A Systematic Review of the Cost of Chronic Pelvic Pain in Women.

OBJECTIVE: To systematically summarize the evidence on costs related to chronic pelvic pain (CPP) for women. DATA SOURCES: Electronic databases (MEDLINE, EMBASE, PubMed, and Cochrane Library) were searched for English and French articles published from 1990 to January 2021 STUDY SELECTION: Of 1304 articles screened, 67 were screened in full-text form, and a total of 13 articles were included in the final analysis. Articles included involved cost studies that estimated hospital or health system costs for pelvic pain, dysmenorrhea, dyspareunia, endometriosis with pain, interstitial cystitis, or painful bladder syndrome. DATA EXTRACTION AND SYNTHESIS: A standardized form was created to extract study setting, design, and population; patient demographics; study duration; and reported costs of CPP components and amounts. Two independent reviewers completed the data extraction, and discrepancies were resolved through discussion with a third reviewer. CONCLUSION: Estimated health care costs ranged from US$1367 to US$7043 per woman per year. Prescription costs ranged from US$193 to US$2457 per woman per year. Indirect costs ranged from US$4216 to US$12 789 per woman per year. Combined costs ranged from US$1820 to US$20 898 per woman per year. The yearly costs of CPP varied according to country; yearly costs were estimated to be $2.8 billion, ¥191,680 to ¥246,488, and $16 970 to $20 898 per woman per year in the United Sates, Japan, and Australia, respectively. The literature suggests that CPP represents a considerable economic burden on women and health care systems internationally, with indirect costs contributing a significant portion of total costs.

The Use of Pulsed Radiofrequency for the Treatment of Pudendal Neuralgia: A Case Series.

OBJECTIVE: Pudendal neuralgia is a recognized cause of chronic pelvic pain. The diagnosis is complex, and there is no consensus on ideal management. Many current methods do not provide adequate relief. Pulsed radiofrequency is a minimally invasive option that has been reported for its use in other neuropathies. This study aimed to evaluate the feasibility and safety of using transvaginal pulsed radiofrequency for the treatment of pudendal neuralgia and to generate a hypothesis on its efficacy. METHODS: A retrospective review was conducted of women who were treated with pulsed radiofrequency for chronic pelvic pain owing to pudendal neuralgia between January 2012 and December 2017 at an academic tertiary care centre. (Canadian Task Force Classification II-3). RESULTS: A total of seven patients were included. The mean age was 43.7 (standard deviation 7.97). The average number of pulsed radiofrequency treatments was 4.43 (range 1-12), and the duration of effect averaged 11.4 weeks (standard deviation 3.09). There were no major or minor complications at the time of procedure or at follow-up visits. CONCLUSIONS: Pulsed radiofrequency may be an effective and safe treatment option for the management of pudendal neuralgia for women in whom conservative management has not been effective. Future controlled studies are needed to confirm this hypothesis.

Hospital-associated Costs of Chronic Pelvic Pain in Canada: A Population-based Descriptive Study.

OBJECTIVE: To determine the hospital-related costs incurred by women requiring surgery or inpatient admission for chronic pelvic pain in Canada. METHODS: We conducted a population-based, cross-sectional study, focusing on women ages 15-59 with a most responsible International Classification of Diseases diagnosis of pelvic and perineal pain, dysmenorrhea, or dyspareunia who had surgery or inpatient admission with a discharge date between April 1, 2008 and March 31, 2012. This study was based on the Canadian Institute for Health Information Discharge Abstract database and the National Ambulatory Care Reporting System. Clinical diagnoses and interventions and resource intensity weights (RIW) were extracted. Hospital costs were estimated by multiplying cost per weighted case (CPWC) calculated at the national level with respective RIWs. RESULTS: Over four years, there were 34 346 cases of surgery or inpatient admission for chronic pelvic pain amounting to $100.5 million with an average cost of $25 million per year. Pelvic and perineal pain accounted for 61.5% (n = 21 127) of the cases, while dysmenorrhea accounted for 31.8% (n = 10 936), and dyspareunia accounted for 6.6% (n = 2283). The vast majority of the cases (92.9%, n = 31 923) were associated with surgical interventions, with the most common surgeries being hysterectomy (47.1%, n = 16 189), followed by laparoscopy (25.8%, n = 8850), adnexal surgery (6.8%, n = 2349), and other procedures (11.6%, n = 3968). CONCLUSION: While these estimates do not take into account non-hospital related costs, such as outpatient treatment, loss of productivity, and impact on quality of life, this study demonstrates that chronic pelvic pain represents a considerable economic burden to Canada's health care system.

Intrathecal Analgesia for Chronic Refractory Pain: Current and Future Prospects.

The intrathecal drug-delivery system (IDDS) is one mode of infusing analgesic medications directly into the cerebrospinal fluid in close proximity to their site of action. This modality has been employed in patients with refractory pain either due to malignant or non-malignant causes for over 30 years. Unfortunately, and despite the number of years it has been in use, there is still a scarcity of rigorous evidence to guide its integration into clinical practice. Current best evidence is inconclusive as to the comparative effectiveness and harms of the IDDS relative to routine medical care of patients. There are far more systematic reviews than high-quality primary comparative studies of the IDDS vs. conventional pain treatment. Existing clinical practice recommendations are best viewed as expert opinion with competing interests. This article will review the existing literature for indications, contraindications, consensus statements, different technologies, and complications of the IDDS. Although approved analgesics for IDDS delivery are limited to morphine and ziconotide, many other analgesics, alone or in combination, are routinely used in this setting. This review will also focus on the pharmacology, clinical efficacy, and safety of intrathecal medications extensively used in clinical practice; including agents approved, unapproved, and under development.