with meticulous hemostasis as well as under bleeding conditions known to compromise the effect of other adhesion barriers (INTERCEED, Spraygel). These data correlate well with preliminary clinical data now available and provide justification for the further clinical development of ProGEL AB.
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Open Communications 2dPain (12:17 PM d 12:22 PM)
The Effect of Depression on Pain Scores in Women with Chronic Pelvic Pain Howard FM, Droz J, Martinez A. Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY Study Objective: To evaluate whether the presence of depression affects ratings of pain in patients with chronic pelvic pain. Design: Retrospective cohort study. Setting: University-based chronic pelvic pain clinic. Patients: 334 consecutive women it evaluated for chronic pelvic pain. Intervention: Charts of patients were reviewed to collect data regarding depression, ratings of pain with a numeric rating system (NRS) and the Short Form McGill Pain Questionnaire (MPQ), and clinical diagnoses. Measurements and Main Results: Data were compared between patients with and without depression using t-test compariaon of mean scores for parametric data (P ! 0.05), and odds ratios for non-parametric values (95% confidence intervals). Patients with depression had higher scores on 9 of the 11 NRS ratings of pain and higher scores on 13 of the 15 MPQ descriptors . Depressed patients were more likely to describe their pain as continuous. The only diagnoses that were statistically more likely in patients with depression were irritable bowel syndrome and ovarian remnant syndrome. Conclusion: Patients with depression have significantly higher pain scores than non-depressed patients with chronic pelvic pain. It is important to evaluate patients with chronic pelvic pain for depression as it will influence the assessment of their pain.
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Open Communications 2dPain (12:23 PM d 12:28 PM)
How Does Visceral Pelvic Pain Differ from Nonvisceral Pelvic Pain? Tu FF,1 Edelmann C,3 Roybal A,2 Pozolo K,1 Senapati S.1 1Ob/Gyn, NorthShore University HealthSystem, Evanston, IL; 2Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL; 3College of Letters, Arts, and Science, University of Southern California, Los Angeles, CA Study Objective: Characterize differences between visceral and nonvisceral presentations of chronic female abdominal and pelvic pain. Design: Retrospective cross-sectional study of differences between pelvic pain patients with and without visceral components. Data was collected from the clinic’s new patient intake questionnaire packet including medical history, the Medical Outcomes Trust’s Short-Form Health Survey (SF-12), McGill Pain Inventory, and the Coping Strategies Questionnaire (CSQ) subscale. Two research assistants independently abstracted this data. Two physicians then characterized each woman’s pain as either visceral or non-visceral. Group comparisons were performed using t-tests, Wilcoxon-rank sum and X2 test of proportions. A multivariate linear
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model was performed to model the relationship between visceral pain history and SF-12 scores. Setting: Tertiary gynecological pain clinic patients seen between October 1, 2004 and April 1, 20080. Patients: Women aged 18-55 presenting with the complaint of pelvic and/or abdominal pain. Intervention: N/A Measurements and Main Results: 214 women (mean age 5 36.3 11.6 years) were identified with abdominal or pelvic pain. 55% were defined as having visceral pain. Duration of pain was higher among visceral pain patients, but not statistically significant (means, SD, 47.3 55.4 mths vs. 35.5 51.1 mths, p 5 0.12). A higher proportion of these women had concurrent diagnoses of endometriosis (32.8% vs. 15.5% of women with non-visceral pain, p 5 0.004). Higher affective pain reports, depression, anxiety, and catastrophizing are associated with visceral pain. Adjusted SF-12 Mental Component scores (means, SE) were worse in visceral pain patients (n 5 177, 41.8 1.00 vs. 45.1 1.15, p 5 0.03.) SF-12 Physical component scores did not differ by visceral pain status. Conclusion: Our study suggests that visceral pelvic pain has higher morbidity than non-visceral pelvic pain, but this assocation is overestimated when not controlling for concomitant depression and catastrophizing. Studies of pelvic pain should account for emotional influences on pain symptomatology.
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Open Communications 2dPain (12:29 PM d 12:34 PM)
The Short Form McGill Pain Questionnaire as a Diagnostic Tool in Women with Chronic Pelvic Pain Droz J, Howard FM. Obstetrics & Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY Study Objective: To evaluate the Short Form McGill Pain Questionnaire pain descriptors in the diagnostic evaluation of chronic pelvic pain. Design: Retrospective cohort study. Setting: University-based clinical practice specializing in chronic pelvic pain. Patients: Data were collected on 331 consecutively evaluated women with chronic pelvic pain. Intervention: The relationships between pain descriptors and subsequent diagnoses were evaluated for sensitivities, specificities, positive predictive values and negative predictive values. Measurements and Main Results: The most common diagnoses were endometriosis, interstitial cystitis/painful bladder syndrome (IC/PBS), and irritable bowel syndrome. 71% of the patients had more than one diagnosis. Odds ratios for pain descriptors as diagnostic tools for specific diagnoses were statistically significant for: cramping for endometriosis, 5.46; cramping for IC/PBS, 2.25; sickening for irritable bowel syndrome, 2.52; splitting for pelvic floor tension myalgia, 2.64; and aching for sacroiliac pain, 4.27. The highest statistically significant negative predictive values were: cramping for endometriosis, 89%; cramping for IC/BPS, 82%; sickening and tiring-exhausting for irritable bowel syndrome, 83% each; splitting for pelvic floor tension myalgia, 92%; and shooting, throbbing, heavy and aching for sacroiliac pain, 96% each. Conclusion: Although we found that several of the Short Form McGill Pain Questionnaire descriptors had high negative predictive values, suggesting they have diagnostic value in their abilities to preclude the likelihood of the specific diagnoses of endometriosis, interstitial cystitis/painful bladder syndrome, irritable bowel syndrome, pelvic floor tension myalgia, and sacroiliac pain, these descriptors have limited usefulness as diagnostic tools.
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Open Communications 2dPain (12:35 PM d 12:40 PM)
Bupivacaine Causes Cytotoxicity Via Extracellular Signal-Regulated Kinase (ERK) and Akt Pathways in Mouse Myoblast C2C12 Cells Maurice JM,1 Gan Y,2 Hibner M,2 Huang Y.2 1Obstetrics and Gynecology, Rush University Medical Center, Chicago, IL; 2Obstetrics and Gynecology, St Joseph’s Hospital and Medical Center, Phoenix, AZ
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Open Communications 2dPain (12:17 PM d 12:22 PM)
The Effect of Depression on Pain Scores in Women with Chronic Pelvic Pain Howard FM, Droz J, Martinez A. Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY Study Objective: To evaluate whether the presence of depression affects ratings of pain in patients with chronic pelvic pain. Design: Retrospective cohort study. Setting: University-based chronic pelvic pain clinic. Patients: 334 consecutive women it evaluated for chronic pelvic pain. Intervention: Charts of patients were reviewed to collect data regarding depression, ratings of pain with a numeric rating system (NRS) and the Short Form McGill Pain Questionnaire (MPQ), and clinical diagnoses. Measurements and Main Results: Data were compared between patients with and without depression using t-test compariaon of mean scores for parametric data (P ! 0.05), and odds ratios for non-parametric values (95% confidence intervals). Patients with depression had higher scores on 9 of the 11 NRS ratings of pain and higher scores on 13 of the 15 MPQ descriptors . Depressed patients were more likely to describe their pain as continuous. The only diagnoses that were statistically more likely in patients with depression were irritable bowel syndrome and ovarian remnant syndrome. Conclusion: Patients with depression have significantly higher pain scores than non-depressed patients with chronic pelvic pain. It is important to evaluate patients with chronic pelvic pain for depression as it will influence the assessment of their pain.
37
Open Communications 2dPain (12:23 PM d 12:28 PM)
How Does Visceral Pelvic Pain Differ from Nonvisceral Pelvic Pain? Tu FF,1 Edelmann C,3 Roybal A,2 Pozolo K,1 Senapati S.1 1Ob/Gyn, NorthShore University HealthSystem, Evanston, IL; 2Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL; 3College of Letters, Arts, and Science, University of Southern California, Los Angeles, CA Study Objective: Characterize differences between visceral and nonvisceral presentations of chronic female abdominal and pelvic pain. Design: Retrospective cross-sectional study of differences between pelvic pain patients with and without visceral components. Data was collected from the clinic’s new patient intake questionnaire packet including medical history, the Medical Outcomes Trust’s Short-Form Health Survey (SF-12), McGill Pain Inventory, and the Coping Strategies Questionnaire (CSQ) subscale. Two research assistants independently abstracted this data. Two physicians then characterized each woman’s pain as either visceral or non-visceral. Group comparisons were performed using t-tests, Wilcoxon-rank sum and X2 test of proportions. A multivariate linear
S11
model was performed to model the relationship between visceral pain history and SF-12 scores. Setting: Tertiary gynecological pain clinic patients seen between October 1, 2004 and April 1, 20080. Patients: Women aged 18-55 presenting with the complaint of pelvic and/or abdominal pain. Intervention: N/A Measurements and Main Results: 214 women (mean age 5 36.3 11.6 years) were identified with abdominal or pelvic pain. 55% were defined as having visceral pain. Duration of pain was higher among visceral pain patients, but not statistically significant (means, SD, 47.3 55.4 mths vs. 35.5 51.1 mths, p 5 0.12). A higher proportion of these women had concurrent diagnoses of endometriosis (32.8% vs. 15.5% of women with non-visceral pain, p 5 0.004). Higher affective pain reports, depression, anxiety, and catastrophizing are associated with visceral pain. Adjusted SF-12 Mental Component scores (means, SE) were worse in visceral pain patients (n 5 177, 41.8 1.00 vs. 45.1 1.15, p 5 0.03.) SF-12 Physical component scores did not differ by visceral pain status. Conclusion: Our study suggests that visceral pelvic pain has higher morbidity than non-visceral pelvic pain, but this assocation is overestimated when not controlling for concomitant depression and catastrophizing. Studies of pelvic pain should account for emotional influences on pain symptomatology.
38
Open Communications 2dPain (12:29 PM d 12:34 PM)
The Short Form McGill Pain Questionnaire as a Diagnostic Tool in Women with Chronic Pelvic Pain Droz J, Howard FM. Obstetrics & Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY Study Objective: To evaluate the Short Form McGill Pain Questionnaire pain descriptors in the diagnostic evaluation of chronic pelvic pain. Design: Retrospective cohort study. Setting: University-based clinical practice specializing in chronic pelvic pain. Patients: Data were collected on 331 consecutively evaluated women with chronic pelvic pain. Intervention: The relationships between pain descriptors and subsequent diagnoses were evaluated for sensitivities, specificities, positive predictive values and negative predictive values. Measurements and Main Results: The most common diagnoses were endometriosis, interstitial cystitis/painful bladder syndrome (IC/PBS), and irritable bowel syndrome. 71% of the patients had more than one diagnosis. Odds ratios for pain descriptors as diagnostic tools for specific diagnoses were statistically significant for: cramping for endometriosis, 5.46; cramping for IC/PBS, 2.25; sickening for irritable bowel syndrome, 2.52; splitting for pelvic floor tension myalgia, 2.64; and aching for sacroiliac pain, 4.27. The highest statistically significant negative predictive values were: cramping for endometriosis, 89%; cramping for IC/BPS, 82%; sickening and tiring-exhausting for irritable bowel syndrome, 83% each; splitting for pelvic floor tension myalgia, 92%; and shooting, throbbing, heavy and aching for sacroiliac pain, 96% each. Conclusion: Although we found that several of the Short Form McGill Pain Questionnaire descriptors had high negative predictive values, suggesting they have diagnostic value in their abilities to preclude the likelihood of the specific diagnoses of endometriosis, interstitial cystitis/painful bladder syndrome, irritable bowel syndrome, pelvic floor tension myalgia, and sacroiliac pain, these descriptors have limited usefulness as diagnostic tools.
39
Open Communications 2dPain (12:35 PM d 12:40 PM)
Bupivacaine Causes Cytotoxicity Via Extracellular Signal-Regulated Kinase (ERK) and Akt Pathways in Mouse Myoblast C2C12 Cells Maurice JM,1 Gan Y,2 Hibner M,2 Huang Y.2 1Obstetrics and Gynecology, Rush University Medical Center, Chicago, IL; 2Obstetrics and Gynecology, St Joseph’s Hospital and Medical Center, Phoenix, AZ